WHAT IS A PEG TUBE?

A percutaneous endoscopic gastrostomy (PEG) tube is a

plastic tube that is put into your stomach through your skin.
PEG tubes are most often used to give you food or liquids if
you are not able to eat or drink. Medical formula, medicines,
and water can be given through a PEG tube.

HOW DO I USE THE PEG TUBE?

Your healthcare provider will tell you when and how often to
use your PEG tube for feedings. You may need a bolus,
intermittent, or continuous feeding. A bolus feeding is when
formula is give over a short period of time. An intermittent
feeding is scheduled for certain times throughout the day.
Continuous feedings run all the time. Ask your healthcare
provider which method is best for you:

Use a feeding syringe. Connect the feeding syringe to

the end of the PEG tube. Pour the correct amount of
formula into the syringe. Hold the syringe up high. Formula
will flow into the PEG tube. The syringe plunger may be
used to gently push the last of the formula through the
PEG tube.

Use a gravity drip bag. Connect the tubing from the

gravity drip bag to the end of the PEG tube. Pour the
formula into a gravity drip bag. Hang the bag on a medical
pole, a hanger, or other device. Adjust the flow rate on the
tubing according to your healthcare provider's instructions.
Formula will flow into the PEG tube. Ask how long it
should take to complete your feeding.

Use a feeding pump. You may use an electric pump to

control the flow of the formula into your PEG tube. Your
healthcare provider will teach you how to set up and use
the pump.
HOW DO I CARE FOR MY PEG TUBE?

Always flush your PEG tube before and after each

use. This helps prevent blockage from formula or
medicine. Use at least 2 tablespoons (30 milliliters) of
water to flush the tube. Follow directions for flushing your
PEG tube.
If your PEG tube becomes clogged, try to unclog it as
soon as you can. Flush your PEG tube with a 60 milliliter
(mL) syringe filled with warm water. Never use a wire to
unclog the tube. A wire can poke a hole in the tube. Your
healthcare provider may have you use a special medicine
or a plastic brush to help unclog your tube.
Check the PEG tube daily.
o Check the length of the tube from the end to
where it goes into your body. If it gets longer, it
may be at risk for coming out. If it gets shorter, let
your healthcare provider know right away.
o Check the bumper (piece that goes around the
tube, next to your skin). It should be snug against
your skin. Tell your healthcare provider if the
bumper seems too tight or too loose.
Use an alcohol pad to clean the end of your PEG
tube. Do this before you connect tubing or a syringe to
your PEG tube and after you remove it. When you
disconnect tubing or a syringe from your PEG tube, do not
let the end of the PEG tube touch anything.

HOW DO I CARE FOR THE SKIN AROUND MY PEG TUBE?

Do not remove the stitches or medical tape that hold

your PEG tube in place when you first get it. Your

healthcare provider will take them off once the skin around
your tube heals. Leave clean bandages over the tube area
for the first 24 hours after the tube is put in. You may not
need to use bandages after 24 hours if the skin around the
tube looks dry. Ask when you can shower or bathe.
Routine skin care:
o Clean the skin around your tube 1 to 2 times
each day. Ask your healthcare provider what you
should use to clean your skin. Check for redness
and swelling in the area where the tube goes into
your body. Check for fluid draining from your
stoma (the hole where the tube was put in).
o Gently turn your tube daily after your stitches
come out. This may decrease pressure on your
skin under the bumper. It may also help prevent
an infection.
o Keep the skin around your PEG tube dry. This
will help prevent skin irritation and infection.
Use topical medicines as directed. You may need to put
antibiotic cream on the skin around your tube after you are
done cleaning it.

WHAT ELSE DO I NEED TO KNOW ABOUT A PEG TUBE?

You may need to keep track of how much formula and

other liquids you have each day. You may also need to
keep track of how much you urinate and how many times
you have a bowel movement each day. Bring this log to
your follow-up visits.

You may need to check your weight daily or weekly. Keep

a record of your weights and bring it to your follow-up
visits. Your healthcare provider may need to change your
feedings if your weight changes too quickly.

Take your medicines as directed. Learn which of your

medicines can be crushed, mixed with water, and given
through the PEG tube. Certain medicines should not be
crushed or may clog the PEG tube.

Go to all follow-up appointments. You may need to have

blood tests and other tests when you see your healthcare
provider.
WHEN SHOULD I CONTACT MY HEALTHCARE
PROVIDER?

