WHAT IS PEG?
PEG is the process of placing a feeding tube into the stomach through the anterior abdominal wall, by entering through the mouth with a device called an endoscope, which has a lighted camera on its tip, in cases where sufficient nutrition cannot be taken from the mouth. This method allows solid, liquid foods and oral medications to be taken directly into the stomach.
WHAT IS THE PURPOSE OF PEG?
PEG, especially for periods exceeding 2-3 weeks. It is a feeding method applied to improve the nutrition of patients who cannot feed adequately orally for a long time, whose food gets into their lungs when they are fed orally, or who cannot swallow what they eat. Aim; It aims to correct important nutritional deficiencies, ensure the body's fluid balance, prevent weight loss, improve the quality of life, and accelerate growth if children have developmental delays. With PEG, it may be possible for the patient to eat more safely and comfortably and get enough calories. However, PEG does not cure the disease that causes the patient to be malnourished.
HOW IS THE PEG PROCEDURE DONE?
PEG procedure can be performed intensively in the endoscopy unit under sterile conditions, at the patient's bedside when necessary. It can be done in the care unit and operating room. The patient must be fasting for at least 8 hours before the procedure. After the patient is put to sleep and his throat is anesthetized, the endoscope is reached through the esophagus into the stomach. Meanwhile, the area on the abdominal wall where the catheter tip will be inserted is anesthetized with local anesthesia, and a small incision is made on the skin and subcutaneous tissue. A guide wire is sent through this incision to the stomach, and the PEG catheter is slid over the guide wire and placed into the stomach. When the procedure is completed, there will be a PEG tube in the patient's abdominal wall that will be used for feeding.
DOES IT HAVE AN OBSTACLE WITH NORMAL FEEDING?
Unless it is prohibited by the doctor, there is no difficulty in swallowing or there is no food intake. If it does not get into the lungs (if there is no cough or choking sensation after feeding), normal oral feeding can be continued with the approval of the follow-up doctor.
IS PEG AN IRREVERSIBLE PROCEDURE? CAN IT BE REMOVED IF THE NEED IS NO LONGER?
It is not an irreversible process, it does not harm normal swallowing organs and mechanisms. It can be removed effortlessly when adequate nutrition can be achieved through normal means.
HOW SHOULD PEG MAINTENANCE AND CLEANING BE DONE?
First week: Dressing is done every day, the skin is cleaned and covered with a compress.
After the first week: Dressing is done every two or three days, the skin is cleaned with antiseptic and covered with a compress. Compresses used for cleaning should be sterile, the surface that will come into contact with the skin should not be touched.
WHEN CAN A PATIENT BATH AFTER PEG INSTALMENT?
There is no harm in washing after the first week. After washing, it should be dried thoroughly and dressed (the skin is cleaned with an antiseptic solution and covered with a compress).
HOW TO FEED WITH PEG?
Wide-mouth syringes or infusion. The patient can be fed using pumps.
WHICH FOODS CAN BE GIVEN THROUGH PEG?
Apart from ready-made nutritional solutions, all normal foods that have been ground or crushed to a fluid pudding consistency can be given through the PEG catheter. Care should be taken to ensure that the food is warm, hot food may cause deformation in the tube, and very cold food may block the tube. Particulate foods should not be given without crushing them. Medicines can be given by diluting after being crushed.
WHEN SHOULD PEG BE CHANGED?
There is no expiration time for PEG catheters, they can be used as long as they are functional. If the PEG catheter is punctured, if an infection resistant to treatment develops on the skin, if the PEG catheter is buried, or if the PEG catheter changes shape to the extent that it becomes difficult to deliver nutrition, it should be replaced.
HOW TO REMOVE PEG CATHETER?
Depending on the type of catheter, it is removed by endoscopy or by pulling it from the abdominal wall.
WHAT ARE THE ALTERNATIVE METHODS?
Feeding with a nasogastric (NG) tube inserted through the nose and the end placed in the stomach: Feeding with this method is applied to patients who are thought to be able to feed orally after a while (6-8 weeks), but when used for a long time, it can cause wound formation in the nose, esophagus and even the stomach. It is not a preferred method because it may cause If the NG tube moves out of place and goes unnoticed, it may cause life-threatening problems (the loss of nutrients to the lungs). such as running away).
Surgical gastrostomy: Surgical gastrostomy is the process of placing a tube into the stomach by surgeons under general anesthesia. It may be necessary to apply PEG in patients who cannot be inserted by endoscopic method or in patients who need reflux surgery for medical reasons (in the same session).
Radiological gastrostomy: This procedure can be performed in specialized centers by an experienced radiologist under the guidance of ultrasonography and/or fluoroscopy (by giving light).
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