NG v PEG
The Patient’s View
By Helen Baxter
I have had several NG tubes and now I have a PEG. An NG tube stands for nasal gastric tube
whilst a PEG is a tube inserted into the stomach. Both are to provide nutrition.
An NG tube is a good short term option if you are in hospital and too weak to eat enough. A
PEG is a more long term solution. You might be considering it if you are finding eating
extremely fatiguing or are having difficulty swallowing.
The first time an NG tube was mentioned I was terrified. I knew I didn't have an option. I was
getting weaker but I was very scared. As if by fate my horse had to have an NG tube 3 days
before me. My mum told me he wasn't frightened, he just swallowed the tube. This made me
think if he didn't know what was happening and he was OK, I would be too. A nurse sites an
NG tube. It is certainly nothing to fear. It is neither painful nor unpleasant. The tube is very
narrow. The tube tickles the end of your nose as it goes in and then you don't feel anything
until it is at the back of your throat: then you automatically want to swallow; you usually
swallow the tube with a sip of water and it glides down into your stomach. It really is that
easy. About 8 inches of the tube is not inserted, a bit of the tube is attached to your nose with
a plaster. I'm allergic to plasters and tape so I usually end up with half my face covered in
Steristrips! Very attractive!
Your liquid nourishment, water and drugs (usually in syrup form) are given via the tube after
you've had an X-ray to check the tube is in the right place. If you are ever told you need an
NG don't worry, there really is nothing to fear.
If it is felt a PEG is more appropriate you will be seen by a gastroenterologist, who will
explain it in further details. Fitting the PEG takes about 20 minutes. You are given a sedative
via a canula and 2 litres of oxygen via your nostril. After the procedure you come round
quickly. You have a narrow tube, about 8 inches long, out of your stomach. You may have a
psychological response to the tube. I didn't expect to, but found myself hating the tube and
saying I wouldn't be able to wear nice clothes again. In reality, the tube is very discreet and I
will be able to wear the same clothes again.
Initially after the procedure, the site hurts about as much as a small cut. On the day, the
downside of the PEG is that until the doctor can hear bowel sounds (mine took 6 hours) you
can't have any medication; this can be particularly painful if you're taking Gabapentin or pain
relief whereas with the NG you only have to wait for an X-ray. The disadvantage of the NG is
that each time you are given medication, water or feed, you have to aspirate the tube, ie. draw
up stomach fluid with a syringe and test it on litmus paper to check the tube is in the right
place. With a PEG you just administer whatever is necessary.
For about 12 hours after the PEG was sited I was my usual self but after this I became very
sleepy and unresponsive. This went on for about 3 days. Medically I was fine, I think it was
the effect of the sedative.
Usually you are only in hospital 24 to 48 hours after having a PEG. You are given a feed
pump and stand which fits on a bedside table. The feed-pump also comes with a backpack to
go on a wheelchair. A Homeward Nurse will show you how to operate the feed-pump. If you
are unsure ASK, ASK & ASK AGAIN. It is probably a good idea to write down the sequence
in which you do things and to set up a feed using your feed pump in the hospital where staff
are on hand. If you do get home and panic, Homeward have a call centre manned 24/7, 365
days a year and will tell you what to do over the phone. (Actually it's very easy). If possible in
the 24 hours you are in hospital have your carer(s) with you as much as possible so they gain
experience syringing medication and water. Air in the syringe can be painful in the tummy!!
And its best to learn in a supportive environment.
You will be allocated a Homeward Nurse or Dietician who will work out the number of
calories you need and see you every two months at home. Homeward also supply your feed.
They are extremely reliable. They ring you and tell you when they will deliver (better that the
Pizza Delivery!!) and have a second address if you are unable to answer the door.
You will also be shown how to clean the PEG site. At first you feel afraid of touching the tube
in case you damage it but they are very resilient. (A disc inside the stomach wall stops the
tube coming out). You have to clean around the tube with cotton wool. Sometimes scabs need
to be rubbed off (it's not painful) and don't worry if it bleeds. Wearing a dressing means the
scab attaches to the dressing making cleaning easier. Occasionally over-granulation occurs –
when you get fleshy skin around the tube - again it's not painful. (My skin appears to be of
the over-granulating variety!!) A cream will get rid of this (I have super hypo-allergenic skin
and have suffered no adverse effects from the cream).
You also need to turn the tube each day. (I know this sounds daunting and disgusting, but
actually it's not). I confidently turn mine. Whereas there is a risk of over-granulation with the
PEG, with an NG the constant friction where the tube rubs your nose and throat as you
swallow means you get a raw spot on your nose and a sore throat.
The PEG last two to three years and is certainly resilient. I have put mine to the test. My noise
intolerance can result in fit-like spasms. Whilst my PEG is still going strong, my NGs have
come out in the same situation. A coughing fit can dislodge an NG tube meaning it has to be
resited.
You can eat with both an NG and a PEG in. The nurse or dietician will just adjust the amount
of liquid feed you have accordingly. If at a later stage you can eat sufficiently to not require
the PEG or NG the PEG just needs 200 mls of water syringed down the tube daily to keep it
functioning in case you need to use it again whereas an NG would be taken out and need to be
resited.
I'm glad I opted for a PEG. Getting the right number of calories has improved my health (at
certain times I was too fatigued to eat sufficiently). It is resilient enough to withstand my
spasms whereas the NG tubes have not been. I also know it will last 2-3 years and my
nutrition, medication and fluid intake can be managed at home.