Percutaneous endoscopic gastrostomy (PEG) tube feeding is recommended by the American Gastroenterological Association as the preferred device to provide long-term enteral nutrition when oral intake is inadequate. Although PEG placement is a relatively common procedure--more than 200,000 are placed annually--it often presents a clinical dilemma for healthcare workers. This pragmatic discussion focuses on the comprehensive clinical care of PEG tubes from the initial discussion with the patient and the caregiver to place the tube to long-term management issues.