PEG (Percutaneous Endoscopic Gastrostomy) tube – Stomach Tube


Key Points

A PEG tube is a stomach tube that is placed into the stomach, through the body wall on the left side of the pet, usually with the assistance of a flexible camera called an endoscope

This is an excellent means to provide a route for feeding if your pet will not eat

 

PEG tube

  • A PEG tube is a stomach tube that is placed into the stomach, through the body wall on the left side of the pet, usually with the assistance of a flexible camera called an endoscope
  • The procedure
    • the pet is anesthetized
    • the left side of the abdomen is shaved
    • an endoscope is placed into the stomach via the mouth
    • a strong suture is placed through the outer body wall into the stomach which is distended with gas
    • the suture is retrieved with the scope and pulled from the stomach to the mouth
    • the stomach tube is tied to the suture and pulled into the stomach and out of the body wall
    • the stomach tube is secured in place
    • a cap is placed on the end of the stomach tube

 

Indications for a PEG tube

  • Any animal that refuses to eat or take in adequate amounts of food and water
  • Many diseases can cause lack of appetite
  • Injury or fracture of the jaw bones
  • In cats, fatty liver disease is an indication to have the tube placed
  • Below is a cat that has a PEG tube in place; a shirt is used to cover the tube

Care of PEG tube

  • For the first 2 weeks the skin around the PEG tube should be gently cleansed to remove any discharge using a clean Q-tip and hydrogen peroxide or dilute antiseptic solution such as Betadine or Chlorhexidine; thereafter, occasional cleaning may be needed

  • After the site has been cleansed, triple antibiotic ointment such as Neosporin is applied to help heal the site

 

Feeding through the PEG tube

  • Prior to feeding, the amount of stomach contents is measured by aspirating on the stomach tube with a 35 or 60 ml catheter tip syringe
  • If the residual fluid in the stomach is greater than 15 ml, the feeding is delayed for a couple of hours and the residuals are rechecked again
  • Generally the residual fluids are removed and discarded; it is unusual that discarding the fluid will cause alkalosis or significant electrolyte problems in the blood
  • A total needed amount of feeding will be calculated for your pet; this amount is divided into about 4 equal feedings per day
  • We usually recommend a dense food such as Iams Maximum-Calorie Plus diet as smaller volumes of food are needed versus other brands; after a can of food is opened it should be refrigerated; it should be warmed to a luke warm temperature prior to feeding; usually a small amount of water is added to the food to make it more liquid and easier to pass through the PEG tube
  • Always flush the PEG tube with 15 ml of luke warm water after administering food or medications through the PEG tube
  • Place the cap back on the tube after feeding or administration of medications via the tube
  • If your pet is not drinking, additional water is recommended
    • Daily requirement of water is roughly 60 ml/kg/24hours
    • calculate the amount of water that is in the food (about 70% of total food fed per day) and subtract this from the daily requirement
    • Subtract also the 15 ml of water that is used to flush the tube after each feeding
  • Always offer food free choice of food – once the pet is eating well the PEG feedings can be stopped or gradually weaned off

 

Improving passage of food through the stomach

  • If you find that the residual amount of fluid/food in the stomach is greater than 15 ml prior to a feeding, your pet likely has poor motility of the stomach, thus the food and fluids are not being properly pumped out of the stomach
  • Encouraging your pet to walk around after the feeding will help to get the stomach to pump the food into the intestine
  • Medications are sometimes prescribed to help empty the stomach

 

Unclogging a PEG tube

  • If food has not been adequately flushed through the PEG tube after a feeding, the tube may become clogged
  • Try flushing the tube with luke warm water
  • If this is not effective, put 5 ml Coca cola down the tube and let it sit for about 30 minutes, then flush with luke warm water
  • If this is not effective consult us or your regular veterinarian

 

Removal of a PEG tube

  • A PEG tube must stay in place for about 10 days prior to removal so that peritonitis or infection of the abdominal cavity does not occur
  • The PEG tube should be removed by a veterinarian; the tube is simply pulled out and does not require anesthesia
  • The tube is generally removed once the pet is eating well

 

Potential complications

  • Anesthetic death – rare
  • Infection  – uncommon
  • Poor stomach motility
  • Vomiting from feeding too fast or too much food at one time
  • Premature dislodgement of the stomach tube

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