Percutaneous Gastrostomy Tube Placement: Recognizing When Things Go Wrong

Hoang, P.; Menias, Christine O.; Niemeyer, Matthew M.

doi:10.1055/s-0039-1693983

Cited by 6 publications

(6 citation statements)

References 43 publications

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“…The gastrostomy procedure was performed under general anesthesia during PEG tube replacement in 22.5% of the cases in 1 study, 27 but in most cases, the procedure is performed under conscious sedation with intravenous midazolam and/or fentanyl 28,29 . Recently, the procedure has been conducted under local anesthesia, and in our study, it was performed without sedation in all patients.…”

Section: Discussionmentioning

confidence: 74%

Safety of Gastrostomy Tube Placement in Patients with Advanced Amyotrophic Lateral Sclerosis With Noninvasive Ventilation

Kim

Kang

Suh

et al. 2020

J Parenter Enteral Nutr

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Background In patients with amyotrophic lateral sclerosis (ALS), bulbar muscle dysfunction can occur, which eventually requires the initiation of enteral tube feeding. However, there is no consensus on the optimal timing for the gastrostomy or the proper ventilator support method during the procedure. We aimed to investigate the safe range of gastrostomy according to respiratory support status and forced vital capacity (FVC) % of predicted values classification and to compare the safety of noninvasive and invasive mechanical ventilation during the procedure in ALS patients with FVC < 30% of predicted. Methods A total of 477 patients diagnosed with ALS at our institution from January 1, 2009, to December 31, 2018, were evaluated, and 105 patients were enrolled in this study. All medical records covering ventilation status and complications within 6 months to 1 year after the initial gastrostomy were gathered and reviewed. Results The gastrostomy procedure was considered safe regardless of FVC status or modality of respiratory support. There were complications related to the gastrostomy procedure in 6 of 105 patients and all were managed through conservative care. The incidence of complications, including respiratory ones, for noninvasive and invasive positive pressure ventilation was 5.5% and 9.6%, respectively, which were not statistically significantly different (P = .294). Conclusion The procedure and tube placement of a gastrostomy can be safely performed in ALS patients with minimal FVC regardless of ventilation invasiveness. We suggest that there should be a new standard for FVC % of predicted to facilitate performing gastrostomy in ALS patients.

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Section: Discussionmentioning

confidence: 74%

Safety of Gastrostomy Tube Placement in Patients with Advanced Amyotrophic Lateral Sclerosis With Noninvasive Ventilation

Kim

Kang

Suh

et al. 2020

J Parenter Enteral Nutr

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“…Bleeding after gastrostomy is difficult to avoid, and reports suggest that approximately 1.4–2.5% of patients may experience injury to the inferior epigastric artery, resulting in iatrogenic pseudoaneurysm, rectus sheath hematoma, and wound oozing [ 20 , 21 ]. Although preoperative thin-slice enhanced CT can reveal the course of blood vessels in the rectus abdominis and intercostal areas [ 8 ], the incidence of bleeding in this study was slightly greater than that reported by Yasin et al [ 15 ]; however, the bleeding volume was lower, and all cases of bleeding were successfully managed conservatively.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of stoma site selection in CT-guided percutaneous gastrostomy: a retrospective analysis

