Saturday, 31 January 2015

NG versus PEG feeding tubes – This patient’s view


For the last two and a half months I have been fed through an NG tube. For the first two weeks much of this was done for me by the nurses at my local hospital and I had time to observe and get used to the feeding regime. For the last one and a half months my consultant has been trying to organise switching me to a PEG. For various reasons the procedure kept getting moved and finally on Thursday I had a PEG fitted under general anaesthetic. On Friday I returned home and now have to manage feeding myself with a new system that I have only seen used once in a hospital setting.

Everyone I spoke to assured me that the PEG was far better and easier to care for than the NG tube but having managed with the NG for nearly three months I have my doubts and I am not sure I would have switched if I had known then what I know now.

In an attempt to put things into perspective here are my pros and cons for the two systems.

NG tube

Pros

1.       It enters your body through your nose and a new stoma (hole) does not have to be created to accommodate its insertion

2.       It can be tucked discretely behind your ear and therefore doesn’t get in the way when not in use.

3.       The way my tube was set up there were two taps which could be used to insert feed, meds and water into the tube. This meant if you need water during you feed your could stop the feeding pump and flush water without needing to disconnect anything.

4.       Tap water can be used to flush the line and for ‘drinking’.

5.       If the NG falls out a new one can be inserted into your nostril relatively easily. It is uncomfortable but the hole is already there so no cutting new ones is needed.

Cons

1.       The tube has to be taped to the side of your nose and possibly to the side of your face to ensure it doesn’t fall out. This tape leaves your face sticky and difficult to wash and has to be replaced every few days.

2.       The tube coming out of your nose means everyone knows you have one – although if you’re looking for a sympathy vote this is actually a pro.

3.       In order to use the NG tube your first have to check it hasn’t moved. It is possibly that it could slip into your lungs. This is unlikely, but possible, so every time your use the tube from scratch you have to aspirate. This involves drawing fluid from the tube and testing it on a pH strip. The fluid should be stomach acid and should turn the strip red. There are a number of problems with this:

a.       Sometimes you can’t draw any fluid. In this case it is recommended that you lie on your left side and wait. Hopefully in about twenty minutes you should be able to draw some fluid.

b.      You draw fluid but it turns the pH strip blue. This could be for a variety of reasons but it means you cannot use the tube as you cannot be sure that it is in the right place. Again you are recommended to lie on your left side and wait, trying again later. If this still doesn’t work there are a number of ways to check the tube is in the right place but they all involve a trip to the hospital.

 
PEG

Pros

1.       It can be tucked down your trouser leg when not in use. Hopefully it will not get tangled in my trouser when they need removing but this has yet to be seen.

2.       You do not need to aspirate to check it is in the right place and it is sticking out the side of your stomach – there is no place else it could go.

3.       No one knows you have one.

4.       My throat needs to heal so being fed through a tube which isn’t going through your throat is a good thing.

Cons

1.       It goes directly into your stomach and therefore a hole has to be cut through your stomach lining to the outside world. This hole has to be cleaned and maintained – by rotating the tube – to ensure the tube doesn’t get embedded in your stomach lining.

2.       My tube only has one tap. In order to take on water whilst feeding I have to stop the feeding pump, remove the line and then flush water. This is not a difficult task but does require at least three hands in order not to have to put anything on a surface that may not be totally clean.

3.       I have been advised to use sterile water as the PEG misses out some of your stomach.

4.       It the PEG gets pulled out I need surgery to refit it.

5.       My PEG is very long and dangles down by my knee. This seems too long and has the chance that I may roll onto it in the night or sit on it during the day and displace it. I have been told I can cut it but I am not sure about this. If I do it wrong, it is surgery to get a new one fitted.

6.       Currently my PEG hurts. This is mainly because I have had surgery and a hole cut into the wall of my stomach less than three days ago. I am assuming this will stop soon.

7.       After fourteen days you have to push the PEG in, twist it round and then pull it back out again. This is to stop the thing holding it in your stomach from embedding in your stomach lining and sounds relatively straight forward. However, you have to make sure that when you pull it out it is in EXACTLY the same place as when you pushed it in. There are marking on the tube to help with this. I didn’t really understand the consequences for not doing this right but I do remember it sounded bad. Back to google for me on this one.

8.       The PEG has to be cleaned daily and checked for discharge and rubbing behind the plastic plate that holds it to your stomach. If it gets infected you need to contact a medical professional straight away.

 

I know I have only had my PEG two days so I still am getting used to it, but I do not yet see how it is so much better than an NG. Yes there are things you have to do to look after an NG which are difficult but it seems to me there are just as many things that have to be done to a PEG, and with a PEG if you do it wrong you need surgery to put it right.

Do you have experience of either of these devices? How did you find them? Did you switch between the two and if so which worked better for you?

2 comments:

  1. I'm a pediatric RN, so I LOVED peg tubes because kids were so much less likely to pull them out. They could be hidden, they didn't have as big a chance as being caught on things, they didn't make the kids throw up when we put them down (like an NG) and were easier for the older kids to maneuver themselves if needed, and in some instances there was less skin breakdown/irritation.

    I haven't had it myself as a patient, so I can't exactly emphasize, but I do know that my patients also adjusted to it over time and ended up liking it. Right now you have to pay a lot of attention to it because it's still healing, but eventually it will get to the point where it doesn't require as much help. At least, that's what I hope for you.

    My grandma also got a peg when she was doing chemo/radiation, and it was a pain at first because of all the cleaning and care it required, but over time it was a huge blessing.

    Not sure if this helps! Praying for you!

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    Replies
    1. Thanks Katie. It is interesting to hear it from the point of view of someone caring for others. As you say I have been relatively pain free for the last two months and I am currently in pain. Hopefully once that calms down I will be more objective and see the benefits of the PEG.

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