Gastrostomy

When the oral, gastrostomy, or jejunostomy route cannot or should not be used... 

Gastrostomy tubes, where an incision is made directly through the abdominal wall, are indicated for patients who can tolerate gastric feedings but in whom long-term... 

PEG Percutaneous endoscopic gastrostomy polyethylene R M Routine and microscopic... 

Gastrostomy Operative placement of a new opening into the stomach, usually associated with feeding tube placement. 

Percutaneous endoscopic gastrostomy Gastric feeding tube placed via endoscopic technique. 

Long-term access should be considered when EN is anticipated for more than 4 to 6 weeks. The most popular option is gastrostomy followed by jej unostomy. 

Bolus EN is most commonly used in long-term care residents who have a gastrostomy. This method has the advantage of requiring little administra-... 

Open the capsule and sprinkle the entire contents over approximately 10 ml of water and flush with swirling through a prewetted 16 French gastrostomy tube fitted with funnel at the port end. Additional aliquots of water are used to transfer all pellets and to flush the tube. Do not attempt the administration of pellets through a nasogastric tube. 

Figure 20-1. Growth chart, weight for length, for D.E.C. Note poor weight for length at 5 months before placement of gastrostomy tube (first arrow) and increased weight for length by 2 years 6 months, when she was admitted for metabolic studies and feeding therapies.

Feeding in the first few days may not be important, but later the patient should be kept well nourished since poor nutrition may be associated with worse outcome. There is no evidence to support early initiation of percutaneous endoscopic gastrostomy feeding in patients with unsafe swallow (Dermis et al. 2005). 

The gastrostomy exit site requires general stoma care to prevent inflammation and infection. Jejunostomy may be appropriate in patients at high risk of gastroesophageal reflux disease and aspiration, and with impaired gastric motility or delayed gastric emptying. 

Gastrostomy Long-term Surgically Allows lor all methods of adminisiralion Attendant risks associated with each type of... 

Children with special health care needs will require additional considerations during mass casualty or disaster care. These considerations include decontamination procedures following radiation or chemical exposure for children using wheelchairs, ventilators, or oxygen and decontamination procedures for children with gastrostomy tubes, tracheostomy tubes, indwelling bladder catheters, and indwelling central venous catheters. Replacement supplies would be needed once the cutaneous decontamination is completed. Such supplies may not be readily available, so provisions must be made to secure these items or to have comparable clean or sterile supplies on hand. 

The nasogastric tube and gastrostomy tube routines are used to administer medication when the patient is unable to swallow or ingest. 

Gastrostomy Tube (GT) This is a tube inserted through the skin into the stomach. It is used to administer medication and for permanent feeding. 

When administering medication through the nasogastric or gastrostomy tube ... 

Check the position of the nasogastric tube (the gastrostomy is surgically positioned), using one of the following methods ... 

Gastrostomy A feeding tube is placed in a hole in the abdomen leading to the stomach. 

Oral, nasogastric, gastrostomy, nasoduodenal, nasojejunal, or jejunostomy methods are used for enteral feedings. 

The treatment of gastrointestinal involvement ultimately is aimed at correcting the nutritional deficit present in many patients. In addition to pancreatic enzyme replacement and other drug therapy described below, nutritional supplementation is employed frequently. Nutritional interventions range from behavioral modification to nocturnal feedings via gastrostomies. ... 

The use of antibiotic prophylaxis for percutaneous endoscopic gastrostomy (PEG) is controversial. Although postoperative peristomal infection can occur in up to 30% of patients, clinical trials with cefazolin given 30 minutes preoperatively in this population are conflicting. A pharmacoeconomic study using a meta-analysis of available studies to determine efficacy suggested that antibiotic prophylaxis cost was effective for patients undergoing PEG placements. ... 

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