H Gastrostomy
A gastrostomy involves the placement of a semipermanent tube through the abdominal wall directly into the stomach. These tubes are used for gastric decompression or for feeding. It may be temporary or permanent. A percutaneous endoscopic gastrostomy is often performed. Feeding gastrostomy tubes are indicated in patients unable to feed by mouth but able to absorb enteral nutrition, such as patients with advanced malignancy and intestinal obstruction, inadequate oral intake, and neurologic impairment.
Patients undergoing gastrostomy may have neurologic impairment caused by a stroke and head injury. This compromises their ability to handle oral secretions and increases their risk for aspiration.
a) History and physical examination
(1) Cardiac: Patients are likely to be hypovolemic secondary to chronically poor oral intake and malnutrition.
(2) Respiratory: Patients may have difficulty swallowing and inadequate laryngeal reflexes, placing them at high risk for aspiration of gastric contents and associated pneumonitis. Hypoxemia and decreased pulmonary reserve can be caused by prior pulmonary infections.
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