This information will help you prepare for your procedure to have a percutaneous endoscopic gastrostomy (PEG) drainage tube placed at Memorial Sloan Kettering Cancer Center (MSK).
A PEG is a tube that is inserted into the stomach to drain stomach juices and fluid. This will help relieve the nausea and vomiting caused by a blockage in your stomach or bowel and will make you feel more comfortable. The tube is placed during a procedure called an endoscopy.
Having a PEG tube will let you enjoy eating and drinking. You will be able to drink liquids and eat soft foods or foods that have been mixed in the blender. However, these foods and liquids will only give you a small amount of nutrition. This is because they will mostly drain through the tube into a drainage bag. Your doctor or nurse will discuss with you how you will meet your nutritional needs.
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 medications 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 your procedure is scheduled 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, makeup, or perfume.
- Remove all 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), medications 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 you can walk through that goes from the garage into the hospital. If you have questions about prices, call (212) 639-2338.
There are also other 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.
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 names 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, 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 (a flexible tube with a camera at the end) through your mouth, down your esophagus (food pipe) and into your stomach.
A tiny incision (surgical cut) will be made on the skin of your abdominal wall and the tube will be passed through your incision. The tube will extend 8 to 12 inches outside your body and will be covered by a small bandage dressing to keep in place. When your doctor has completed the procedure, the endoscope will slowly be removed. The end of the PEG tube will be connected to a bag into which your stomach fluids will drain.
After Your Procedure
In the hospital
You will be taken Post Anesthesia Care Unit (PACU), where your nurse will monitor your temperature, pulse, 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.
Your nurse and dietitian will tell you about the types of foods you can eat. Your nurse will also tell you where to get supplies and show you how to:
- Clean the skin around your PEG tube
- Flush the tube
- Fix the tube if it gets clogged
- Take care of and change the drainage bag
- Take medications
- Clamp or cap the tube
Before you are discharged from the hospital, your nurse will give you the following supplies to take home:
- 1 box of 4 x 4 gauze
- 1 roll of 1-inch tape
- 1 irrigation (flushing) kit
- 2 drainage bags
- 2 caps
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 resume your normal activities the day after your procedure.
- You can shower 48 hours after your procedure. Do not take tub baths or swim for 2 weeks after your procedure.
Caring for Your PEG Tube
Caring for the skin around your PEG tube
You will need to care for the skin around your PEG 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 your tube with iodine (Betadine®) swab sticks once a day.
- Apply zinc oxide ointment.
- Cover the insertion site with a 4 x 4 gauze.
- Loop the tube and secure it with tape or use a Cath-Secure® tab to hold it in place (see Figure 1).
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. It may be stained with fluid or mucus. There may also be old blood or crusting around the tube. This is normal.
- Wash the skin around your tube with soap and water, removing any fluids or crusting. 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.
If your tube becomes dislodged or falls out, cover the opening with a thick bandage. Use several 4 x 4 gauzes. Then, call your doctor immediately. Do not eat or drink anything.
Emptying and cleaning the drainage bag
You will need to empty the bag when it is about ⅓ to ½ full of stomach juices, or about every 8 hours.
If you are eating soft foods, clean the drainage bag once a day. If you are not eating, clean the bag every 3 to 4 days. To do this:
- Mix 1 part white vinegar with 3 parts cool water.
- Soak your bag in this solution for 10 to 15 minutes. Allow the bag to dry.
You may feel nausea or discomfort when the PEG tube is capped (not open to draining) while you clean and dry the bag. If this is the case, attach a second bag.
Eating and drinking with your PEG tube
You can drink clear liquids after your procedure. These include ginger ale, apple juice, coffee, tea, broth, flavored ice, and gelatin (Jell-O®).
Sit up when you drink or eat to allow the foods or liquids to drain into the bag. Remain sitting up for 20 to 30 minutes after you eat. If you don't, you may feel nauseous. If you feel nauseous, check to make sure the tube is not tangled. This should make you feel better.
When you are drinking clear liquids without any problems, slowly increase your diet to full liquids. If you have not had any problems after 2 days, you can start eating soft or puréed foods. Purée your foods in a blender or food processor.
If you eat food that is not puréed, you must eat it in tiny pieces and chew it very well. Eat very small portions. Do not eat more than 4 cups of food or drink more than 1 liter (33.8 ounces) of liquids in 24 hours. Each time you eat or drink, you will lose some important nutrients. This is because they drain into the drainage bag with the food or liquid.
Most of what you eat and drink will drain through the tube into the drainage bag. For example, if you eat red Jell-O®, the drainage in the bag will be red. Stomach juices will drain into the bag even if you have not eaten. The colors will range from green to dark yellow.
Most people will need to have IV (given through a vein) liquids when they are at home so they do not become dehydrated. A Mediport® or peripherally inserted central catheter (PICC) will be used to deliver the liquids. Your doctor will insert one of these while you are in the hospital, if you do not already have one.
Connecting your PEG tube to the drainage bag
Your PEG tube should be connected to the drainage bag when you eat, drink, feel nauseous, or sleep. It does not have to be connected at other times. To connect the drainage bag to the PEG tube, take the tube down from the “looped” position. Remove the clear plastic cap from the tubing on the bag and twist the end into the PEG tube.
Flushing your PEG tube
You will need to flush the tube at least once a day. You or your caregiver should flush the tube once you are done eating. This is because the tube can get clogged with food. It may also need to be flushed if thick stomach juices or mucus clog it. If you feel nauseous or full and don't feel better after sitting up, flush your PEG tube.
To flush your tube, follow the instructions below.
- Gather the following:
- 60 mL of water (normal saline or plain tap water)
- A 60 mL catheter tip syringe
- A plastic cap for the tube
- A clean drainage bag
- Paper towels
- Wash your hands well with soap and warm water.
- Place the paper towels under the PEG tube to absorb any drainage.
- Draw up the 60 mL of water into the syringe.
- Clamp the PEG tube.
- Disconnect the PEG tube from the drainage bag.
- Insert the syringe into the opening of the PEG tube. Unclamp the tube and insert the water with a gentle push of the plunger.
- Remove the syringe, reconnect the PEG tube to the drainage bag, and allow it to drain.
If the tube is still not draining anything, or if your nausea does not get better, call your nurse or doctor.
Taking medication with your PEG tube
You can swallow medication tablets by mouth; however, you must cap your tube for at least 30 to 40 minutes after you take any medications.
You will be given a guide about tube feeding with your PEG tube. This guide has important information about getting nutrition and taking medication with a feeding tube.
Call Your Doctor or Nurse Immediately If:
- You have a temperature of 101° F (38.3° C) or higher
- You have shakes or chills
- You have abdominal pain or cramps
- You have any signs of bleeding
- You have pain at your incision site that does not get better with the medication you were prescribed
- You have nausea and vomiting
- You have any signs of redness, swelling, oozing, or pus around the tube
- You need to change your bandages more than 3 times a day or your tube keeps leaking
- Your tube becomes dislodged or falls out