Chang-ming,

Xiao-mei,

et al. 2024

World J Surg Onc

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Purpose To compare the safety and efficacy of CPG in the rectus abdominis and intercostal regions. Materials and methods This retrospective study included 226 patients who underwent CPG at a single center, with the stoma placed in the rectus abdominis or intercostal region. Surgical outcomes and complications, such as pain and infection within 6 months postoperatively, were recorded. Results The surgical success rate was 100%, and the all-cause mortality rate within 1 month was 0%. An intercostal stoma was placed in 56 patients; a rectus abdominis stoma was placed in 170 patients. The duration of surgery was longer for intercostal stoma placement (37.66 ± 14.63 min) than for rectus abdominis stoma placement (30.26 ± 12.40 min) (P = 0.000). At 1 month postsurgery, the rate of stoma infection was greater in the intercostal group (32.1%) than in the rectus abdominis group (20.6%), but the difference was not significant (P = 0.077). No significant difference was observed in the infection rate between the two groups at 3 or 6 months postsurgery (P > 0.05). Intercostal stoma patients reported higher pain scores during the perioperative period and at 1 month postsurgery (P = 0.000), but pain scores were similar between the two groups at 3 and 6 months postsurgery. The perioperative complication rates for intercostal and rectus abdominis surgery were 1.8% and 5.3%, respectively (P = 0.464), with no significant difference in the incidence of tube dislodgement (P = 0.514). Patient weight improved significantly at 3 and 6 months postoperatively compared to preoperatively (P < 0.05). Conclusion Rectus abdominis and intercostal stomas have similar safety and efficacy. However, intercostal stomas may result in greater short-term patient discomfort.

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“…There is likely underreporting of related adverse events. Compared with the relative frequency with which tubes are replaced, there is a low risk of complications, but early and accurate diagnosis of more severe complications is crucial, as prompt intervention may be required 25 …”

Section: Background (Available Knowledge)mentioning

confidence: 99%

“…Education to promote competency should be provided for those who replace G tubes with emphasis on the prevention of adverse events or early recognition of their occurrence. This should include knowledge of factors such as tract maturity, procedure, and tube type as well as patient condition 19,25 . Major principles including control of the replacement tube along the well‐formed gastrocutaneous tract, minimal insertion force during replacement and most importantly, reliable methods for confirmation of intragastric tube insertion should be significant factors in this education and competency training 16 …”

Section: Recommendationsmentioning

confidence: 99%

“…This should include knowledge of factors such as tract maturity, procedure, and tube type as well as patient condition. 19,25 Major principles including control of the replacement tube along the well-formed gastrocutaneous tract, minimal insertion force during replacement and most importantly, reliable methods for confirmation of intragastric tube insertion should be significant factors in this education and competency training. 16 • Evidence-based guidelines for G tube replacement and placement verification as well as accompanying education should be promoted primarily for patient safety and the many related care advantages but also for reduction in cost to the healthcare system and stress on valuable healthcare resources.…”

Section: Recommendationsmentioning

confidence: 99%

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Assessment of the effect of colored beverage on gastric returns after gastric tube replacement to enhance placement verification

2021

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Background: Verification of appropriate placement of newly replaced gastrostomy tubes is essential prior to use to avoid potentially serious adverse events.Problem: A lack of standardized guidance regarding effective and practical means to verify placement exists. Aspiration or drainage of gastric-like contents is one mean suggested to help determine placement, yet when returns are minimal, this becomes challenging. Materials, Method, Intervention:Oral ingestion or the instillation of a colored beverage prior to tube replacement was used in a midwestern healthcare clinical setting to enhance returns in both volume and color via the newly replaced gastrostomy tube. A retrospective review of this practice was conducted, which included 176 gastric tube replacements over 4 years.Results: A significant increase in volume of returns via the newly replaced tube was noted (P < .001) and a strong correlation of color to the ingested or consumed beverage was found with 95% of returns reflecting color tinting of the beverage or in many cases, strong color change to that of the beverage color. Conclusion:Presented is a simple, cost-effective method that has shown to be clinically useful in assessing placement of newly replaced gastrostomy tubes that may be useful in other practices and settings.

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Percutaneous Gastrostomy Tube Placement: Recognizing When Things Go Wrong

Cited by 6 publications

References 43 publications

Safety of Gastrostomy Tube Placement in Patients with Advanced Amyotrophic Lateral Sclerosis With Noninvasive Ventilation

Safety of Gastrostomy Tube Placement in Patients with Advanced Amyotrophic Lateral Sclerosis With Noninvasive Ventilation

Safety and efficacy of stoma site selection in CT-guided percutaneous gastrostomy: a retrospective analysis

Assessment of the effect of colored beverage on gastric returns after gastric tube replacement to enhance placement verification

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