{"id":235,"date":"2006-10-21T16:04:17","date_gmt":"2006-10-21T23:04:17","guid":{"rendered":"http:\/\/wp.onegoodcookie.com\/?p=235"},"modified":"2013-02-20T19:15:42","modified_gmt":"2013-02-21T00:15:42","slug":"peg-tube","status":"publish","type":"post","link":"https:\/\/insidesurgery.com\/2006\/10\/peg-tube\/","title":{"rendered":"PEG tube (Percutaneous Endoscopic Gastrostomy)"},"content":{"rendered":"
Feeding<\/i> – there are several groups of patients that receive PEG tubes. One group is patients with disruption, obstruction (from cancer), or malfunction (achalasia, multiple sclerosis, scleroderma) of the esophagus. Patients with severe head trauma with residual deficits at risk of aspiration are candidates. Additional patients who can not take normal feeds and may require PEG tubes are patients on the ventilator, spinal cord injury patients, dementia patients, and cerebral palsy patients.<\/p>\n
\nGastric decompression<\/i> – patients with the presence of chronic, severe bowel obstruction (tumor, adhesions) often receive PEG tubes to decompress the obstruction and the need for a nasogastric tube, which can be uncomfortable for patients<\/p>\nContraindications<\/h4>\n
Abnormal anatomic position of the stomach (e.g., hiatal hernia or malrotation) or abdominal wall, lack of sufficient abdominal wall, abdominal wall infection or burn generally precludes placement of a PEG tube<\/p>\n
Many of the conditions once thought to be contraindications have been discarded. Although increasing the risk of the procedure, patients with ascites and previous surgery can be considered for PEG tubes.<\/p>\n
None<\/p>\n
Antibiotics<\/i> – one dose of preoperative antibiotics is typically given before PEG tube placement as prophylaxis against mouth flora being carried by the scope and infecting the abdominal wall track.<\/p>\n
Laboratory<\/i> – typically a blood test to measure platelet count (should be greater than 50,000\/dl), PT and INR (should be lower than 1.5) and PTT (should be normal) is obtained.<\/p>\n
Surgical prep<\/i> – usually betadine or chlorhexidine on anterior abdominal wall.<\/p>\n
Position<\/i> – supine (on their back)<\/p>\nIncision<\/h4>\n
1 cm vertical incision at site of exit of PEG tube from anterior abdominal wall<\/p>\n
1. Topical anesthesia administered to back of oropharynx if patient is awake.<\/p>\n
2. Gastroscope is inserted through a mouth guard and down the esophagus to the stomach.<\/p>\n
3. Stomach is fully inflated with air to displace the adjacent colon inferiorly and push the anterior wall of the stomach against the inside of the abdominal wall over the maximal area possible.<\/p>\n
4. The lighted end of the gastroscope is turned upward toward the anterior stomach wall.<\/p>\n
5. The room lights are dimmed and the site of transillumination of the scope is noted and marked. It should be halfway between the umbilicus and the left costal margin.<\/p>\n