First Year Fellows Endoscopy Course (July 30-31)

9-Feeding tubes

Pdf Summary

This document outlines the use and procedures for percutaneous gastrostomy tubes (PEG). The document begins by stating the indications for PEG placement, including the inability to tolerate oral intake and the need for gastric decompression. It emphasizes the importance of pre-PEG assessment, including evaluating the patient's medications, GI anatomy, nutritional status, and co-morbidities. The management of antithrombotic agents before and after PEG placement is discussed, recommending holding these medications for a certain period of time and restarting them after the procedure.<br /><br />The document then lists the contraindications and relative contraindications for PEG placement, including limited life expectancy, dementia, terminal cancer, and technical issues. It provides a detailed description of the PEG tray contents and the technique for PEG placement, emphasizing patient positioning, airway protection, and the use of antibiotics.<br /><br />The location of the PEG, transillumination, and finger indentation techniques are explained. The safe tract technique, incising the skin, inserting the angiocatheter, and securing the bumper are also discussed. The document mentions that repeat endoscopy is not necessary if no problems are suspected during the procedure.<br /><br />After placement, the document states that PEG tubes can be used for medications immediately and that feeding can be started within 4 hours. Adverse events, such as aspiration, infection, bleeding, pneumoperitoneum, and inadvertent removal, are mentioned, along with their management.<br /><br />The document concludes with information on PEG removal, replacement tubes, tube migration, and potential complications, such as PEG site metastases and granulation tissue. It ends with a section for questions and additional clarification. Overall, the document provides a comprehensive overview of PEG placement and management.

Keywords

percutaneous gastrostomy tubes

PEG placement

oral intake

gastric decompression

pre-PEG assessment

antithrombotic agents

contraindications

PEG tray contents

PEG placement technique

adverse events