This page will provide you with information about longer term feeding tubes. The page will tell you what to expect before, during and after your operation.
A member of the medical team, your dietitian or your speech and language therapist can answer any further questions you may have.
A feeding tube is a small tube that passes through the skin into your stomach. This allows special liquid feed, water and medicines to be passed into the stomach. It can help to meet your dietary needs.
The three different operations used in North Bristol Trust are:
The most common tube is the PEG. You may have a RIG or PIGG tube if you cannot have sedation or if the camera cannot access your stomach. We will discuss with you which type is best.
There are many reasons why you may need a feeding tube. We will discuss this fully with you. You may consider a feeding tube when:
Not always, but this needs to be discussed with your doctor or speech and language therapist. It will depend on your medical problem.
The tube itself will not affect your ability to eat and drink. Some patients decide to still eat small amounts for pleasure. Some use the tube to provide extra nutrition on top of what they eat and drink.
If you decide against a feeding tube, it is unlikely that there are any other ways to meet your dietary needs. You should discuss your choices with your doctor and dietitian.
If you decide against tube feeding you will be supported in this decision. Please ensure you know the risks you may be taking.
All types of feeding tube are placed in hospital.
It is likely you will need to stay in hospital for at least a night for monitoring.
Most people will not experience any serious issues from their tube placement. However, the risks of a complication increase with age. Your risk of having issues is also increased if you suffer from heart, chest or other medical problems, such as diabetes or are overweight or smoke.
There is a low mortality rate. To minimise complications, we will choose the technique that is safest for you.
This is done in the Endoscopy Department. You will be given a local anaesthetic to your stomach, some throat spray, and light sedation. An endoscope (a flexible tube with a light and camera at one end) is then passed down into your stomach and lit up.
A small cut is made in your stomach where the light shines and the tube is then passed through.
The operation usually takes around twenty minutes.
You will be in the unit for some time before and after the operation.
This is what and PEG tube looks like:
This is done in the Interventional Radiology Department. A narrow tube is passed through your nose into your stomach. Air will be passed into your stomach via the tube to make it visible on x-ray.
Local anaesthetic will numb your stomach. A small cut is made in your stomach and a wire is passed through to your mouth. The feeding tube is then passed through.
This operation typically takes thirty minutes.
This is what a PIGG tube looks like:
This is done in the Interventional Radiology Department. A narrow tube is passed through your nose into your stomach. Air will be passed into your stomach via the tube to make it visible on x-ray.
Local anaesthetic will numb your stomach and stitches are then placed to hold the stomach close to the wall of the abdomen. A small cut is made near the stitches and a feeding tube is passed through into the stomach
This operation typically takes thirty minutes.
This is what a RIG tube looks like:
Once back on the ward it is necessary to wait between 4-24 hours before you can use the tube. The nursing staff will inform you when you can start to use the tube.
Water will be put through the tube first, followed by feed. Your dietitian will discuss the amounts and timings with you.
The nutrition given via the tube is a prescribed liquid mix of the nutrition your body needs. We call this “specialist feed”. The specialist feed, water and medications can be put down the tube using a special syringe or pump.
You will need to be sat upright during feeding and for 30-60 minutes afterwards.
The dietitians will provide training on how to give the feeds and water flushes. This will be done as soon as possible so that you can go home quickly. Either the nursing staff on the ward or the community feeding team can provide further training
After your tube has been inserted there is an increased risk of complications. If you are going home within 72 hours after the tube is inserted, you will need to be aware of these.
Stop feed immediately
Phone your community feeding team or visit your local accident and emergency department for urgent advice
Once the tube is safe for use, you will begin to receive feed, medications and water via the tube.
It is important to flush the tube with water before and after you give the feed. Water should also be given via your tube before and after you give medications to prevent the tube blocking.
You should flush the tube with a minimum of 30mls of water daily if you are not giving nutrition or medications via the tube.
Clean the tube site (area where tube enters the skin) daily with sterile water. This should be done once or twice a day for the first five days.
After five days, use mild soapy water. Ensure the area around the tube is dried gently but thoroughly. Do not reposition the fixation device (triangle) unless advised.
Check for signs of pain, redness, swelling or leakage. Report any concerns to medical staff or the community feeding team.
The tube site doesn’t require a dressing after the first one to two days. A simple gauze dressing may be applied if there is leakage around the tube site.
Continue to clean the tube site including around the fixation device with mild soapy water and dry well.
Two weeks after insertion, or when the tube site has healed, it is important to prevent the overgrowth of skin around the tube inside the stomach. We call this ‘buried bumper’ syndrome.
To prevent a ‘buried bumper’, the tube needs to be moved daily. This is called “advancing and rotating” the tube. The dietitian will show you how to do this before you leave hospital. The community feeding team will also demonstrate this.
This should only be done when the tube site is healed.
