This information will help you prepare for your procedure to have a percutaneous endoscopic gastrostomy (PEG) feeding tube or a percutaneous endoscopic jejunostomy (PEJ) feeding tube placed at Memorial Sloan Kettering Cancer Center (MSK).
A PEG is a feeding tube that is placed into your stomach (see Figure 1, left). If the tube can't be placed into your stomach, you may have a PEJ tube placed instead (see Figure 1, right). A PEJ tube is placed in your jejunum, which is the first part of your small intestine. The tube is placed during a procedure called an endoscopy.
Figure 1. PEG tube placement (left) and PEJ tube placement (left)
The feeding tube will give you nutrients if you are not able to get enough through eating and drinking. If you are able to eat, you can continue to do so after the PEG or PEJ tube is inserted. You will use the tube to give yourself enough nutrition to meet your needs. If you need long-term nutrition support, your doctor may convert your PEG or PEJ into a low-profile EndoVive® gastrostomy tube into your stomach or intestines (see Figure 2).
Figure 2. Low-profile EndoVive gastrostomy tube
1 Week Before Your Procedure
Ask about your medications
You may need to stop taking some of your medications before your procedure. We have included some common examples below.
- If you take medication to thin your blood, ask the doctor who prescribes it for you when to stop taking it. Some examples are warfarin (Coumadin®), dalteparin (Fragmin®), heparin, tinzaparin (Innohep®), enoxaparin (Lovenox®), clopidogrel (Plavix®), and cilostazol (Pletal®).
- If you take insulin or other medications for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medication what you should do the morning of your procedure.
Get a letter from your doctor, if necessary
If you have an automatic implantable cardioverter-defibrillator (AICD), you will need to get a clearance letter from your cardiologist before your procedure.
Arrange for someone to take you home
You must have someone 18 years or older take you home after your procedure. Please call one of the agencies below if you do not have someone who can do this. They will help find someone to take you home.
Partners in Care (888) 735-8913
Caring People (877) 227-4649
Prime Care (212) 944-0244
3 Days Before Your Procedure
You will receive a telephone call from an endoscopy nurse. He or she will review the instructions in this guide with you and ask you questions about your medical history. The nurse will also review your medications and tell you which ones to take the morning of your procedure. Use the space below to write them down.
The Day Before Your Procedure
A clerk from the Admitting Office will call you after 2:00 pm the day before your procedure. He or she will tell you what time you should arrive at the hospital for your procedure. If you are scheduled for your procedure on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call (212) 639-5014.
If you need to cancel your procedure for any reason please call the doctor who scheduled it for you.
Do not eat or drink anything after midnight the night before your procedure. This includes water, gum, and hard candy.
The Day of Your Procedure
Things to remember
- Do not eat or drink anything the morning of your procedure. This includes water, gum, and hard candy.
- Take only the medications your doctor told you to take the morning of your procedure. You may have written them down above. Take them with a few sips of water.
- Do not put on any lotion, cream, powder, deodorant, make-up, or perfume.
- Remove jewelry, including body piercings.
- Leave all valuables such as credit cards and jewelry at home.
- If you wear contacts wear your glasses instead.
What to bring with you
- A list of the medications you take at home, including patches and creams.
- Medications for breathing problems (such as inhalers), medicines for chest pain, or both.
- A case for your glasses.
- Your Health Care Proxy form, if you have completed one.
Where to park
Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that goes from the garage into the hospital. There are also garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues. For questions about prices, call (212) 639-2338.
Where to go
Please arrive at the Surgical Day Hospital (SDH) at 1275 York Avenue (between East 67th and East 68th Streets). This is the main building of MSK. Take the M elevator to the 2nd floor.
What to expect
Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to state and spell your name and date of birth many times. This is for your safety. Patients with the same or similar name may be having procedures on the same day.
Your doctor will explain the procedure to you and answer any questions you may have. He or she will ask you to sign a consent form.
When it's time for your procedure, you will be brought into the procedure room and helped onto an exam table. You will be attached to equipment to monitor your heart rate, breathing, and blood pressure. You will also receive oxygen through your nose. A mouth guard will be placed over your teeth to protect them.
You will receive anesthesia (medication to make you sleepy) through your IV. Once you are asleep, your doctor will pass the endoscope through your mouth, down your esophagus (food pipe), into your stomach, and into the first part of your small intestine. Your doctor will inspect your stomach and small intestine before placing your PEG or PEJ tube
A tiny incision (surgical cut) will be made on the skin of your abdominal wall and a feeding tube will be passed through the incision. The feeding tube will extend 8 to 12 inches outside your body and will be covered by a small bandage to keep it in place. When your doctor has completed the procedure, the endoscope will slowly be taken out.
After Your Procedure
In the hospital
You will be taken to the Post Anesthesia Care Unit (PACU), where your nurse will monitor your temperature, heart rate, breathing, and blood pressure. He or she will also check the bandage around your tube. You will stay in the PACU until you are fully awake.
When you are fully awake, your nutrition nurse will show you and your caregiver how to give yourself the feedings and care for your PEG or PEJ tube. It is very important to have your caregiver with you during the teaching session. You will also receive a resource that explains how to give yourself feedings with your PEG or PEJ tube.
Your nutrition nurse will go over possible side effects that you may experience with your feeding tube and will give you the Oley Complication Chart as a reference. This chart provides guidelines on how to treat possible complications. To view the chart online, go to www.oley.org/charts/newHEN.pdf. However, we encourage you to call your doctor, nurse practitioner, or physician assistant if you are experiencing any problems.
You will also receive supplies for your feeding tube before you leave the hospital. These include:
- Materials for your dressing care
- Syringe for flushing your tube with water
- Cath-Secure® which holds your tube in place
- Gravity bag to get you started on feedings at home until your supplies or formula are delivered by your home care agency
Your doctor may also prescribe pain medication for discomfort at your incision site.
- You may feel some soreness in your throat. This is normal and will get better in 1 or 2 days.
- You may have some discomfort at your incision site for the first 24 to 48 hours. If so, take your pain medication as instructed.
- You can shower 48 hours after your procedure. Do not take tub baths or go swimming for 2 weeks after your procedure.
- You may see dark green drainage around your PEG or PEJ site. A small amount of green drainage is normal.
Caring for the Skin Around Your PEG or PEJ Tube
You will need to care for the skin around your PEG or PEJ tube. Follow the steps below.
Every day, inspect the skin around your feeding tube for any redness, swelling, or pus. Tell your doctor or nurse practitioner if you are having any of these symptoms.
For the first 2 days after your procedure:
- Remove the old dressing.
- Clean the skin around the tube with iodine (Betadine®) swab sticks once a day.
- Apply zinc oxide ointment.
- Cover the insertion site with a 4x4 gauze.
- Loop the tube (see Figure 3) and secure it with tape or use a Cath-Secure® tab to hold it in place.
Figure 3. Looping the tube
On the third day after your procedure, begin a daily routine of caring for the skin around your tube while showering.
- Before you shower, remove the old dressing around your tube.
- Wash the area with soap and water. Gently pat it dry.
- Apply zinc oxide ointment.
- Cover your insertion site with a 4 x 4 gauze pad.
- Loop the tube and secure it with tape or with a Cath-Secure® tab.
Call Your Doctor or Nurse if You:
- Have chest pain or shortness of breath
- Have severe abdominal pain, hardness, or swelling
- Are vomiting blood
- Have a temperature of 101° F (38.3° C) or higher
- Feel weak, faint, or both
- Have any sign of bleeding
- Have pain at your incision site that does not get better with the medication you were prescribed
- Have any sign of redness, swelling, or discharge around the tube