Gastrostomy Techniques and Care Quiz

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Questions and Answers

What is a primary reason for performing a gastrostomy?

Providing enteral nutrition (correct)

Administering chemotherapy

Gastric bypass surgery

Removing gastric contents

Which technique is commonly used for gastrostomy insertion?

Laparoscopic cholecystectomy

Percutaneous endoscopic gastrostomy (PEG) (correct)

Open surgical procedure

Transabdominal approach

Under which circumstance is gastrostomy tube insertion indicated?

Normal swallowing capability

Short-term food intake

Acute pancreatitis

Gastroesophageal reflux disease (correct)

Which of the following is a contraindication for gastrostomy?

Recent abdominal surgery Signup and view all the answers

What is the duration for which gastrostomy is preferred over other methods of nutrition delivery?

4 to 6 weeks Signup and view all the answers

What does the acronym PEG stand for in the context of gastrostomy?

Percutaneous Endoscopic Gastrostomy Signup and view all the answers

What is one of the common complications associated with gastrostomy tube feeding?

Infection at the insertion site Signup and view all the answers

How long does the insertion of a percutaneous endoscopic gastrostomy (PEG) typically take?

15 to 20 minutes Signup and view all the answers

What should be assessed at the PEG tube exit site to identify signs of infection?

Redness, edema, and purulent drainage Signup and view all the answers

What is the purpose of rotating the outer bumper of the PEG tube 90 degrees?

To avoid applying the same tension to the skin area Signup and view all the answers

What action should be taken if leakage is observed at the PEG tube exit site?

Apply a sterile dressing and external stabilization device Signup and view all the answers

What is the proper way to ensure the outer bumper is not too tight against the skin?

One finger’s breadth should fit between the skin and the bumper. Signup and view all the answers

What information should be included when labeling the dressing at the PEG tube exit site?

The date, time, and initials of the caregiver Signup and view all the answers

What is the primary purpose of providing oral hygiene every 2–4 hours for patients?

To ensure comfort and maintain buccal cavity integrity Signup and view all the answers

What should be done immediately after removing gloves during gastrostomy site care?

Perform hand hygiene Signup and view all the answers

How often should the skin around the gastrostomy tube's exit site be cleaned while healing occurs?

As needed, daily Signup and view all the answers

What indicates that a gastrostomy or jejunostomy tube may need to be replaced?

Wear and tear on the tube Signup and view all the answers

What should be used to clean the skin around the gastrostomy tube during the first stage of care?

Cotton-tipped applicator with normal saline solution Signup and view all the answers

What is a necessary precaution when removing the dressing from a gastrostomy site?

Carefully remove to prevent skin stripping Signup and view all the answers

What action should be taken if the residual is above 100 ml?

Stop feeding Signup and view all the answers

What is the purpose of coiling the gastrostomy or jejunostomy tube and taping it to the abdomen?

To prevent pulling and contamination Signup and view all the answers

What should minimal wound drainage from a new tube installation appear to be doing after the first week?

Subsidizing Signup and view all the answers

Why is it important to monitor infusion rate and signs of respiratory distress?

To prevent complications such as diarrhea and ensure client safety Signup and view all the answers

How often should the reusable gavage bag be washed?

Every 24 hours Signup and view all the answers

What is the primary purpose of flushing the tube with water every 4 hours?

To maintain the patency of the tube Signup and view all the answers

What should be done when the feeding bag is empty?

Add prescribed amount of water and close clamp Signup and view all the answers

What is a key reason for adjusting the drip rate of the feeding tube?

To infuse the formula over the prescribed time and reduce risk of diarrhea Signup and view all the answers

What is necessary for verifying feeding tube placement?

Check tube placement every 4 hours Signup and view all the answers

What is the primary function of the internal fixation bolster in a PEG tube placement?

To secure the tube against the stomach wall Signup and view all the answers

Why should disposable feeding bags be replaced at least every 24 hours?

To decrease transmission of microorganisms Signup and view all the answers

What should be done immediately after a PEG tube placement regarding the patient's position during feeding?

The patient should be elevated at least 30˚ Signup and view all the answers

Which of the following is NOT a recommended immediate care guideline after PEG tube insertion?

Perform deep cleaning of the site with alcohol every hour Signup and view all the answers

What is the recommended action if a PEG tube becomes blocked?

Attempt to flush with 50ml of soda water Signup and view all the answers

How often should the PEG tube be rotated in a circle after insertion?

Daily, with no specified limit Signup and view all the answers

When can a patient take baths after PEG tube insertion?

After two weeks Signup and view all the answers

What should be done if a PEG tube falls out within two weeks of insertion?

Insert a replacement immediately Signup and view all the answers

What is a key indicator that a RIG tube is to be inserted instead of a PEG tube?

Endoscope cannot be passed through due to obstruction Signup and view all the answers

What is the purpose of aspirating gastric contents before administering a feeding?

To assess the volume and detect delayed gastric emptying. Signup and view all the answers

What action should be taken if the gastric residual is greater than 50–100 ml?

Hold the feeding until the residual diminishes. Signup and view all the answers

What is the purpose of allowing the enteral formula to warm to room temperature before administration?

