First Year Fellows Endoscopy Course (August 7 - 8)

9-Feeding tubes

Pdf Summary

This document provides information on percutaneous gastrostomy tubes (PEG) placement techniques, indications, contraindications, and management. PEG tubes are used in patients who are unable to tolerate adequate oral intake and require nutrition, hydration, medications, or gastric decompression. Prior to PEG placement, a thorough assessment is necessary, considering factors such as GI anatomy, prior surgeries, nutritional status, and co-morbidities.<br /><br />Antithrombotic agent management is important, especially in high-risk patients, and includes holding antithrombotics and bridging with LMWH. Holding periods vary depending on the specific agent. The PEG procedure involves inserting a finder needle while aspirating, visualizing the needle's position in the stomach, incising the skin, inserting an angiocatheter, and securing the bumper. The PEG tube should be placed to the left of the midline and below the rib margin. The procedure should be performed in a semi-reclined position to protect the airway, and antibiotic prophylaxis should be administered.<br /><br />Post-procedure, the PEG tube can be used for medication administration immediately and feeding can start within four hours. Adverse events such as aspiration, infection, bleeding, and leakage are possible and should be monitored for. Treatment options depend on the specific complication, but may include stabilizing the tube, wound care, antibiotics, or repeat procedures. Tube migration, PEG site metastases, granulation tissue, and PEG removal are also discussed, along with appropriate management strategies.<br /><br />In summary, PEG placement requires thorough assessment, proper management of antithrombotic agents, and adherence to technique guidelines. Complications should be recognized and treated promptly. PEG tubes can provide a safe and effective means of enteral nutrition and medication administration in patients unable to take them orally.

Keywords

Percutaneous gastrostomy tubes

PEG placement techniques

Indications for PEG tubes

Contraindications for PEG tubes

PEG tube management

Antithrombotic agent management

Procedure for PEG placement

Post-procedure care for PEG tubes

Complications of PEG tubes

Management of PEG tube complications