PEG – PEXACT - Insertion and Care of a Feeding Tube

A feeding tube is placed directly into the abdomen if tube feeding is expected to continue for at least 4 to 6 weeks. Two types of feeding tubes are explained below. Depending on your situation, we will choose either a PEG or a PEXACT tube.

PEG tube

The PEG tube (Percutaneous Endoscopic Gastrostomy tube) is a feeding tube (a small plastic tube) that is placed into the stomach using an endoscopy and a small incision in the abdominal wall.
The end of the tube consists of two disc-shaped plates. The first plate is positioned on the inside of the stomach wall and prevents the tube from falling out. On the outside, the other plate is pushed against the abdominal wall and secured. This prevents the tube from moving too much.

PEXACT probe

The PEXACT tube is essentially similar to the PEG tube, but instead of a plate at the tip, it has a balloon that is filled with 5 ml of water. The main difference between the two tubes is the method of placement. A PEXACT tube is chosen for patients with a tumor in the mouth or throat, or if there is an esophageal stent or a narrowing in the mouth and/or esophagus.

At the doctor’s office, you will receive a “patient booklet for surgery or a procedure under anesthesia.” It is important—once you have agreed to the placement of the feeding tube and have received the necessary explanation—that you sign the consent forms. The consent forms can be found on pages 6 and 7 of the patient booklet. By signing these forms, you are giving the doctor permission to insert the feeding tube and are also consenting to the necessary anesthesia and pain relief.

If you are taking strong blood thinners, be sure to inform your treating physician in advance. It is best to do this when your treating physician schedules an appointment with you to have a feeding tube inserted.

If you have had a heart attack or received a stent in the past year, it is best to discuss any changes to your anticoagulant medication with your cardiologist and/or anesthesiologist in advance.

Placing the feeding tube

Placing a feeding tube and starting tube feeding usually requires a hospital stay of a few days. This is because tube feeding must be gradually increased.

You must fast for 6 hours before the procedure. This means you must not eat, drink, or smoke starting 6 hours before the procedure.

In the morning, you may still take your daily medication with a small amount of water, with the exception of medication that affects the acidity of your stomach acid. This includes the following medications: Cimetidine®, Ranitidine®, Zantac®, Esomeprazole®, Nexiam®, Dakar®, Lansoprazole®, Omeprazole®, Acidcare®, Acidozol®, Losec®, Pantozol®, Pantomed®, Pantoprazole®, Maalox Control®. Do not take these medications just this one time.

When you are admitted, an IV will be inserted. An antibiotic will be administered through the IV one hour before the feeding tube is placed. This is to prevent a wound infection. If you are allergic to a specific antibiotic, be sure to tell the nurse.

If there is hair growth on your abdomen, it will be shaved in the ward.
Your dentures must also be removed before you go to the endoscopy unit or the operating room. You will be asked to brush your teeth thoroughly and/or rinse them with mouthwash
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PEG tube

The feeding tube is inserted under local anesthesia. If you request it, you will also be given medication to help you relax. This will make the insertion of the feeding tube less noticeable to you. The procedure is performed using an endoscopy. A flexible tube with a camera (gastroscope) is inserted through the mouth and guided down the esophagus into the stomach. This allows the exact location of the feeding tube to be determined and marked.

The abdominal wall is disinfected, and the skin is numbed with a local anesthetic. A hollow needle is used to puncture the abdominal wall at the site of the anesthetic. A long, thin thread is passed through the needle and pulled out through the mouth along with the camera.

The PEG tube is attached to this wire and then guided back in the opposite direction through the mouth, esophagus, and stomach, before finally being pulled out through the abdominal wall.

The round plate at the end of the PEG tube prevents the tube from falling out. On the abdominal side (outside), the tube is also secured with a fixation plate. The entire procedure usually takes 20 to 30 minutes.

The PEXACT Probe

When the PEXACT probe is inserted, you will be briefly put under general anesthesia. A flexible tube with a camera (gastroscope) will be guided into your stomach. Your stomach will be inflated, and the room will be darkened briefly. A light is shone through the stomach wall, and that spot is where the probe will be placed. This spot is marked.

The next step is to suture the stomach to the abdominal wall so that it cannot shift out of place when the stomach is punctured.

Next, a thick needle is inserted through the abdominal wall into the stomach. The needle is then removed, leaving a small tube in place. The feeding tube is inserted into this tube, and the balloon is inflated with water.

The tube that is still wrapped around the feeding tube is torn open until it is completely removed.

The procedure itself takes 20 to 30 minutes.

The remaining sutures will stay in place for 10 days.

Getting Started with Tube Feeding

At the earliest, after 3 hours, a small amount of water will be passed through the feeding tube to check that it is properly positioned. In the meantime, the department has notified the dietitian that a feeding tube has been placed for you. The dietitian will then calculate your energy and protein requirements. Based on this, the type and amount of tube feeding will be determined, and a feeding schedule will be drawn up.

Once the feeding tube has been properly placed, the doctor has given approval, and the tube feeding formula has been calculated and a titration schedule has been drawn up, tube feeding can begin. Over the next few days, the nurse and dietitian will monitor how well you tolerate the tube feeding. You can find more information in the Tube Feeding brochure.

Unless otherwise advised by a doctor and provided there are no swallowing difficulties, it is recommended to continue eating by mouth. This helps stimulate saliva production.

Wound Care

Once the anesthesia wears off, the injection site may be painful, in which case appropriate pain management is recommended. Pain medication can be administered systematically during the first few days. It is important to treat the pain promptly. If the site starts to feel painful, please let the ward nurse know so that medication can be administered right away.

For the first 10 days after insertion, it is important to leave the catheter in place. This allows a fistula tract to form. However, the insertion site must be checked daily and cleaned with saline solution. If signs of infection are observed, an aqueous antiseptic solution, such as Isobetadine dermique® (or Hibidil® in case of an iodine allergy), should be used. Alcohol-based antiseptics must not be used because alcohol damages the catheter material.

Administration of Medication

Medication should never be given along with tube feeding.‍

That is why it is important to thoroughly flush the feeding tube with 20 cc of water before and after administering the medication. You can find more information in the "Tube Feeding" brochure.

Oral Care

Good oral care remains important. Because you are eating little or nothing, your mouth is at risk of becoming dry. This can cause uncomfortable problems.

Here are a few tips for good oral hygiene:

• Brush your teeth twice a day.
• Rinse your mouth several times a day with water, chamomile tea, or an alcohol-free mouthwash.
• You can also moisten the mouth using, for example, a mouth spray (alcohol-free) or artificial saliva, which is available at pharmacies.
• If there are scabs on the tongue, they can be removed with borax glycerin or plain yogurt (without sugar).
• If there is a white coating on your tongue, it is best to show it to your family doctor or treating physician.
• In addition, it's also important to take good care of your lips by using a rich ointment or lip balm.