PROCEDURE:Â CT-guided gastrostomy tube placement
DATE:Â
CLINICAL INDICATION: __-year-old male achalasia, small bowel obstruction, unable to place nasogastric tube. Venting gastrostomy tube Â
OPERATING PHYSICIANS: John Doe, MD (Attending)/Jane Doe, MD (Fellow) Â Â
MEDICATIONS: Versed 1 mg, 25 mg fentanyl and Ancef 1 gÂ
COMPLICATIONS:Â None
PROCEDURE:Â
The risks, benefits and alternatives to the procedure and sedation were explained to the patient. Written informed consent was obtained.Â
The patient was placed supine on the CT scan table. A skin marker was placed. A time out/call to order was performed.Â
Preliminary CT images were obtained to delineate the location of the stomach and a mark was placed on patient’s skin. The skin was prepped and draped in the usual sterile fashion. The subcutaneous tissues about the puncture site were infiltrated with lidocaine. The lidocaine needle was left in place and several CT slices obtained to confirm position.Â
An 18-gauge Chiba needle was advanced into the stomach until air was aspirated and a Amplatz wire was advanced through the needle. CT images confirmed intragastric position. 3 T-fasteners were placed to appose the gastric wall to the anterior abdominal wall. CT images were again used to confirm apposition of the anterior gastric wall to the anterior abdominal wall. The 18-gauge needle was removed over the wire and the tract serially dilated. Finally a 14 French APDL was placed over the wire. The the wire was removed. The Cope loop was formed and locked. Imaging was performed to confirm location. The gastrostomy tube was sutured in place and sterilely dressed.
The drain was connected to a drainage bag. The patient tolerated the procedure well and left the department in stable condition.Â
FINDINGS:Â
- CT scan demonstrates adequate window for gastrostomy tube placement
- Successful CT-guided placement of gastrostomy tube.
IMPRESSION:Â Â
Uneventful CT-guided gastrostomy tube placement for venting as described above.
Frequently Asked Questions
What is a CT-guided gastrostomy tube placement?
CT-guided gastrostomy tube placement is a procedure where a feeding tube is inserted into the stomach using CT imaging to guide the process. This technique allows precise placement, especially useful for patients who cannot have a nasogastric tube, such as those with achalasia or small bowel obstruction.
Why would a patient need a gastrostomy tube?
A gastrostomy tube is needed when a patient cannot eat by mouth due to conditions like achalasia, obstruction, or other swallowing difficulties. It allows for direct delivery of nutrition and medications to the stomach, or for venting the stomach to relieve pressure and discomfort.
During the procedure, the patient lies on a CT table. A skin marker is placed, and CT images are used to locate the stomach. After sterilizing the area, local anesthesia is applied. A needle is inserted into the stomach under CT guidance, followed by a wire and a tube. CT images confirm correct placement, and the tube is secured and connected to a drainage bag.
What are the risks and benefits of CT-guided gastrostomy tube placement?
The benefits include precise tube placement, which reduces complications and improves patient outcomes. Risks may include infection, bleeding, or injury to nearby organs, but these are minimized with CT guidance. The procedure is well-tolerated and typically uneventful, as detailed in the case study.
What medications are used during a gastrostomy tube placement?
Medications commonly used include sedatives like Versed (midazolam) and pain relievers like fentanyl to ensure patient comfort. Ancef (cefazolin) might be administered prophylactically to prevent infection. Local anesthetics like lidocaine are used to numb the insertion site.
What is the recovery like after a gastrostomy tube placement?
Recovery from a CT-guided gastrostomy tube placement is generally quick. Patients typically tolerate the procedure well and can leave the hospital the same day if stable. Post-procedure care involves monitoring for complications and ensuring the tube remains secure and functional for feeding or venting as needed.
How does CT imaging assist in gastrostomy tube placement?
CT imaging provides detailed, real-time images of the internal structures, allowing precise identification of the stomach's location and the safe insertion of the gastrostomy tube. This reduces the risk of complications and ensures accurate placement of the tube within the stomach.