PEG — PEXACT - Installing and caring for a feeding tube

The doctor will send you 'a patient booklet for surgery or anaesthesia procedure'. It is important - if you agree 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 in the patient booklet on pages 6 and 7, giving the doctor permission to place the feeding tube and also giving permission for the necessary anaesthesia and pain relief.

If you are taking strong blood thinners, you should definitely report this to the treating doctor beforehand. This is best when the treating doctor agrees with you to install a feeding tube.

If you have had a heart attack or got a stent in the past year, it is best to discuss adjusting the intake of anticoagulant medication with your heart specialist and/or anaesthetist in advance.

Installing the feeding tube

When installing a feeding tube and starting the tube feeding, a hospital stay of a few days is usually required. This is because the tube feed must be built up gradually.

You must be sober for 6 hours prior to placement. This means that you should not eat, drink or smoke 6 hours before the procedure.

In the morning, you can still take your daily medication with little water, with the exception of medication that affects the acidity of the gastric juice. This concerns the following medications: Cimetidine®, Ranitidine®, Zantac® Esomeprazole®, Nexiam® Dakar®, Lansoprazole® Omeprazole®, acidcare®, Acidozol®, Losec® Pantozol®, Pantomed®, Pantoprazole®, Maalox Control®. You will not take this medication once.

An infusion will be placed when you are admitted. An antibiotic is administered via the infusion 1 hour before the feeding tube is placed. This is to prevent a wound infection. If you are allergic to a particular antibiotic, you should definitely report this to the nurse.

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

The probe is placed under local anaesthesia. If you ask this, medication will also be given to calm you down. As a result, you will experience the placement of the feeding tube less consciously. The procedure is performed using a stomach exam. A flexible tube with a camera (gastroscope) is inserted through the mouth that is pushed through the esophagus into the stomach. Here, the exact location of the probe can be determined and indicated.

The abdominal wall is disinfected and the skin is anesthetized locally. At the site of the anaesthetic, the abdominal wall is punctured with a hollow needle. A long fine thread is passed through the needle and pulled out with the camera through the mouth.

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

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

The Pexact probe

When the Pexact probe is installed, you will be fully sedated for a short time. A flexible tube with a camera (gastroscope) is inserted into the stomach. The stomach is inflated and the room is darkened for a moment. A light is lit through the stomach wall and that will be where the probe is placed. This place will be marked.

The next step is to sew the stomach to the abdominal wall so that while puncturing the stomach, it cannot change its position.

Then you pierce the abdominal wall into the stomach with a thick needle. This needle is removed and a tube remains in place. The feeding tube is inserted into this tube and the balloon is inflated with water.

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

The procedure itself takes 20 to 30 minutes.

The threads that are still present will remain on site for 10 days.

Starting with tube feeding

At the earliest after 3 hours, a small amount of water is introduced through the probe to see if the probe is in good condition. The dietician has now been notified by the service that you have been placed with a probe. Here, the dietician calculates your energy and protein needs. Based on this, the type and amount of tube feeding will be determined and a structure schedule will be drawn up.

With the correct placement of the probe, approval by the doctor and after calculating the tube feed and drawing up a structure schedule, you can start administering the tube feed. In the coming days, the nurse and dietician will monitor how much you tolerate tube feeding. Further information can be found in the Probe Feeding brochure.

Without advice from the doctor and if there are no swallowing disorders, it is advisable to still take food by mouth. In this way, saliva production is still stimulated.

Wound care

If the anaesthetic has worn off, the puncture site may be painful, then good pain treatment is indicated. In the first few days, pain relief can already be administered systematically. It is important to treat the pain on time. If the area starts to feel sore, report this to the ward nurse so that something can already be administered.

The first 10 days after installation, it is important that the probe is left in place. In this way, a fistula canal can form. However, the insertion hole must be checked daily and cleaned with physiological water. If infection parameters can be observed, an aqueous disinfectant solution such as Isobetadine dermique® (in case of iodine allergy: Hibidil®) should be used. Alcoholic disinfection should not be used because alcohol corrodes the material of the probe.

Administration of medication

Medication should never be given together with the tube feed.‍

Therefore, it is important to rinse the feeding tube thoroughly with 20 cc of water before administration and after administration of the medication. Information can be found in the Probe Feeding brochure.

Oral care

Good oral care remains important. Because nothing or little is taken by mouth, your oral cavity risks becoming dehydrated. This can cause annoying problems.

A few tips for good oral hygiene:

• Brush your teeth twice a day.
• Rinse the mouth several times a day with water/chamomile tea or a mouthwash without alcohol.
• The mouth can also be moistened with, for example, a mouth spray (without alcohol) or by using artificial saliva, available in pharmacies.
• If there are scabs on the tongue, they can be removed with borax glycerin or natural yoghurt (without sugar).
• If there is a white coating on the tongue, it is best to show this to your doctor or treating doctor.
• In addition, it is also important that the lips are well cared for with a greasy ointment or lip balm.