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Percutaneous endoscopic guided gastrostomy

Percutaneous endoscopic guided gastrostomy

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Percutaneous endoscopic guided gastrostomy is suitable for patients with normal gastrointestinal function but with swallowing disorders or unwilling to eat. The course of disease is more than 1 month. 1. Swallowing reflex injury (multiple sclerosis, amyotrophic lateral sclerosis, cerebrovascular accident), central paralysis, and disturbance of consciousness (intensive care patients) 2. Dementia. 3. Otolaryngology tumors (pharyngeal, larynx, oral cavity). 4. Maxillofacial tumor.

Percutaneous endoscopic guided gastrostomy

Percutaneous endoscopic gastrostomy; PEG

Percutaneous endoscopic guided gastrostomy is suitable for patients with normal gastrointestinal function but with swallowing disorders or unwilling to eat. The course of disease is more than 1 month.

1. Swallowing reflex injury (multiple sclerosis, amyotrophic lateral sclerosis, cerebrovascular accident), central paralysis, and disturbance of consciousness (intensive care patients)

2. Dementia.

3. Otolaryngology tumors (pharyngeal, larynx, oral cavity).

4. Maxillofacial tumor.

1. No fluoroscopy can be performed, the esophagus is blocked, and it is impossible to bring the stomach wall and abdominal wall close to each other (partial gastric resection, ascites, liver enlargement, etc.).

2. Acute pancreatitis or peritonitis.

3. It is very difficult or dangerous to place a PEG tube in the following situations: it should be used with caution: gastric tumors, sepsis, coagulopathy (such as hemophilia).

1. The patient prepares to introduce the treatment method, purpose and process before the operation, and obtains the cooperation of the patient.

2. Preparation and medical devices

1. The main operation steps of PEG (pulling out method) Strictly follow the operating instructions provided by the manufacturer.

(1) The conventional method is to enter the gastroscope, and use the gastroscope light source to determine the puncture point;

(2) conventional skin disinfection, towel spreading, local anesthesia, cut the skin, and pierce the stomach vertically with a 16-gauge trocar;

(3) Pull out the needle core and feed it into the ring guide wire;

(4) Insert the snare device, tighten the ring guide wire, and withdraw with the gastroscope;

(5) The ring guide wire pulled out of the mouth and the ring guide wire at the end of the ostomy tube are looped in an "8" shape;

(6) Pull the annular guide wire on the side of the abdominal wall, draw the ostomy tube through the mouth, esophagus, and cardia to the stomach, and pull it out from the abdominal wall ostomy tube;

(7) Enter the mirror again, observe whether the head of the fistula tube is in proper contact with the stomach wall, and fix the fistula tube and connector.

2. Postoperative measures

(1) The brand, diameter and length of the gastrostomy tube placed in the body must be recorded in the nursing medical record.

(2) After placing the gastrostomy tube under the guidance of percutaneous endoscope for 6-8 hours, it is best to start the infusion of the nutrition solution after 24 hours.

(3) Each time a new enteral nutrient solution is replaced, or if there is any doubt as to whether the pipe is in the correct position, a pH test paper should be used to determine the location of the pipe and checked at least 3 times a day.

(4) The tube should be flushed with 25ml of sterile normal saline or sterilized water before and after tube feeding and administration, and at least once every hour to prevent the tube from being blocked.

(5) Check the skin of the stoma site for redness or swelling daily, and perform local disinfection of the skin. After the stoma is fully healed, the skin around the stoma can be washed and the skin kept dry. Rotate the gastrostomy tube 180 ° every day to prevent "embedding" syndrome.

(6) After 8 to 10 months, check the status and position of the gastrostomy tube by endoscopy.

(7) For long-term PEG-fed patients, if a PEG catheter needs to be replaced, a balloon-type gastrostomy tube can be used for percutaneous replacement without the need for re-endoscopic placement.

3. Catheter removal It is recommended to remove the catheter under endoscopy.

1. The PEG tube can be fed intermittently after placement, and an appropriate amount of enteral nutrients should be injected each time to avoid rapid and large infusion and gastroesophageal reflux.

2. The patient should remain in a semi-recumbent position to reduce the risk of aspiration.

3. After discharge, patients can continue to use PEG for continuous enteral nutrition support to maintain normal nutritional status.

4. The fistula tube should be replaced and removed in time. If the PEG tube is worn, ruptured or obstructed, it should be replaced in time. When the patient's condition improves, he can remove the fistula when he can eat by himself. However, extubation must be performed after the sinus is formed, usually at least 10-14 days after placement. At present, the commonly used PEG tubes can be removed with the help of endoscopy, without surgery, and some PEG tubes can also be removed directly from the body.

In order to make it more convenient and beautiful, the patient can also replace a compression type gastrostomy device after removing the original PEG tube. Generally, the device should be placed after the abdominal wall sinus is formed and the gastrostomy tube is removed before removal.

5. Before the patient is discharged, the patient and his family should be educated:

(1) Tube Feeding Guidance: Instruct patients how to properly perform tube feeding, including some precautions.

(2) Nutrition guidance: According to the actual situation of each patient, the nutritional ingredients are reasonably and scientifically matched to ensure the quantity and quality requirements.

(3) Guidance on cleaning and nursing of fistula and ostomy tube.

(4) Complication prevention guidance, inform related complications, and seek medical treatment in a timely manner if any.

(5) Regular follow-up visits.

6.Complications after PEG

(1) Incision infection, slipping and displacement of fistula, leakage beside fistula, clogging of fistula, incision hematoma, etc. Wound infections are more common.

(2) Serious complications include: bleeding, aspiration, peritonitis, cushion syndrome, gastric fistula, etc.

(3) Attention to prevention of infection, aseptic operation, strict adherence to operating procedures, and careful postoperative care can effectively avoid complications.