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Questions and Answers
What is the primary purpose of the PEG tube after its initial insertion?
What is the primary purpose of the PEG tube after its initial insertion?
- To prevent gastric reflux
- To provide long-term nutritional support (correct)
- To enable regular monitoring of gastric pH
- To facilitate surgical procedures on the stomach
What is a characteristic feature of the low-profile gastrostomy device (LPGD)?
What is a characteristic feature of the low-profile gastrostomy device (LPGD)?
- It requires regular clamping to maintain the flow
- It is inserted flush with the skin (correct)
- It has a large external crossbar
- It uses a balloon for internal anchoring only
When can the PEG device initially be replaced?
When can the PEG device initially be replaced?
- Immediately after placement
- Only after a year of use
- Only if there is visible leakage
- Once the tract is established, typically after 10 to 14 days (correct)
What distinguishes the nonobturated device (MIC-KEY) from the obturated device (G-button)?
What distinguishes the nonobturated device (MIC-KEY) from the obturated device (G-button)?
What is the purpose of fluoroscopically guided percutaneous gastrostomy (FGPG)?
What is the purpose of fluoroscopically guided percutaneous gastrostomy (FGPG)?
What is the main advantage of using a gastrostomy over NG feedings in a comatose patient?
What is the main advantage of using a gastrostomy over NG feedings in a comatose patient?
What type of incision is required for the Stamm gastrostomy procedure?
What type of incision is required for the Stamm gastrostomy procedure?
Which technique is used to create a permanent stoma in the Janeway gastrostomy procedure?
Which technique is used to create a permanent stoma in the Janeway gastrostomy procedure?
What is a key aspect of the percutaneous endoscopic gastrostomy (PEG) procedure?
What is a key aspect of the percutaneous endoscopic gastrostomy (PEG) procedure?
Which statement accurately describes the use of a gastrostomy in patients needing prolonged nutrition?
Which statement accurately describes the use of a gastrostomy in patients needing prolonged nutrition?
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Study Notes
Gastrostomy Overview
- Gastrostomy is a surgical creation of an opening into the stomach for administering nutrition.
- Preferred for prolonged nutrition in patients, particularly the elderly or comatose, exceeding 3-4 weeks.
- Reduced risk of regurgitation and aspiration compared to nasogastric (NG) feedings.
Types of Gastrostomy Procedures
- PEG (Percutaneous Endoscopic Gastrostomy):
- Involves two physicians; one employs endoscopy, while the other inserts a cannula.
- A nonabsorbable suture threads through a cannula to set up the feeding tube.
- Stamm Gastrostomy:
- Utilizes purse-string sutures to secure the tube; requires abdominal incision.
- Janeway Gastrostomy:
- Creates a permanent stoma through a tunneled gastric tube.
PEG Tube Placement and Maintenance
- Initially inserted PEG devices can be replaced after 10-14 days; replacement is for nutritional support or to address tube issues.
- Secured at the stoma to prevent gastric acid leakage using internal and external anchoring.
- Low-Profile Gastrostomy Device (LPGD) can be inserted 3-6 months post-operation; eliminates tube migration with antireflux valves.
Types of LPGDs
- Obturated Devices (G-button):
- Dome-tip provides internal stabilization but require larger tube for insertion.
- Nonobturated Devices (MIC-KEY):
- Inserted without force; a balloon stabilizes the placement.
Candidates and Risks for Gastrostomy
- Patients with severe gastroesophageal reflux may face aspiration pneumonia and are not suitable for gastrostomy; jejunostomy is preferred in such cases.
Preoperative Assessment
- Focus on the patient's understanding and readiness for surgery, psychological status, and adaptability to potential body image changes.
- Explanation of the procedure ensures the patient understands the goal of bypassing mouth and esophagus for nutritional delivery.
- Emotional preparation is crucial, particularly for permanent prosthetics; relief from discomfort can aid acceptance.
Postoperative Care
- Assessment of fluid and nutritional needs to ensure correct intake.
- Regular inspection of the feeding tube and surgical site for infection or complications.
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