PROCEDURE: Percutaneous image guided antegrade gastrostomy tube placement
INDICATION:
DATE:
OPERATORS: John Doe, MD (Attending)/Jane Doe, MD (Fellow)
MEDICATIONS: Glucagon mg IV, Versed mg IV, and Fentanyl mcg IV
CONTRAST:
FLUOROSCOPY TIME: minutes
CATHETER: 20F Kimberly Clark gastrostomy tube
COMPLICATIONS: None
TECHNIQUE: The risks, benefits, and alternatives to the procedure and sedation were explained. The specific risk of damage to adjacent structures was detailed and accepted. Written informed consent was obtained.
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. 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 over the wire and pulled from the anterior abdominal wall out the oral cavity. The peel-away sheath was removed. 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 capped 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:
- There is a safe window for percutaneous gastric access free of liver and overlying bowel.
- Contrast injection through the tube confirms intraluminal gastric location.
IMPRESSION:
Uneventful percutaneous image guided placement of a 20 French antegrade gastrostomy tube as described.
PLAN: NPO for 24 hours with G-tube to gravity drainage. After 24 hours, flush tube with 20 ml of saline every hour x 4 – if there is no pericatheter leak or pain the tube may be used for enteral feeds at the direction of the primary team.
Frequently Asked Questions
What is a percutaneous antegrade pull gastrostomy tube placement?
Percutaneous antegrade pull gastrostomy tube placement is a minimally invasive procedure used to insert a feeding tube into the stomach. This method involves using imaging guidance, such as fluoroscopy, to navigate and secure the tube through the abdominal wall and into the stomach, allowing for direct nutritional support when oral intake is not possible.
Why is a gastrostomy tube needed?
A gastrostomy tube is needed when a patient cannot consume adequate nutrition orally. This can occur due to swallowing difficulties, neurological disorders, or conditions affecting the digestive tract. The tube provides a direct route to the stomach for feeding and hydration, ensuring the patient receives necessary nutrients.
The procedure involves prepping the abdominal area and using imaging to guide the insertion. A needle punctures the stomach, and a guidewire is passed through and pulled out through the mouth. The tube is then attached and pulled into the stomach. The position is confirmed with contrast, and the tube is secured with a sterile dressing.
What are the risks associated with gastrostomy tube placement?
While generally safe, risks include injury to adjacent organs, infection, bleeding, or tube misplacement. Proper imaging and technique minimize these risks, and informed consent is obtained after discussing potential complications with the patient.
How should a patient care for a new gastrostomy tube?
After placement, patients should follow their healthcare provider's instructions, which typically include keeping the area clean and dry, monitoring for signs of infection, and waiting 24 hours before using the tube for feeding. Patients may also need to flush the tube regularly to maintain patency.
What is the typical recovery time after gastrostomy tube placement?
Recovery from gastrostomy tube placement is usually quick, with most patients being discharged the same day. They should avoid strenuous activity and keep the site clean. Normal feeding through the tube generally begins after 24 hours, once the healthcare team confirms proper placement and no complications.
What is the role of fluoroscopy in gastrostomy tube placement?
Fluoroscopy is used to provide real-time X-ray images during gastrostomy tube placement. It helps the physician visualize the stomach and guide the instruments accurately, ensuring the tube is correctly positioned and reducing the risk of complications.
Can anyone undergo a percutaneous gastrostomy tube placement?
Not everyone is a candidate for this procedure. Patients must be evaluated for risks, such as bleeding disorders or anatomical variations, that might complicate the procedure. A healthcare provider will assess the patient's overall health and specific needs before deciding on tube placement.