Our Moto,To get knowledge about:-PEG?

Indications.Complication.

Major complication.Nursing management.

Feeding through G-tube and its types.

Management after insertion.Benefi ts of PEG feeging.

What is a Gastrostomy Tube (G-tube)? A Gastrostomy Tube (G-tube) is either a tube or button (skin-level device) placed into the stomach through the abdominal (belly) wall. This is usually done during the same operation as a Nissen fundoplication if the child also has reflux. A gastrostomy tube is needed when the child cannot take enough nutrition by mouth for proper growth and development, and also to “burp” a baby who has had an anti-reflux procedure (Nissen Fundoplication). The type of tube used will depend on the size and needs of the child. The Percutaneous endoscopic gastrostomy (PEG) feeding tubes were first described in 1980.  PEG feeding tubes are increasingly used for long term  Enteral nutrition.

Indication for Gastrotomy tube:

1.Feeding.2.Medicine.3.Diagnostic purpose. 4.It is used where patients cannot maintain adequate nutrition with oral intake.5.

Foley’s catheter

Gastrostomy Tube

Surgical prosedure:-

Feeding through a G-tubeThere are many ways to feed through a gastrostomy tube. A feeding plan that meets the child’s needs will be created. The two most common types of feedings are:

Bolus: a specific amount of formula is given at a set time. The formula runs in the tube by gravity. For example, 10ml every 3 hours.

Continuous/Pump: Formula is given over an extended amount of time by using a pump. For example, 5ml per hour for 24 hours.

Attachment of tube:

Practically insertion of dye through tube:

GI tract showing stomoch,liver,esophgeos(sphincter)

What is a PEG tube?Another type of gastrostomy tube is the Percutaneous Endoscopic Gastrostomy tube, or PEG tube. This means the tube is placed with the help of a scope. In the operating room, the scope is passed into the mouth and down to the stomach. A small opening is made in the stomach and a tube is placed. No other cuts are made. This procedure is usually for children who do not need an anti-reflux procedure.

Benefits of PEG feeding Benefits reported include: Well tolerated (better than nasogastric tubes) Improved nutritional status Ease of usage over other methods (nasogastric or

oral feeding) reported by carers Satisfactory use by home carers35

Low incidence of complications Reduction in aspiration pneumonia associated

with swallowing disorders36

Cost effective relative to alternative methods particularly when reasonably long survival expected37

Management after insertion Education of carers and patients is essential to

reduce tube problems and complications.38

A number of studies indicate the support and education of patients should be multidisciplinary involving: Nurses (wound care and ostomy expertise). Dietitians (nutritional advice and support).

Ongoing care involves:

Care of PEG tube This routine care can be performed by the patient and/or the

carers with suitable training. After about 10 days following insertion asepsis is not required.

Examine skin around site for infection/ irritation. Note measuring guide number at end of external fixation device. Remove tube from fixation device and ease away from abdomen. Clean stoma site with sterile saline. Dry area with gauze. Rotate gastrostomy tube to prevent adherence to sides of track. Re-attach external fixation device to abdomen. Attach gastrostomy tube gently to fixation device and position as

before according to mark/number on tube. Avoid use of bulky dressings.

Complications Morbidity and mortality are generally considered to

be low with studies reporting major complications between 3% and 8% of patients and minor in around 14%.14,39 Mortality from the procedure itself is very low and less than 1%.40 However other studies report higher and rising complication rates.3 These often relate to the underlying illnesses with for example higher rates of wound infections in malignant disease and may also reflect a lowered threshold for PEG insertion.3

gastric or abdominal wall).

Major complications Gastric perforation Gastrocolic fistula Internal leakage.

Dehiscence.

Peritonitis.

Aspiration pneumonia Subcutaneous abscess Buried bumper syndrome (migration of the internal

bumper of the PEG tube into the gastric or abdominal wall).

Thanks for comingAbdul Fattah R.N, NICU Aga Khan University

Uospital