Publicidad
Idiomas disponibles
Idiomas disponibles
2. Check for moisture around the stoma. If there are signs
of gastric leakage, check the tube position and SECUR-
LOK* ring placement. Add fluid as needed in 1-2 ml
increments. Do not exceed balloon capacity as indicated
previously.
3. Begin feeding only after confirmation of proper patency,
placement and according to physician instructions.
Suggested Endoscopic Placement Procedure
1. Perform routine esophagogastroduodenoscopy (EGD).
Once the procedure is complete and no abnormalities are
identified that could pose a contraindication to placement
of the tube, place the patient in the supine position and
insufflate the stomach with air.
2. Transilluminate through the anterior abdominal wall to
select a gastrostomy site that is free of major vessels,
viscera and scar tissue. The site is usually one third the
distance from the umbilicus to the left costal margin at
the midclavicular line.
3. Depress the intended insertion site with a finger. The
endoscopist should clearly see the resulting depression
on the anterior surface of the gastric wall.
4. Prep and drape the skin at the selected insertion site.
Gastropexy Placement
CAUTIoN: IT IS RECoMMENDED To PERFoRM A THREE
PoINT GASTRoPExy IN A TRIANGLE CoNFIGURATIoN To
ENSURE ATTACHMENT oF THE GASTRIC WALL To THE
ANTERIoR ABDoMINAL WALL.
1. Place a skin mark at the tube insertion site. Define
the gastropexy pattern by placing three skin marks
equidistant from the tube insertion site and in a triangle
configuration.
WARNING: Allow adequate distance between the
insertion site and gastropexy placement to prevent
interference of the T-Fastener and inflated balloon.
2. Localize the puncture sites with 1% lidocaine and
administer local anesthesia to the skin and peritoneum.
3. Place the first T-Fastener and confirm Intragastric
position. Repeat the procedure until all three T-Fasteners
are inserted at the corners of the triangle.
4. Secure the stomach to the anterior abdominal wall and
complete the procedure.
Create the Stoma Tract
1. Create the stoma tract with the stomach still insufflated
and in apposition to the abdominal wall. Identify the
puncture site at the center of the gastropexy pattern.
With endoscopic guidance confirm that the site overlies
the distal body of the stomach below the costal margin
and above the transverse colon.
CAUTIoN: AvoID THE EPIGASTRIC ARTERy THAT
CoURSES AT THE jUNCTIoN oF THE MEDIAL TWo-
THIRDS AND LATERAL oNE-THIRD oF THE RECTUS
MUSCLE.
Warning: Take care not to advance the puncture needle
too deeply in order to avoid puncturing the posterior
gastric wall, pancreas, left kidney, aorta or spleen.
2. Anesthetize the puncture site with local injection of 1%
lidocaine down to the peritoneal surface.
3. Insert a .038" compatible introducer needle at the center
of the gastropexy pattern into the gastric lumen.
NoTE: For gastrostomy tube placement , the best angle
of insertion is a true right angle to the surface of the
skin. The needle should be directed toward the pylorus if
conversion to PEGJ tube is anticipated.
4. Use endoscopic visualization to verify correct needle
placement. Additionally, to aid in verification, a water
filled syringe may be attached to the needle hub and air
aspirated from the gastric lumen.
5. Advance a J tip guidewire, up to .038", through the needle
and into stomach. Confirm position.
6. Remove the introducer needle, keeping the J tip
guidewire in place and dispose of according to facility
protocol.
Dilation
1. Use a #11 scalpel blade to create a small skin incision
that extends alongside the guidewire, downward through
the subcutaneous tissue and fascia of the abdominal
musculature. After the incision is made, dispose of
according to facility protocol.
2. Advance a dilator over the guidewire and dilate the stoma
tract to the desired size.
3. Remove the dilator over the guidewire, leaving the
guidewire in place.
Tube Placement
NoTE: A peel-away sheath may be used to facilitate
advancement of the tube through the stoma tract.
1. Select the appropriate gastrostomy feeding tube
and prepare according to the directions in the Tube
Preparation section above.
2. Advance the distal end of the tube over the guidewire,
through the stoma tract and into the stomach.
3. Verify that the tube is in the stomach, remove the
endoscope, remove the guidewire or peel-away sheath if
utilized and inflate the balloon.
