Percutaneous Endoscopic Gastrostomy (PEG) removal

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1 Feedback We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff or contact the Patient Advice and Liaison Service (PALS): Freephone: From a mobile or abroad: ext or pals@nuh.nhs.uk Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR Percutaneous Endoscopic Gastrostomy (PEG) removal Endoscopy Department Information for patients If you require a full list of references for this leaflet please patientinformation@nuh.nhs.uk or phone ext The Trust endeavours to ensure that the information given here is accurate and impartial. This document can be provided in different languages and formats. For more information, please contact: The Endoscopy Centre City Hospital campus: QMC Hospital campus: ext Lorraine Clark (Gastroenterology & Endoscopist Nurse Lead), Tracey Buchanan (Nutrition Nurse Specialist) Endoscopy Department October All rights reserved. Nottingham University Hospitals NHS Trust. Review May Ref: 1494/v2/0514/AS NUH02595N

2 This leaflet aims to explain what a PEG removal involves. It will answer frequency asked questions for you. Notes/questions Section (cont) Why do I need my PEG removed? You are now able to meet your nutritional requirements by mouth and do not use your PEG tube for feeding therefore it is best the PEG tube is removed to avoid any complications or infections. What is a PEG removal? This is the permanent removal of the PEG tube, this includes the removal of the internal bumper and the external part of the feeding tube (the whole tube is removed) How is the PEG removal? The PEG is removed in Endoscopy by an endoscopist and this is done by passing a long flexible tube with a camera in the tip known as an endoscope (thinner than your little finger) through your mouth and into your stomach. A PEG removal procedure allows the endoscopist to look into your stomach and see your PEG tube from the inside of your stomach, which is essential to be able to remove the internal bumper that holds your PEG tube in place. The tube will be cut from the outside next to your skin and this will allow the endoscopist to remove the whole of the tube including the internal bumper Are there any alternatives to an endoscopy PEG removal? Endoscopy PEG removal is the most simple way of removing your PEG tube. There are other methods but there is a potential risk of causing bowel obstruction. 2

3 PLEASE WRITE YOUR RELATIVE S/FRIEND S NAME AND TELEPHONE NUMBER BELOW: Name: Telephone No: CHECKLIST Things to remember before your PEG Nothing to eat for 6 hours before your procedure and/or do not use your PEG tube for 6 hours before the procedure. Nothing to drink from 2 hours before your procedure. Check for specific medication instructions. Transport arrangements made. Plus contact name and number written in this booklet. Responsible adult arranged to stay with you for 12 hours if you are thinking about having sedation and to be discharged home that day, e.g. if you normally live in a Nursing Home. Bring all this information pack with you to your endoscopy appointment. Notes/questions Section Please write down a list of any medications you are taking and any questions you have: How do I prepare for the test? It is advised that you wear loose fitting clothing, as this is more comfortable for you after the test. To allow a clear view during the test, your stomach must be empty. Therefore do not have anything to eat for at least 6 hours before the procedure. Please do not use your feeding tube 6 hours prior to the procedure If appropriate, you may have sips water up to 2 hours before the procedure unless it is deemed unsafe for you to take fluids by mouth. Please remove any coloured nail varnish, as this may affect how well our monitoring equipment is able to detect your heart rate and breathing during your endoscopy test. What about my medication? Please list your usual medication on the Notes/Questions section at the back of this booklet. Specific instructions have been put into your information pack: If you are Diabetic see green leaflet If you take Warfarin or Clopidogrel see pink leaflet Take any other medication as normal. Any essential medication can be taken up to 2 hours before the procedure if unsure please contact the endoscopy centre. NOTE If you take steroids or immuno-suppressant medication, please bring your Alert Cards with you. If your doctor has told you that you may have had a stroke or heart attack within the last 3 months, please contact the Endoscopy Unit as soon as possible. 3

