Procedure: Percutaneous antegrade gastrostomy tube placement
Indication: Altered Mental Status;
Date:
Operators: John Doe, MD (Attending)/Jane Doe, MD (Fellow)
Medications: 1 mg IV glucagon, 600 mg IV Clindamycin, 4 mg IV Zofran, mgs IV Versed and mcg IV fentanyl
Contrast: 15 mL nonionic
Fluoroscopy time: minutes
Catheter: 20 French MIC Kimberly-Clark gastrostomy tube
Complications: None immediate.
Technique:
The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. The specific risk of damage to adjacent structures was detailed and accepted. Written informed consent was obtained. A time out/call to order was performed prior to procedure initiation.
The patient was assessed for conscious sedation and found to be an adequate candidate. A dedicated nurse monitored heart rate, blood pressure, and oxygen saturation throughout the procedure.
The anterior abdominal wall was prepped and draped in sterile fashion. Ultrasound was used to mark the liver edge. Fluoroscopy was utilized to localize the transverse colon. IV glucagon was administered. Through a nasogastric tube, the stomach was insufflated with air.
Under fluoroscopic guidance, the stomach was punctured toward the GE junction with an 18 gauge needle. Contrast injection confirmed location. A 0.035-inch Amplatz wire was advanced into the stomach and negotiated across the gastroesophageal junction. The guidewire was advanced out the oral cavity and grasped.
A 9F peel-away sheath was placed retrograde from the dermatotomy in the left upper quadrant. A snare device was advanced “monorail” over the wire and pulled from the anterior abdominal wall out the oral cavity. The gastrostomy tube was attached to the snare device and pulled through the esophagus into the gastric lumen. The disc was pulled firmly against the gastric wall utilizing fluoroscopic guidance.
The catheter was cut to length and the hub attached. Contrast was injected to confirm location. A sterile dressing was applied.
The catheter was placed to gravity drainage and orders written for NPO and no tube use for 24 hours.
The procedure was well tolerated, and the patient discharged from the angio suite in satisfactory condition.
Findings:
The tube enters the gastric body to the left of midline. Contrast injection confirms appropriate intragastric location.
Impression:
Uneventful percutaneous image guided placement of a 20 French antegrade gastrostomy tube as described.
Frequently Asked Questions
What is percutaneous antegrade gastrostomy tube placement?
Percutaneous antegrade gastrostomy tube placement is a medical procedure used to insert a feeding tube into the stomach through the abdominal wall. It is guided by imaging techniques like fluoroscopy and ultrasound to ensure accurate placement. This method is often used for patients who cannot eat by mouth due to conditions affecting mental status or swallowing.
Why is a gastrostomy tube needed?
A gastrostomy tube is needed when a patient cannot consume food orally due to various medical conditions, such as neurological impairments, cancers affecting the mouth or throat, or other disorders that impede swallowing. The tube provides a direct method for delivering nutrition, hydration, and medication into the stomach.
What are the risks associated with gastrostomy tube placement?
The procedure for placing a gastrostomy tube, while generally safe, carries some risks such as infection, bleeding, or damage to nearby organs like the liver or colon. The medical team takes precautions to minimize these risks by using imaging guidance and sterile techniques during the procedure.
The procedure involves prepping the abdominal area, marking the liver edge with ultrasound, and using fluoroscopy to guide the insertion of a needle into the stomach. A guidewire is then passed through the mouth and out the abdomen, allowing the tube to be pulled into place. The tube is secured within the stomach, and the site is dressed to promote healing.
What happens after a gastrostomy tube is placed?
After the gastrostomy tube is placed, the patient is usually monitored for any immediate complications. The tube is left to gravity drainage, and the patient is often kept NPO (nothing by mouth) for 24 hours to allow the site to stabilize. Instructions for care and use of the tube are provided to ensure proper maintenance and function.
How is the patient's safety ensured during gastrostomy tube placement?
Patient safety is ensured through informed consent, constant monitoring of vital signs, and the use of imaging techniques to guide the procedure accurately. A dedicated nurse monitors the patient's heart rate, blood pressure, and oxygen levels, while the medical team takes a time-out to confirm procedural details before starting.
What medications are used during gastrostomy tube placement?
During gastrostomy tube placement, medications such as glucagon to relax the stomach, clindamycin to prevent infection, Zofran for nausea, and sedatives like Versed and fentanyl for conscious sedation are used. These medications help ensure the procedure is as safe and comfortable as possible for the patient.
Immediate complications from gastrostomy tube placement are rare but can include bleeding, infection, or damage to nearby organs. The medical team takes various precautions to minimize these risks, and the procedure is generally well tolerated by patients. Monitoring post-procedure helps in early detection and management of any complications.