After this the tube will be flushed with 50ml of sterile water. If there are no concerns after 2-3 hours, then the tube is safe to use.
If there are signs of pain or leakage, let the nurse know.
You may have a dressing over the tube. The dressing should be changed daily for the first seven to ten days after insertion.
Clean the site daily with sterile water. You can lift up the edges of the bolster (white circular disk) and clean underneath. Ensure the area around the tube is dried well.
Do not move the bolster for first two weeks after insertion.
Always check the marking where the bolster sits before giving anything via the tube. If there is a change in position of the tube do not use and contact the community feeding team immediately.
The stitches can be removed after seven to ten days. This can be done by a district nurse or nutrition nurse if you are not in hospital.
Some people like to keep a simple dressing on the tube, but it is not needed.
Continue to clean the tube site with sterile water and dry well.
The tube can be rotated daily once stoma tract has healed to prevent any overgrowth of skin. To do this, clean around the site with warm mild soapy water and dry well. Ensure you lift up the edges of the bolster and clean underneath. Turn the tube in a full circle (360 degrees).
The water in the balloon should be changed two weeks after insertion and weekly thereafter. This is to ensure the balloon remains inflated to hold the tube in place.
In hospital, the ward dietitian or nurse will change the balloon water. You will be shown how to do this by the dietitian or community feeding team. When changing the balloon water, you can “advance and rotate” the tube at the same time. This helps prevents any overgrowth of skin on or around the tube.
The tube needs to be changed approximately three months after insertion. This is usually done where you reside by the community feeding team.
Further tube changes will be done every 3-6 months, depending on your tube. If you wish, you or your carers can be trained to change the tube yourselves.
Your ward dietitian will refer you to the community feeding team or an alternative service in your area. The community feeding team are known as the home management services (HMS).
The team comprises of dietitians, home enteral feeding nurses and a delivery company. They will contact you to arrange a monthly delivery of feeds and plastic equipment, such as syringes.
We may initially send you home from hospital with a small supply of feeds and equipment.
Your ward dietitian will explain your home feeding regimen and provide contact details for the HMS team. Your GP may also be involved in the management of your tube.
Medicines may block the tube if they are not given correctly. You may need to be prescribed medicines in a more suitable form such as liquid. Your doctor or pharmacist should arrange this for you. Each medication should be given individually.
To help prevent tube blockage, we advise that you do not give anything other than the feeds, water and medications via your tube.
If you find you are unable to flush the tube or can see a blockage you should:
Note: For a RIG tube, only trial these methods if the tube can be advanced and rotated. Otherwise, contact your community feeding team.
If the tube comes out you will need to attend your nearest accident and emergency department immediately. The longer the tube is out, the greater the risk of the site closing over.
If your RIG tube comes out, ring the community feeding team or 24 hour helpline. You may need to attend your nearest accident and emergency department to have another tube inserted.
The community enteral feeding nurses may have trained you to insert a device into the stoma called Corstop ACE stopper or ENPlugs.
In the case of the tube coming out, you can insert this device. Then call the community feeding team or 24 hour helpline for further advice.
NHS Constitution. Information on your rights and responsibilities. Available at: www.gov.uk/government/publications/the-nhs-constitution-for-england
Nutricia website provides information on specialist feed and using a feeding pump. There is also information on the nursing team who help people with feeding tubes.
www.nutriciaflocare.com/Flocare2020/Infinity_Simulator.php
www.nutricia.co.uk/
PINNT helps people on enteral and parenteral nutrition providing advice and local help groups.
Telephone 020 3004 6193
www.pinnt.com
Arvanitakis, M., Gkolfakis, P., Despott, E., Ballarin, A., Beyna, T., Boeykens, K., Elbe, P., Gisbertz, I., Hoyois, A., Mosteanu, O., Sanders, D., Schmidt, P., Schneider, S. and van Hooft, J., 2020. Endoscopic management of enteral tubes in adult patients – Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 53(01), pp.81-92.
Gkolfakis, P., Arvanitakis, M., Despott, E., Ballarin, A., Beyna, T., Boeykens, K., Elbe, P., Gisbertz, I., Hoyois, A., Mosteanu, O., Sanders, D., Schmidt, P., Schneider, S. and van Hooft, J., 2020. Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 53(02), pp.178-195.
Nutricia Homeward (2021) Balloon Gastrostomy Tube Advice. Available at: (https://www.nutriciahomeward.co.uk/uploadedFiles/Pages/Tube_Feeding/Equ… (Accessed: 09 July 2021).
Potack, Z. and Chokhavatia, S., 2008. Complications and controversies associated with Percutaneous Endoscopic Gastronomy. Report of a Case and Literature Review. The Medscape Journal of Medicine, 10(6), pp. 142.
Toussaint, E., Van Gossum, A., Ballarin, A. and Arvanitakis, M., 2015. Enteral access in adults. Clinical Nutrition, 34(3),pp. 350-358.
© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002346.