Procedure:  Percutaneous Mic Key button gastrostomy tube placement          

Indication:  Head and neck cancer

Date:  01/01/2021

Operators:   John Doe, MD (Attending)/Jane Doe, MD (Fellow)     

Medications:  1 mg IV glucagon, Ancef,  4 mg IV Zofran, Versed and IV fentanyl, Glucagon [ 2mg ]

Contrast:  [20] mL nonionic  

Fluoroscopy time: [5 ] minutes

Catheter: 20 French MIC Key Button 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 fluoroscopically placed a 5 French catheter, the stomach was insufflated with air.

2 T-fasteners were placed appropriately placed in the anterior abdominal wall.  Gastrostomy was made this was dilated a 20 French. An 18-gauge Chiba needle was used to access the stomach between the T-fasteners. Air was aspirated contrast injected and a wire passed into the gastric lumen. The dilator was passed over the wire. The 18 French by 4 CM Mic key button was inserted through a peel-away sheath and inflated with dilute contrast to verify adequate location within the gastric lumen. Contrast was injected

The balloon was inflated with 5 mL of saline. Contrast was injected through the MIC key button to verify adequate location within the stomach .  The T-fasteners locks were set.  

Sterile dressings were applied to the anterior abdominal wall.  The G-tube was connected to external passive drainage system.

The catheter was placed to gravity drainage and orders written for NPO 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 an 18F MIC Key Button gastrostomy tube as described.