Indications
Patients with normal gastrointestinal function, but with swallowing disorder or unwillingness to eat, with a disease duration of more than 1 month.
1, swallowing reflex injury (multiple sclerosis, amyotrophic lateral sclerosis, cerebrovascular accident), central palsy, impaired consciousness (patients in intensive care).
2.Dementia.
3, ENT tumors (pharynx, larynx, oral cavity).
4. Maxillofacial tumors.
Contraindications
1, Fluoroscopy is not available, esophageal obstruction, impossibility of apposing the stomach wall to the abdominal wall (major gastric resection, ascites, large liver, etc.).
2.Acute pancreatitis or peritonitis.
3.The following cases are very difficult or dangerous to place PEG tubes and should be used with caution: gastric tumor, sepsis, coagulation disorders (such as hemophilia).
Preparation
1.Patient preparation Preoperative introduction of the treatment, purpose and procedure to obtain the patient’s cooperation.
2.Preparation and medical equipment
Methods
1.Main operation steps of PEG procedure (drag-out method) Strictly follow the operation instructions provided by the manufacturer.
(1) Routine method to enter the gastroscope and determine the puncture point using the gastroscopic light source.
(2) Routine skin disinfection, towel laying, local anesthesia, skin incision, and vertical puncture into the stomach with a 16-gauge trocar needle.
(3) Withdraw the needle core and feed the loop guide wire.
(4) Insert the loop sleeve, tighten the loop guide wire, and withdraw it with the gastroscope.
(5) Pulling out the oral cricoid guidewire with the end of the fistula in an “8” shaped loop snare.
(6) pulling the looped guidewire on the abdominal wall side to bring the fistula tube through the oral cavity, esophagus, and cardia to the stomach, and pulling it out by the abdominal wall fistula opening.
(7) Re-enter the scope, observe whether the contact between the fistula head and the stomach wall is appropriate, and fix the fistula and the connector.
2.Postoperative measures
(1) The brand, tube diameter and length of the gastrostomy tube placed in the body must be recorded in the nursing medical record.
(2) After 6-8 hours of placement of the percutaneous endoscopy-guided gastrostomy tube, it is best to start the infusion of nutrition solution after 24 hours.
(3) Each time a new enteral nutrition solution is changed, or if there is any doubt about whether the tube is in the correct position, pH test strips should be used to determine the position of the tube and checked at least 3 times a day.
(4) Flush the tube with 25 ml of sterile saline or sterile water before and after tube feeding and drug administration, and at least once an hour to prevent tube obstruction.
(5) Check the skin of the stoma site daily for redness or swelling, and disinfect the skin locally. Once the stoma is completely healed, the skin around the stoma can be cleaned and kept dry. Rotate the gastrostomy tube 180° every day to prevent the occurrence of “encapsulation” syndrome.
(6) The condition and position of the gastrostomy tube should be verified by endoscopy after 8 to 10 months.
(7) In patients with long-term PEG feeding, if the PEG catheter needs to be replaced, the balloon type gastrostomy tube can be used for percutaneous replacement of the original position without reintroducing the tube via endoscopy.
3.Catheter removal It is recommended to remove the catheter under endoscopy.
Caution
1.Intermittent feeding can be carried out after the PEG tube is placed, and the right amount of enteral nutrients should be injected each time to avoid gastroesophageal reflux due to rapid and large infusion.
2.Patients should be kept in semi-recumbent position to reduce the risk of accidental aspiration.
3.Patients can continue to use PEG for continuous enteral nutrition support after discharge to maintain normal nutrition status.
4.The fistula tube should be replaced and removed in a timely manner. If the PEG tube is worn, ruptured or obstructed, it should be replaced in a timely manner. When the patient’s condition improves and he/she can eat through the mouth on his/her own, then the fistula can be removed. However, the tube must be removed after sinus tract formation, usually at least 10-14 days after placement. Currently, PEG tubes can be removed with the help of endoscopy without surgery, and some PEG tubes can be removed directly from outside the body. For greater convenience and aesthetics, the patient can be replaced with a pressurized gastrostomy device after removal of the original PEG tube, which is usually placed after the formation of the abdominal wall sinus tract and removal of the previous gastrostomy tube.
5. Before the patient is discharged from the hospital, the patient and his or her family should be educated about.
(1) tube feeding instruction: instruct the patient on how to properly perform tube feeding, including some precautions.
(2) Nutritional guidance: according to the actual situation of each patient, a reasonable and scientific mix of nutritional components to ensure the quantity and quality of needs.
(3) Guidance on the clean care of the fistula and fistula tube.
(4) Guidance on complication prevention, informing of relevant complications and promptly seeking medical attention if they occur.
(5)Regular follow-up.
6.Complications that can occur after PEG surgery
(1) Incisional infection, slipped and displaced fistula, leakage next to the fistula, blockage of the fistula, incisional hematoma, etc. Wound infection is more common.
(2) Serious complications include bleeding, aspiration, peritonitis, endoprosthetic syndrome, and gastric fistula.
(3) Attention to infection prevention, aseptic operation, strict compliance with operating procedures, and careful postoperative care can effectively avoid the occurrence of complications.