Feeding Tube Service | Home Care Instructions after Placement of a Percutaneous Endoscopic Gastrostomy (PEG) Tube

1. Gather these supplies:
   • 2-3 clean cotton swabs (Q-tips) or gauze pads
   • water and mild soap
2. If there is crusty drainage around your child’s PEG tube site, you may also need the following:
   • ¼-strength peroxide, made by mixing three parts normal saline or tap water with one part hydrogen peroxide
3. Wash your hands with soap and water.
4. Tell your child what you will be doing.
5. Dip the cotton swab or gauze pad in soap and water, and wash around the tube. Be sure to gently lift the crossbar to clean underneath it. If there is crusty drainage that does not easily wash off with soap and water, you can use ¼ strength hydrogen peroxide. Rinse any hydrogen peroxide off the skin.
6. Dry the area around the PEG tube with a clean gauze pad. Do not tape down the crossbar or put a bandage over or under the crossbar. The area just around the PEG tube may be slightly pink with a small amount of crusted drainage. This is normal. If there are any signs of redness, rash, swelling, green or yellow liquid drainage, or red beefy tissue (called granulation tissue) growing around the tube, contact the GI office as the PEG tube site may need to be looked at by a doctor or nurse.

1. Turn the PEG tube crossbar a ¼ turn daily. Check to make sure the crossbar is not tight. The crossbar should turn freely and rest lightly on the skin. There should be no pressure marks on the skin.
2. Make sure the PEG tube is stabilized. Cut a piece of tape about five inches long. Put the tape completely around the PEG tube about five to six inches from the stoma. Pinch the tape together under the PEG tube to form a “tape tent.” There should be extra tape on either side of the tube to stick onto the skin. This taping will help the PEG tube to form a loop over your child’s stomach. The loop should be big enough so that the PEG tube enters the stoma at a 90-degree angle to prevent any tension or pulling at the stoma. A nurse will show you how to do this.

• Your GI doctor or nutritionist will work with you to make a feeding plan that is best for your child. Continue your feeding plan as prescribed by your GI doctor.
• Give liquid medicine when possible through the PEG tube. ALWAYS flush with at least 3⁄10 cc/ml of water (unless you have been told a different amount) before and after giving medicine to avoid clogging the PEG tube.
• After giving thick medicine, flush with extra water to help stop the PEG tube from clogging. If your child is on a fluid restriction, talk to your doctor or nurse about how much water to use.
• If a medicine is only available in tablet or capsule form, check with your pharmacist and doctor to be sure it can be safely crushed. Pills should be crushed into a fine powder and completely dissolved in water before giving through the PEG tube. You can buy a pill crusher at a local pharmacy.
• Do not mix one medicine with another or put medicine in formula, unless clearly told to do so by your child’s GI doctor. Some medicines do not mix well together.
• Remember: Flush the PEG tube with water before and after feedings and giving medicine to keep the tube from clogging. Your GI doctor or nurse will tell you how much water to use.

• Your child may take a bath in the bathtub one week after PEG placement.
• Your child may return to most regular activities as soon as he/she feels ready. Talk to your GI doctor about when your child can return to sports. Check with your GI doctor for ideas about how to protect the PEG tube during play and/or sports.
• Young children will be curious about their PEG tube and may pull on it. Do not let your child do this. Keep the PEG tube covered with clothing, such as a “onesie” (one-piece snap tee-shirt) for infants and toddlers to help stop pulling at the tube.
• For older children or young adults, you can place stretchy gauze around the stomach to cover the tube.

Do not try to replace the tube. The tube must be replaced by a trained doctor or nurse. Call your GI doctor, tape gauze over the stoma, and bring your child to the Boston Children’s Emergency Department right away.

If you cannot get to Boston Children’s within two hours, you may have to take your child to a closer hospital first. Please have the local doctor call the GI doctor on-call at Boston Children’s to discuss the best plan when you arrive. Your child’s stoma may close up if the PEG tube is out for more than a few hours.

Your child will be scheduled for a follow-up visit with one of our GI nurses two weeks after PEG placement. Your child will also be scheduled for a check-up visit with their GI doctor and nutritionist four weeks after the PEG placement. At these follow-up visits, we will check to make sure the stoma is healing and the PEG tube is working well. If you need to change your appointment date or time, please call the GI clinic at 617-355-6058.

Call if:

• you are not able to flush the PEG tube
• the end of the PEG tube is cracked or the tube is leaking
• your child shows signs of having trouble with feedings, such as coughing, choking, throwing up, diarrhea, stomach pain, or constipation
• you notice signs of infection at the stoma, such as redness, rash, fluid draining, swelling, soreness, strange smell, or fever.

Please call the GI office at 617-355-6058 if you have questions or concerns. Our GI nurses can help you with all types of PEG tube questions:

• 8 a.m. to 4:30 p.m. weekdays: A nurse in the GI clinic will be available to help you.
• Weekdays after 4:30 p.m., weekends, holidays: Use the same number to reach a GI doctor on-call for urgent questions or emergencies.

If your child is followed by General Surgery:

• 8:30 a.m. to 5 p.m. weekdays: Call the General Surgery outpatient nurses at 617-355-7716 or 617-355-7704.
• Weekdays after 5 p.m., weekdays, holidays: Call the Boston Children’s page operator at 617-355-6369 and ask for the general surgery senior resident on-call.