Equipment
In addition to a standard upper endoscope, equipment used in percutaneous endoscopic gastrostomy (PEG) tube placement includes a PEG kit (commercially available) that contains the following:
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PEG tube (see the image below)
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Guide wire
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Snare
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Syringe, 5 mL
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Needle, 22 gauge
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Sterile fenestrated drape
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Lidocaine
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Needle-catheter assembly
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Surgical blade, No. 11, attached to a scalpel
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Gauze
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Lubricant
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Scissors
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Swab sticks containing povidone-iodine solution
Percutaneous endoscopic gastrostomy (PEG) tube. Image courtesy of Wikimedia Commons.
Patient Preparation
Anesthesia
Typically, this procedure is performed with moderate sedation using intravenous midazolam and fentanyl (or meperidine), along with local anesthesia (ie, lidocaine) at the site of tube placement. However, some patients may require deeper sedation with an agent such as propofol, and this is usually administered and monitored by an anesthesiologist. For more information, see Procedural Sedation and Local Anesthetic Agents, Infiltrative Administration.
Positioning
The patient should be supine, with the head end of the bed elevated at a 30º angle to reduce the risk of aspiration.
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Placement of percutaneous endoscopic gastrostomy (PEG) tube. Procedure performed by Reuben Garcia-Carrasquillo MD, ColumbiaDoctors, New York, NY. Video courtesy of ColumbiaDoctors (http://www.columbiadoctors.org).
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Regarding tube-site infections, most catheter-related infections involve local cellulitis, as shown here, with erythema and tenderness. These infections frequently respond to local wound care and oral antibiotics.
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Percutaneous endoscopic gastrostomy (PEG) tube. Image courtesy of Wikimedia Commons.
