Following an Acquired or Traumatic Brain Injury, the muscles involved in chewing and swallowing can become weak, slow and or uncoordinated. A Percutaneous Endoscopic Gastrostomy (PEG) feeding tube can improve a person’s nutritional intake and contribute to a greater quality of life where there are severe swallowing difficulties.

• What is a PEG Feeding Tube?
• How are PEG Feeding Tubes inserted?
• How is someone assessed for a PEG Feeding Tube?
• How to avoid Complications
• What is the best Feeding Position and how to choose a Feeding Formula

What is a PEG Feeding Tube?

After an acquired or traumatic brain injury swallowing can become problematic due to poor muscle coordination. This can lead to the problem of aspiration, where food and water enter the lungs and lead to subsequent chest infections. Also, people may eat less, resulting in inadequate nutrition and fluid intake and subsequent weight loss. A PEG is a feeding tube which passes directly into the abdominal wall so that nutrition can be provided without chewing or swallowing. A dietitian will prescribe a liquid formula which is the most suitable for the individual which contains all nutritional requirements including protein, fat, carbohydrate, fluid, vitamins and minerals. There are three main ways that the liquid feed can be administered:

• by bolus method - the liquid feed is poured down a syringe into the tube. This is the most common method of PEG feeding
• by gravity - a bag of liquid food is hung from a stand and allowed to drip through the tube
• by an electric pump ⁵

A qualified dietitian will advise on the most suitable method for the individual.

How are PEG Feeding Tubes Inserted?

Insertion of the tube involves a minor surgical procedure which takes about 30 minutes under a mild sedative or general anesthetic and involves the following:

• An endoscope, a flexible instrument used to examine the inside of the stomach, is passed down via the mouth into the stomach and, after the area has been anaesthetized, a small incision is made through the abdominal wall
• A guide wire is inserted into the incision from the outside
• The guide wire is brought up through the endoscope into the stomach with the feeding tube attached
• The tube is prevented from moving by a small plastic disc internally and a flange externally
• A cap is placed over the end of the tube when feeding is not taking place.¹

A common misconception when first learning about PEG feeding is that if a person accidentally or deliberately pulls a feeding tube out this can be life threatening for a person. This is not life threatening, however it is important that the tube be correctly re-inserted by a trained person, such as a nurse or trained family member. For methods to prevent feeding tubes from being removed talk with a registered nurse or medical professional.

How is someone assessed for a PEG Feeding Tube?

Before a PEG feeding tube is considered, a person should receive a thorough assessment by a dietitian, speech pathologist or internal nurse who will then provide a referral to the hospital specialist who will insert the feeding tube. The Dietician will design a nutrition plan tailored to the individual’s needs and the patient should be well informed as to all aspects of the feeding regime.

How to Avoid Complications

The most common gastrostomy tube problems are blocked feeding tubes, exit site infection, deteriorated tubes, incorrect feeding formula or gastrostomy tubes that have been inadvertently removed ³. Infection of the tube exit site can be avoided by washing the site with warm water and soap and cleaning around the external bumper with a cotton bud, ensuring that the area is also dried thoroughly ⁴. After each feed, the tube should be flushed with cooled, boiled water to avoid tube blockages.

The tube should be checked each day and any changes in the appearance of the exit site eg. Redness, itchiness or presence of discharge or the tube itself e.g. cracking or leakages should be reported to the referring doctor immediately. A feeding tube will generally last between one to two years and can be easily replaced without hospital admission.

What is the best Feeding Position and how to choose a Feeding Formula

A person should never be positioned laying down flat but instead should lie with their head at a 30° angle or sitting upright in a chair, remaining in this position for approximately 30 - 60 minutes afterwards ². Some people may not tolerate certain feeding formulas. Adverse reactions to the type of feeding formula can include nausea and diarrhea. If you begin to experience these symptoms contact your prescribing specialist as some experimentation may be required before finding the type of formula and quantity that best meets the individual’s needs.

Links and References

[1]http://mnd.asn.au/cms/images/pdfs/Factsheets/factsheet_peg_2007.pdf . MND Victoria, Updated 2007.

[2]http://www.health.qld.gov.au/nutrition/resources/etf_tfah.pdf . Queensland Health. Updated 2007.

[3]K Dollard,G Young, PEG Care and Support Service. 1999, Adelaide: Flinders Medical Centre.

[4] Hong Kong Geriatrics Society, Clinical Guidelines on Enteral Tube Feeding. Amended ed. 2003, Hong Kong: Hong Kong Geriatrics Society.

[5]http://mnd.asn.au/cms/index.php?option=com_content&task=view&id=106&Itemid=108 . MND Australia. Updated 2007.

For More Information

Gastrostomy Information Support Society http://www.giss.org.au

Gastroenterological Society of Australia http://www.gesa.org.au

Dieticians Association of Australia http://www.daa.asn.au