You have nausea, diarrhea, or abdominal bloating or

discomfort.

You have stomach pain after each feeding or when you

move around.

You have discomfort or pain around your PEG tube site.

The skin around your PEG tube is red, swollen, or draining

pus.

You weigh less than your healthcare provider says you

should.

Your PEG tube is longer than it was when it was put in.

You have questions or concerns about your condition or

care.
WHEN SHOULD I SEEK IMMEDIATE CARE OR CALL 911?

You start coughing or vomiting during or after a feeding.

You have severe abdominal pain.

Blood or tube feeding fluid leaks from the PEG tube site.

Your PEG tube is shorter than it was when it was put in.

Your PEG tube comes out.

Your mouth feels dry, your heart feels like it is beating too
fast, or you feel weak.

COLOSTOMY CARE
WHAT IS COLOSTOMY CARE?
You or a family member will need to learn to care for your
colostomy. It may require changes in your lifestyle. You may
work with an ostomy specialist to find the best ways to care for
yourself.
HOW DO I CHANGE MY POUCH?
How you change your pouch depends on the type you have.
Your healthcare provider will give you specific instructions on
how to change your colostomy pouch. The following is general
information about how to change your pouch:

Ask how often to change your colostomy pouch: The

type of pouch you wear affects the amount of time it can
be worn. The kind and amount of bowel movement you
have also affects how long the pouch stays on.

Remove the pouch: Gently remove the pouch by pushing

the skin down and away from the adhesive skin barrier
with one hand. With the other hand, pull the pouch up and
away from the stoma.

Gently clean the skin around your stoma: Use mild

soap and water. Do not use soaps that have oil or
perfumes. Pat your skin dry.

Use a pouch with the right size opening: Use a pouch

that has an opening that is of an inch larger than your
stoma.

Use skin products to help reduce irritation: These

products can help protect your skin and keep it dry.

Use slight pressure to place your pouch: Center the

pouch over the stoma and press it firmly into place on
clean, dry skin. It may be helpful to hold your hand over
the new pouch for 30 seconds. The warmth of your hand
can help stick the adhesive skin barrier into place.

Dispose of the used pouch correctly: If the pouch is

disposable, place the old pouch in another plastic bag and
throw it in the trash. If you use a reusable pouch, talk to
your healthcare provider about how to clean it.
HOW DO I EMPTY MY POUCH?

Empty the pouch when it is to full: Do not wait until

the pouch is completely full. This could put pressure on
the seal and cause it to leak or spill.

Hold the pouch up by the bottom end: If the pouch has

a clamp system, remove the clamp. You may need to roll
the end back to keep it from getting soiled.

Drain the pouch: Place toilet paper into the toilet before
you empty the pouch to reduce splash back. Drain the
pouch by squeezing the contents into the toilet.

Clean the end of the pouch: Use toilet paper or a moist

paper towel. You may also rinse the pouch but it is not
necessary. Keep the end of the pouch clean.

Close the end of the pouch: Unroll the end of the pouch.
Replace the clamp or close the end of the pouch
according to your caregiver's instructions.
HOW DO I CARE FOR MY SKIN?
Look at the skin around your stoma each time you change your
pouch. Your stoma should be pink or red and moist. You may
have a small amount of bleeding when you clean your stoma.
This is normal. Your stoma will get smaller and become its
normal size in about 8 weeks.

Make sure the skin barrier opening fits well: The skin
barrier is the part of the pouch that sticks to the skin of
your abdomen. It should be no more than of an inch
larger than your stoma. If the opening is too large, bowel
movement can leak onto your skin and cause irritation.

Measure the size of your stoma with the guide that comes
with your colostomy supplies. Make sure you cut the skin
barrier smaller as your stoma gets smaller.
Soothe irritated skin: If your skin is red, it may mean that
the skin barrier was on too long. It is important to find the
cause of your skin irritation. Ask your healthcare provider if
you need help finding the cause of your skin irritation.

WHAT TYPES OF FOODS CAN I EAT AFTER A

COLOSTOMY?

Eat a variety of healthy foods: Healthy foods include fruits,

vegetables, whole-grain breads, low-fat dairy products,
and lean meats. Do not eat foods that give you cramps or
diarrhea.

Limit foods that may cause gas and odor: These include
vegetables such as broccoli, cabbage, and cauliflower.
Beans, eggs, and fish may also cause gas and odor. Eat
slowly and do not use a straw to drink liquids. Yogurt,
buttermilk, and fresh parsley may help control odor and
gas.

