Edward Kasarskis, M.D., Ph.D. is Director of the multidisciplinary ALS Center at the University of Kentucky Neuroscience Center in Lexington, Kentucky, professor in the Department of Neurology at the University of Kentucky, and Chief of Neurology at the VA Medical Center in Lexington KY. 

Dr. Kasarskis

Q: I have had a PEG tube for several months, but from time to time I have trouble with leakage around the tube where it comes out from my stomach area. Sometimes my shirt or pants get damp, or my skin gets irritated from the moisture.  Do you have any advice about how to deal with this problem? What should I know about managing the PEG tube?

A: There are a number of potential solutions to your problem. As you know, the PEG (percutaneous endoscopic gastrostomy) tube that is inserted through the skin directly into your stomach is an important and often essential way to give you nutritional supplements, medication, and extra fluids. For many people, it’s hard to visualize exactly how the tube goes into your stomach but basically the tube goes through the skin, muscle and fat into the stomach.  The tube is held in place by two retention devices:  internally in the stomach by an inflatable balloon and externally on the skin, by a plastic “washer.”  So the final arrangement can be visualized as a “sandwich” held together by the two retention devices:  from the inside out — the internal balloon, the stomach wall, muscle and fat, the skin, and the external washer.  You can go to Google under the “images” tab and see many diagrams and examples of the PEG tube.

A little oozing around the tube is normal and not usually a sign of infection. (If you’re worried about there being a potential infection, however, you should check with your physician).  You can put a 4 inch square of gauze around the tube between the skin and the external washer to capture moisture that may leak out. Avoid putting ointment or a topical antibiotic on the skin, such as Neosporin.  They will prevent the skin from “breathing” and lead to skin irritation.  Be sure to regularly gently wash the skin around the tube with soap and water, and occasionally with hydrogen peroxide. 

If you find large amounts of fluid leaking several weeks or months after the tube was placed, you should check with your physician. You may need a different sized tube, or an ultrasound to ensure the tube is placed properly.  But most often, any early leakage diminishes as the layers of skin, muscle and fat heal around the silicone tube to create a tract over the weeks after  it was inserted.

If the external washer is too loose against your skin, it can cause irritation. It’s common for the introduction of nutritional supplements through a PEG to gradually cause a desirable weight gain, but such new weight may make the initial washer placement snug. It’s easy to adjust; just slide the exterior washer up or down the tube for comfort.
If you should ever find that it’s difficult to get fluid into your stomach for a feeding, call your physician promptly. You shouldn’t have to force food in; it should flow in easily and quickly.

Most tubes need to be replaced about every six to 12 months. Look to see if the tube is cloudy, hard to keep clean, or if the tube tends to get “gunked up” or stiff. Replacement of a tube is an easy outpatient procedure and you will not need the whole endoscopy procedure again.

If your tube should accidentally come out, know that it will need to be replaced promptly, and certainly within 24 hours, to prevent the passageway that has been created by the presence of the tube from closing up.

Know that even with the minor hassles of having a PEG, you’re helping ensure your health and comfort by having it. Ask for help when questions arise; there are solutions! 

If you would like to submit questions for a future Q & A, please send your questions to Amber Walters at awalters@alsa-national.org. Please understand that we won’t be able to address all questions and we won’t be able to respond to individuals personally.