4 What happens when I arrive? On arrival, please report to the main reception desk where the receptionist will check your personal details. You will then be greeted by the nurse responsible for your care and escorted to the assessment area. Here you will be asked a number of questions, including your medical history and your arrangements for transport home. The nurse will also take your pulse and blood pressure. If there is a possibility that you are going to have sedation the nurse will discuss this with you, you will not be allowed to use public transport or drive. You must arrange for a responsible adult to collect you, even if going home by taxi. It is also strongly recommended that the responsible adult should stay with you for 12 hours following the sedation for your own safety. You will then be asked to wait in the sub-waiting area before being called through for your PEG removal. Please note there often are several endoscopy procedure rooms running at the same time with different procedures and endoscopists. If another patient is called through from the sub-waiting area for their procedure before yourself they are not jumping the queue. What happens after the procedure? After the procedure, you will remain on the trolley and will be taken to the recovery area. Here you will be allowed to rest until you are safe to return to the ward area if you are going to stay in the hospital. You may feel a little bloated or have some discomfort in your stomach, this will wear off during the day. If the hole/stoma site continues to leak after 5 days please contact the nutrition nurse specialist : City Campus ext or bleep via switchboard 6993 Queens Campus ext or bleep via switchboard After you are discharged home If you experience any of the following problems please contact your GP immediately, informing them that you have had a colonoscopy: A severe abdominal pain (not just cramp caused by wind) A sudden passing of a large amount of blood from your back passage (for a very small amount of blood take no action) A firm and swollen abdomen High temperature or feeling feverish Vomiting Alternatively, contact the Endoscopy Unit at the hospital campus where you had your colonoscopy: City Hospital Campus 8am - 6pm, Monday to Friday Tel: QMC Campus 8am - 6pm Monday to Friday Tel: ext

5 Are there any complications? As with every medical procedure, the risk must be compared to the benefit of having the procedure carried out: the doctor who has requested the procedure will have considered this very carefully. A removal PEG is what is known as an invasive procedure and, therefore, carries risks/complications. These are rare. The major risks/complications include: Allergic reaction to the equipment or medication used for the procedure. Disturbance of your heart rate and breathing. Wound infection (1 person in every 10 procedures carried out). Inflammation of the peritoneum (a lining of the abdominal cavity). Chest infection (1 person in every 100 procedures carried out). Significant bleeding (less than 1 person in every 1000 procedures carried out). Perforation (small tear or damage to the lining of the gullet or stomach (less than 1 person in every 10,000 procedures carried out). This may require surgery. More about Sedation and Throat Spray Sedation This will make you sleepy, but not unconscious. It is NOT a general anaesthetic. You will be in a state called co-operative sedation: this means that, although drowsy, you will still hear what is said to you and will be able to carry out simple instructions during the test. You will be relaxed and should be able to breathe quite normally during the procedure. Sedation has an amnesic effect (making you forgetful for a short time); the chances therefore of you remembering anything about this investigation are very unlikely. It is very important that you understand if you decide to have sedation you SHOULD NOT drive, operate heavy machinery or sign any legal documents for 24 hours following the procedure. You must also not drink any alcohol for 8 hours before or after the test if you plan to have sedation. Throat Spray This is a local anaesthetic spray. It may taste unpleasant, but is intended to make your throat less sensitive and numb during the test. 5

6 So what does removal of a PEG involve? You will be introduced to the nurses and endoscopists who will be with you throughout the removal of your PEG. An endoscopist will then check that you have a full understanding of your procedure, all that is involved, and that you are willing to go ahead. The endoscopist will also examine your abdomen to check that it is safe to go ahead with the procedure and also check the PEG rotates and retracts freely. You and, if you wish, your relatives will be given the opportunity to discuss whether to have sedation and how it may affect you. You will be asked to remove any dentures and/or spectacles and these will be stored for safe keeping under the trolley that you are lying on. At this point, most people have the back of their throat sprayed with a local anaesthetic spray, whilst they are sitting up. A needle will be put into the back of your hand or a vein in your arm, through which the sedative will be given. In order to monitor your heart rate and breathing, the nurse looking after you will place a monitor onto one of your fingers. A nurse will be with you at all times, giving guidance and support. Any saliva you produce will be removed with a small suction tube, similar to that used at the dentist. You will be able to breathe normally throughout your procedure. The flexible endoscopy tube will then be passed over the back of your tongue, down your gullet, into your stomach. Air is put into your stomach so that a clear view of the lining of your stomach can be seen and identify the internal bumper of your PEG. This may cause you to feel bloated during or after the procedure. This is normal and should resolve on its own. Once we have located the internal bumper a snare (looped device) will be passed down the endoscope and around the internal bumper. This is so we can remove the internal bumper from your stomach. The PEG tube will be cut on the outside near to the insertion site. Once the tube has been cut the internal bumper will be removed by removing the endoscope and snare through your mouth. The procedure should take about 10 minutes to complete. Within hours the hole/stoma site where your Peg was sited will close. A dressing will place over the hole/stoma site to prevent any leakage onto your clothes. 6 7