Drink liquids as directed: Ask your healthcare provider how

much liquid to drink each day and which liquids are best
for you. This may help reduce constipation.
WHAT ARE SOME PROBLEMS THAT CAN HAPPEN WITH A
STOMA?
Most stoma problems happen during the first year after your
surgery.

Stoma retraction: This is when the height of the stoma

goes down to or below the skin level. Retraction may
happen soon after surgery if the colon does not become
active soon enough. Retraction may also happen if you
gain weight. The type of pouch you use may need to be
changed to fit the stoma shape.

Peristomal hernia: This is when a part of your large

intestine bulges into the area around the stoma. A hernia
may be more obvious when you sit, cough, or strain.
Hernias may make it difficult to create a proper pouch seal
or irrigate. You may need to change the type of pouch you
use or wear a hernia belt. You may need surgery to repair
the hernia.

Prolapse: This is when a part of your bowel pushes out of

your stoma. The stomal prolapse may be caused by
increased abdominal pressure. Surgery may be done to fix
the prolapse.

Stenosis: Your stoma may become more narrow. Your

healthcare provider may be able to stretch your stoma if it
has mild stenosis. Severe stenosis can cause blockage
and surgery is usually needed.
WHEN SHOULD I CONTACT MY HEALTHCARE
PROVIDER?
Contact your healthcare provider if:

You have a fever.

You have a foul odor coming from your colostomy bag or

stoma that lasts longer than a week.

Your skin around the stoma becomes red and irritated.

You have nausea, vomiting, pain, cramping, or bloating.

You do not have regular bowel movements through your

stoma.

The size of your stoma changes.

You have questions or concerns about your condition or

care.
WHEN SHOULD I SEEK IMMEDIATE CARE?
Seek care immediately or call 911 if:

Your bowel movements are black or bloody.

Your stoma is bleeding and you cannot stop the bleeding.

You are too weak to stand up.

You have severe abdominal pain.

TRACHEOSTOMY CARE
WHAT IS TRACHEOSTOMY CARE?
Tracheostomy (trach) care is done to ensure your trach tube
and the area around it stays clean. This helps prevent a
clogged tube and decreases the risk of infection. Trach care
includes suctioning and cleaning your skin and parts of the
tube. Your caregiver will show you how to care for your trach
tube, and what to do in an emergency.
What are the parts of a trach tube?

Flanges: These are the curved wings on each side of the

trach tube. The flanges help keep the trach tube in place.

Trach ties: The ties go around your neck and hold the
flanges in place. The ties may be made of fabric tape. A
trach holder made from hook and loop fasteners may also
be used.

Inner cannula: This is a smaller tube that sits inside the

trach tube. The inner cannula can be removed for
cleaning.

Obturator: This is a small device used to insert a new

trach tube.

Cuff: Some plastic trach tubes have a cuff that fills with air
and helps hold the tube in place. A thin tube and reservoir
may hang from the trach tube so you can inflate and
deflate the cuff.
WHAT SUPPLIES DO I NEED FOR TRACH CARE?
Keep spare supplies with you at all times while you have a
trach tube. You may at any time need to suction or change
your tube if it gets clogged or needs to be replaced quickly.

One trach tube the same size as your current tube and
another trach tube that is 1 size smaller

Obturator for each trach tube

One set of trach ties or a trach holder

Portable suction machine with battery backup and tubing

that connects to the suction machine

Catheters with a suction valve

Sterile saline

Rescue breathing bag and mask

Emergency phone numbers

HOW CAN I PREVENT INFECTIONS?

Wash your hands: Always wash your hands before and

after any trach tube care.

Clean your trach equipment: Use clean or sterile trach

care methods and clean your equipment as your caregiver
directs.

Keep your neck clean and dry: Change the gauze and
trach ties when they are wet or dirty.

Keep your mouth clean: Saliva and mucus contain

germs that cause infection if they enter your airway. Brush
your teeth twice a day and suction your mouth as needed
to help prevent infections.
HOW DO I SUCTION MY TRACH TUBE?
You may be told to suction your trach tube at least twice a day.
Your caregiver will tell you when or if you need to suction more
often.

Prepare your suction machine: Each suction machine has

a pressure gauge. Your caregiver will tell you what amount
of pressure to use when you suction your trach tube. You
can test the pressure before you suction by covering the
suction valve on the catheter with your thumb.