To reduce the risk of diarrhea. Signup and view all the answers

Why is it important to flush the tubing with 30–60 ml of water after administering the formula?

To prevent air from entering the stomach and maintain tube patency. Signup and view all the answers

What is the rationale for hanging the feeding bag 18 inches above the client's head during intermittent gavage feeding?

To promote gravity infusion of the formula. Signup and view all the answers

What is the recommended action after removing the plunger from the barrel of the syringe?

Attach the syringe to the feeding adapter. Signup and view all the answers

What should be done to prevent air from entering the tubing during administration?

Pinch the tubing before commencing the feeding. Signup and view all the answers

What complication does flushing the tubing help to prevent?

Air entering the stomach. Signup and view all the answers

Study Notes

Gastrostomy

A gastrostomy is a surgical procedure that creates an opening into the stomach. It's used to deliver nutrition, fluids, and medications via a feeding tube.
A gastrostomy is also used for gastric decompression in patients with gastroparesis, gastroesophageal reflux disease, or intestinal obstruction.
It's a preferred method for delivering enteral nutrition support lasting longer than 4 to 6 weeks.

Gastrostomy Procedures

Percutaneous Endoscopic Gastrostomy (PEG): A skilled endoscopic procedure using moderate sedation to insert a tube through the mouth, into the stomach, and into the abdominal wall. A wire guides the PEG tube, and an internal bumper secures the tube against the stomach wall.
Radiologically Inserted Gastrostomy (RIG): A procedure where a skilled provider places the tube using fluoroscopy, usually when an endoscope cannot navigate a strictured or obstructed esophagus. This tube is internally sutured and held in place by an internal balloon inflated with water.
Gastrostomy Button: A small device inserted through the gastrostomy stoma allowing for long term feeding with minimal effect on body image.
Jejunostomy: A procedure where a tube is inserted directly into the jejunum (part of the small intestine). It can be performed surgically or endoscopically.

Objectives

Define gastrostomy
Differentiate gastrostomy techniques
Define enteral nutrition
List indications for gastrostomy tube insertion
List contraindications for gastrostomy tube insertion
List complications for gastrostomy tube insertion
Demonstrate gastrostomy tube feeding
Demonstrate care of the gastrostomy site

Indications for Tube Feedings

General: Clients with a functional GI tract who cannot, or should not, eat, or are malnourished, oral feedings are inadequate to maintain nutritional status.
Specific: Comatose patients, neuromuscular disorders that affect swallowing, severe anorexia due to factors like chemotherapy, HIV or sepsis, upper GI obstruction, conditions requiring heightened nutritional demands (sepsis, cystic fibrosis, burns), dementia.

Contraindications for Tube Feedings

Absolute: Hemodynamic instability with poor end-organ perfusion, active GI bleeding, small or large bowel obstruction, paralytic ileus, peritonitis
Relative: Moderate to severe malabsorption, diverticular disease, fistula in the small bowel, short bowel disease(in early stages)

Delivery Systems (Feeding via Gastrostomy Tubes)

Intermittent Feeding (Bolus): Four to six times per day with formula administration in bolus form (250-400 ml). Often practiced in home care settings but has limitations like possible cramping, vomiting, aspiration, flatus, or diarrhea due to high volumes administered.
Continuous Feeding: Uses an infusion pump to regulate feeding rate. This method keeps gastric volume small, minimizing aspiration pneumonia risk, and potentially reduces bloating, nausea, abdominal distention, and diarrhea. Ideal for seriously ill or comatose patients.

Gastrostomy Site Care

Equipment: Gauze pads (4"x4"), soap and water/saline, cotton-tipped applicators, hypoallergenic tape, gloves, optional external stabilization device
Procedure: Gentle dressing removal, hand hygiene and glove use, assessing the tube exit site and the surrounding skin for issues, clean daily, secure with hypoallergenic tape, rotating the taping site every day.
Ongoing Care: No baths/swimming for two weeks, flush tube if blocked, replace tube if it falls out, consult radiology if tube is less than two weeks old prior to feeding or re-insertion.

Care of PEG and PEJ Site

Slide outer bumper away from skin (1.3 cm), inspect for leakage.
Assess skin around the exit site for infection.
Inspect tube for wear/tear
Clean site, rotate outer bumper, ensure there is a finger's breadth between inner border and skin.
Address any leaks with dressings, handle dislodging risk as necessary.

Short-Term Nutritional Support

Nasogastric (NG): Tube passed through the nose or mouth to the stomach
Naso-Enteral: Tube passed through nose to the duodenum or jejunum (X-ray needed for placement confirmation)

Long-Term Nutritional Support

Gastrostomy: Tube inserted into the stomach (surgical, radiological, or endoscopic procedures)
Gastrostomy Button: Small device inserted through the stoma for long-term feeding
Jejunostomy: Tube directly inserted into the jejunum (surgically or endoscopically)

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Description

Test your knowledge on gastrostomy procedures, including indications, techniques, and care practices. This quiz covers essential information about PEG tube insertion and management, as well as potential complications and best practices for patient care. Perfect for medical students and healthcare professionals alike!