PROCEDURE 133 • Knowledge of the anatomy and physiology of the upper and lower gastrointestinal (GI) system is necessary. • Patients who cannot have enteral tubes passed orally or nasally because of anatomy or surgery and those who need supplemental enteral nutrition support for longer than 4 weeks should be considered as candidates for long-term enteral access. • The most commonly used long-term enteral access is the percutaneous endoscopic gastrostomy (PEG) tube. The PEG tube is inserted without general anesthesia. The use of a local anesthetic (i.e., 1% lidocaine injection) is used at the abdominal puncture site. A guidewire is threaded via endoscope through the oropharynx, esophagus, and stomach and brought out through the abdominal wall. The tube is then threaded over the guidewire and passed into the stomach. The tapered end of the tube is brought through a stab wound in the abdominal wall until the mushroomed end of the tube is set against the stomach wall. An adapter for infusion is attached to the end of the tube, and a disk on the tube is moved up to the abdominal wall to stabilize the tube in place. • PEG tubes are large-bore catheters that range from 18 to 22 Fr and have a mushroom-shaped curved end in the stomach and a two-port distal end to instill enteral nutrition, medications, and fluid. Commercial PEG tubes have disks, perpendicular to the tube, to hold the device close to the skin and lessen shift of tube in and out of the skin (Fig. 133-1). • Relative contraindications for PEG placement include the following: • Replacement gastrostomy tubes usually have a balloon in the intestinal lumen that is inflated with sterile water. This balloon prevents inadvertent dislocation. The distal end of the tube has an infusion port and a port for the balloon instillation (Fig. 133-2). • A jejunostomy tube, which does not have a balloon, is indicated in those patients at risk for aspiration or who are unable to tolerate enteral feedings into the stomach. These tubes are routinely sutured in place for stability (Fig. 133-3
Percutaneous Endoscopic Gastrostomy (PEG), Gastrostomy, and Jejunostomy Tube Care
PREREQUISITE NURSING KNOWLEDGE
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133: Percutaneous Endoscopic Gastrostomy (PEG), Gastrostomy, and Jejunostomy Tube Care