Use saline only as directed: Your caregiver may tell you to

insert a few drops of sterile saline into your trach tube to

make your secretions thin. Do not use saline unless

directed by your caregiver.
Suction your trach tube: The catheter should be inserted
until it is just past the end of the tube. Your caregiver will
tell you how far to insert the catheter. The catheter may
have measurements marked on it for you to follow. You
can also measure and mark the catheter so you do not put
it in too far. Take a deep breath and try to cough up the
secretions before you suction your trach tube. Only cover
the suction valve as you remove the catheter. Gently twist
the catheter as you pull it out. It should take less than 15
seconds.

HOW DO I CARE FOR MY TRACH TUBE?

Clean the area around your tube and the inner cannula at least
once each day.

Check for signs of infection: Wash your hands before you

remove your trach dressing. Look for redness or swelling
of the skin around your tube. Clean the area and replace
the trach dressing as directed. Do not cut the gauze. Fold
the gauze instead so you do not breathe in the cut fibers.

Clean the inner cannula: Suction your trach tube before

you remove the inner cannula. Clean the inner cannula
with a cleaning solution as directed by your caregiver.
Rinse the inner cannula before you replace it in your trach
tube.

Change wet or dirty trach ties: A finger should fit snugly

between your neck and the trach ties. Ties that are too
tight can cause skin breakdown. The trach tube can move
out of place when the ties are too loose. You may need
someone to help you hold the trach tube in place or attach
the new ties.

HOW DO I CHANGE MY TRACH TUBE?

Change your trach tube as often as your caregiver directs.

You may also need to change the trach tube if it moves out
of place, feels uncomfortable, or the cuff leaks. You may
need someone to help you change the trach tube.

Prepare the new trach tube: Insert the obturator into the
new tube. Inflate the cuff with air to make sure it works,

and then let the air out. Place a small amount of lubricant
on the lower end of the tube as directed by your caregiver.
Wipe off excess lubricant.
Deflate the cuff on your current trach tube before you
remove it: You can damage your airway or skin if you
forget to do this. Pull your trach tube out gently.
Insert the new trach tube: Remove the obturator after the
trach tube is in place. Insert a new or clean inner cannula.
Use trach ties or a trach holder as directed to secure the
tube.
Inflate the cuff as directed: Your caregiver will show you
how much air to use. A cuff with too much air can leak,
break, or harm your airway.

HOW DO I KEEP MY SECRETIONS THIN?

Keep water and other materials out of your trach tube: Do

not swim. Use a shower shield or trach cap while you
bathe to keep water from entering your airway. Avoid
breathing in dust. Do not use powders or sprays near your
trach tube.

Drink plenty of liquids: Ask your caregiver which liquids are

best for you and how much liquid you should drink each
day.

Humidify the room: Use a room humidifier or vaporizer

while you sleep.

Humidify your airway: You may be directed to use a heat

moisture exchanger (HME), a trach collar, or fabric stoma
covers. An HME attaches to your trach tube and prevents
moisture loss. A trach collar connects to a machine that
supplies humidified air to your trach. Fabric stoma covers
are moistened and worn over your trach tube.
WHAT STEPS DO I FOLLOW IF I AM HAVING TROUBLE
BREATHING?

Try to clear the trach tube: Cough to help move mucus,

water, or irritants out of your airway. Suction the tube if
coughing does not clear your airway.

Gently move the trach tube: Your tube opening may be

against your airway. Gently reposition the tube to make
sure it sits in your airway properly.

Remove your inner cannula: Look for secretions inside the

inner cannula. Clean the inner cannula if it has mucus in it.

Replace your trach tube: Insert a new trach tube. Try a

smaller size if a regular sized tube will not go in properly.

Call 911: Have someone call 911 if you still cannot breathe
easily.
WHEN SHOULD I CONTACT MY CAREGIVER?
Contact your caregiver if:

You have a fever.

You have increased or thicker secretions than usual.

Your secretions are yellow or green.

You see thick, red tissue growing around your trach tube,
or the skin is red, swollen, or draining pus.

Your trach cuff is leaking or broken.

It hurts to swallow.
WHEN SHOULD I SEEK IMMEDIATE CARE?
Seek care immediately or call 911 if:

You cannot breathe well even after you clean or change

your trach tube.

You find blood around or coming from your trach tube.

You cannot insert a new trach tube.