Procedure: Retrograde 18 F APDL percutaneous gastrostomy tube placement         Â
Indication:Â Soft Palate SCCa post subtotal glossectomy
Date:Â 1/01/2022Â
Operators: Â John Doe, MD (Attending)/Jane Doe, MD (Fellow) Â Â Â
Medications: 2 mg IV glucagon, 1 gm IV Ancef , 4 mg IV Zofran  Â
Fluoro time:Â 18.0 minutes
Contrast:Â 30 mLÂ non-ionic
Catheter:Â 18 F Gaststrostomy tube
Complications: None immediate
The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. The specific risks of bleeding, infection, and damage to bowel or liver were detailed and accepted.Â
Additional risks were considered. 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.
Technique:
The left upper quadrant was prepped and draped in sterile fashion. The liver edge was ultrasonographically identified and marked on the skin. Local anesthetic was used and under fluoroscopic guidance, the stomach was insufflated and punctured with a 20 gauge needle. Contrast was injected to confirm location. . Â
Then a puncture was made above this wit a Cook 18 gauge needle and a T fastener was deployed. Contrast injected to confirm location.Â
The 18 FÂ APDL was passed over the wire and positioned within the gastric lumen under direct fluoroscopic guidance. Contrast injection confirmed location.
The tube was secured to the anterior abdominal wall with Zip tie . A sterile dressing was applied. The gastrostomy tube was placed to gravity drainage.
The procedure was well tolerated, and the patient was discharged from the angiography suite in satisfactory condition. Drain was put to external. drain bag.Â
Orders were written for NPO and no tube use for 24 hours.
Findings:
- The percutaneous window was NARROW. Tract was tested before tube placement. Â
- The gastrostomy tube enters the gastric body to the left of midline and is appropriately positioned.
Impression:Â
Uneventful image guided placement a 18 French APDLÂ tube as described.
Tube to external drainage bag.
Frequently Asked Questions
What is a percutaneous gastrostomy tube placement?
Percutaneous gastrostomy tube placement is a medical procedure used to insert a feeding tube directly into the stomach through the abdominal wall. It's often performed using imaging guidance, such as fluoroscopy, to ensure accurate placement. This procedure is typically indicated for patients who cannot eat by mouth due to conditions like cancer or surgeries affecting the oral cavity.
Why is a gastrostomy tube needed after a subtotal glossectomy?
After a subtotal glossectomy, patients might have difficulty swallowing or be unable to ingest food orally. A gastrostomy tube provides a direct route for nutrition and medication delivery into the stomach, bypassing the oral cavity and esophagus. This is crucial for maintaining nutritional status and medication adherence during recovery.
What are the risks of percutaneous gastrostomy tube placement?
The risks associated with percutaneous gastrostomy tube placement include bleeding, infection, and accidental injury to nearby organs like the bowel or liver. These risks are generally low when the procedure is performed by experienced clinicians. Patients are informed of these risks before the procedure, and precautions are taken to minimize them.
The procedure begins with sterilizing the area and using imaging to guide the process. A needle punctures the stomach through the abdominal wall, and contrast dye is injected to confirm the correct position. A tube is then inserted and secured. The procedure typically lasts a short time and is performed under conscious sedation to keep the patient comfortable.
What is the role of fluoroscopy in gastrostomy tube placement?
Fluoroscopy provides real-time X-ray imaging that guides the placement of the gastrostomy tube. It allows the physician to visualize the stomach and surrounding structures, ensuring the tube is positioned accurately and safely. This imaging technique is crucial for reducing complications and confirming proper tube placement.
What is the recovery process like after gastrostomy tube placement?
After the procedure, patients typically need to refrain from using the tube for about 24 hours to allow the site to heal. They are monitored for any signs of complications, such as infection or bleeding. Once cleared by medical staff, patients can begin using the tube for nutrition and hydration, under the guidance of healthcare providers.
What medications are used during a gastrostomy tube placement procedure?
During a gastrostomy tube placement, medications such as glucagon, Ancef, and Zofran may be used. Glucagon is administered to help relax the stomach, Ancef is an antibiotic given to prevent infection, and Zofran helps manage nausea. These medications help ensure the procedure is as smooth and safe as possible.
How is the gastrostomy tube secured in place?
The gastrostomy tube is secured to the abdominal wall using a device such as a 'Zip tie' and an external dressing. This prevents the tube from moving or being accidentally dislodged. Proper securing is crucial to maintain the tube's position and ensure it functions correctly for feeding and drainage.
What does 'APDL' stand for in the context of gastrostomy tubes?
APDL in the context of gastrostomy tubes stands for 'Antegrade Percutaneous Drainage Loop.' This technique involves placing a looped tube for drainage directly into the stomach, allowing for effective management of nutritional needs in patients who cannot eat orally.