Percutaneous Endoscopic Gastrostomy tube with or without assistance of a laparoscope

A Percutaneous Endoscopic Gastrostomy (PEG) tube is a tube that is inserted surgically into the stomach, through the abdominal wall, with the help of a camera (gastroscopy). The tube is kept in position by a disc in the stomach and another disc, plate or fixator on the skin (retention fixator). This initial gastrostomy will stay in for 3–12 months. An anaesthetic and a gastroscopy will usually be required to change this tube to a low-profile device or ‘button’.

Surgically placed gastrostomy tube

A surgical gastrostomy tube is inserted without the assistance of a camera. It is held in place by a balloon in the stomach and either a disc or taping on the skin. This gastrostomy will stay in place for a minimum six-eight weeks and does not require another anaesthetic to change to a low-profile device or ‘button’.

Care at home

Care of your gastrostomy tube

• Use a clean cloth and tap water to wash around your child’s gastrostomy tube. Clean the skin under the retention fixator one or two times per day. Start with cleaning as part of your child’s daily bathing routine.
• Bathing may recommence three-four days after the initial gastrostomy insertion. Bathing is a good way to keep the stoma and tube clean.
• You MUST rotate (turn) the tube completely both directions, each day, starting three-five days after insertion.
  NOTE: For a surgically placed gastrostomy tube, the surgeon will advise the timing of the commencement of tube rotation on discharge.
  NOTE: Gastrojejunal tubes should NOT be rotated.
• Do not put dressings under the external fixator unless instructed to. Once oozing stops there is no need for a dressing, unless instructed by the PEG team or surgeon. Vaseline can be used as a barrier to protect the skin whilst there is ooze, or at any time with redness or leaking.
• If a dressing is required, a non-adhesive foam is preferred, as it buffers movement and absorbs effectively.
• It is normal for your child’s Gastrostomy tube insertion site to be tender, mildly red, crusty and moist for the first week and sometimes longer. Continue to gently clean and dry the site.
• Please seek a review if the site becomes persistently red or swollen.
• Swimming, either in the sea or pool can be recommenced two weeks post insertion.
• If your child doesn’t not take any feeds by mouth, you will still need to take care of oral hygiene, by cleaning your teeth and using a mouth rinse and lip balm.
• The clamp on the tube should be placed in a new position every day to avoid weakening the tube.
• Flush your child’s tube twice a day with 20ml of tap water, when you are not using it for feeding (cooled boiled water if under six months old).

Granulation tissue skin care

Granulation tissue is a normal part of healing. It is a red/pink soft, wet tissue that appears around the stoma. It can weep fluid that is sticky and pus-like and can bleed easily. This is not an infection. While granulation tissue is bothersome, it is not dangerous. While it remains small and stable, apply Vaseline/paraffin and a foam dressing, while ensuring the tube does not hang, pull or get bumped. If you notice granulation tissue growing larger or not healing despite these methods, book a non-urgent appointment in PEG clinic or with your GP.

When to see a doctor

URGENT

• Your PEG has been accidently removed (your child should be brought to the Emergency Department immediately).
• You are concerned about the position of the tube or if it is not turning.
• There is significant pain, redness, or bulging at the stoma site.
  

Non-urgent

• You notice any granulation growing larger.
• Are concerned about anything relating to the PEG tube or stoma site.

Follow-up

Important contact details (for all gastrostomy related questions and problems):

• The PEG clinic is here to help with all your gastrostomy questions/concerns or education and is located at RCH, Level 2, Day Medical Unit (Reception G) – Motility Room.
• Clinic runs 9am–12pm Mon, Wed, Thurs, Friday (excluding public holidays). These days are subject to change.
• We are an outpatient clinic only and are not able to come to the wards.
• If you do not receive a post-op appointment within 2–4 weeks of initial PEG insertion, please book one through the contact centre.
• A booking is required to discuss any gastrostomy issue and can be made by the Specialist Clinics Contact Centre (03) 93456180 or in the My RCH Portal or on the Specialist Clinic change of appointment form. Gastrostomy concerns cannot be addressed by phone or email. A booked time needs to be allocated via the contact centre. This may be a Telehealth if the Doctor/Nurse does not need to observe the stoma. You may require a follow-up in person appointment.
  

Key points to remember

• If the tube is pulled out, present to emergency immediately.
• If there is increased pain, swelling, redness or bulging at the site, book an urgent appointment, or present to Emergency.
• Remember to rotate (turn) the tube completely every day, once safe to do so.
• Clean site daily, keeping as dry as possible.
• If there is ooze/leakage from the site use a barrier and disposable, absorbent foam dressing to protect the skin.
• If you have any concerns at all regarding the PEG tube or site, make an appointment with the PEG clinic by calling the Contact Centre (03) 9345 6180.

For more information

• RCH Gastroenterology Department: PEG clinic and gastrostomy care.

Developed by The Royal Children's Hospital Department of Gastroenterology and Centre for Community and Child Health. We acknowledge the input of RCH consumers and carers.

Written January 2024

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.