4. Using the Luer slip syringe, inflate the balloon.
• Inflate the LV balloon with 2-3 ml of sterile or distilled
water.
• Inflate the Standard balloon with 7-10 ml of sterile or
distilled water.
CAUTIoN: Do NoT ExCEED 5 ML ToTAL BALLooN
voLUME INSIDE THE Lv BALLooN. Do NoT USE AIR.
4
Do NoT INjECT CoNTRAST INTo THE BALLooN.
CAUTIoN: Do NoT ExCEED 20 ML ToTAL BALLooN
voLUME IN THE STANDARD BALLooN. Do NoT USE
AIR. Do NoT INjECT CoNTRAST INTo THE BALLooN.
5. Gently pull the tube up and away from the abdomen until
the balloon contacts the inner stomach wall.
6. Clean the residual fluid or lubricant from the tube and
stoma.
7. Gently slide the SECUR-LOK* ring to approximately
1-2 mm (approximately 1/8 inch) above the skin.
verify Tube Position and Patency
1. Attach a catheter tip syringe with 10 ml of water to the
feeding port. Aspirate gastric contents. When air or
gastric contents are observed, flush the tube.
2. Check for moisture around the stoma. If there are signs
of gastric leakage, check the tube position and SECUR-
LOK* ring placement. Add fluid as needed in 1-2 ml
increments. Do not exceed balloon capacity as indicated
previously.
3. Begin feeding only after confirmation of proper patency,
placement and according to physician instructions.
Tube Removal
1. First, make sure that this type of tube can be replaced at
the bedside.
2. Assemble all equipment and supplies, cleanse hands
using aseptic technique and apply clean, powder-free
gloves.
3. Rotate the tube 360 degrees to ensure the tube moves
freely and easily.
4. Firmly insert the catheter tip syringe into the balloon port
and withdraw all the fluid from the balloon.
5. Apply counter pressure to the abdomen and remove the
tube with gentle, but firm traction.
NoTE: If resistance is encountered, lubricate the tube
and stoma with water soluble lubricant. Simultaneously
push and rotate the tube. Gently manipulate the tube
free. If the tube will not come out, refill the balloon with
the prescribed amount of water and notify the physician.
Never use excessive force to remove a tube.
WARNING: Never attempt to change the tube unless
trained by the physician or other health care provider.
Replacement Procedure
1. Cleanse the skin around the stoma site and allow the area
to air dry.
2. Select the appropriate size Gastrostomy feeding tube
and prepare according to the directions in the Tube
Preparation section above.
3. Lubricate the distal end of the tube with water soluble
lubricant and gently insert the Gastrostomy through the
stoma into the stomach.
4. Using the Luer slip syringe, inflate the balloon.
• Inflate the LV balloon with 1-3 ml of sterile or distilled
water.
• Inflate the Standard balloon with 7-10 ml of sterile or
distilled water.
CAUTIoN: Do NoT ExCEED 5 ML ToTAL BALLooN
voLUME INSIDE THE Lv BALLooN. Do NoT USE AIR.
Do NoT INjECT CoNTRAST INTo THE BALLooN.
CAUTIoN: Do NoT ExCEED 20 ML ToTAL BALLooN
voLUME IN THE STANDARD BALLooN. Do NoT USE
AIR. Do NoT INjECT CoNTRAST INTo THE BALLooN.
5. Gently pull the tube up and away from the abdomen until
the balloon contacts the inner stomach wall.
6. Clean the residual fluid or lubricant from the tube and
stoma.
7. Gently slide the SECUR-LOK* ring to approximately
1-2 mm (approximately 1/8 inch) above the skin.
8. Verify proper tube position according to the direction in
the Verify Tube Position section above.
Medication Administration
Use liquid medication when possible and consult the
pharmacist to determine if it is safe to crush solid medication
and mix with water. If safe, pulverize the solid medication
into a fine powder form and dissolve the powder in water
before administering through the feeding tube. Never crush
enteric coated medication or mix medication with formula.
Using a catheter tip syringe flush the tube with the
prescribed amount of water.
Tube Patency Guidelines
Proper tube flushing is the best way to avoid clogging and
maintain tube patency. The following are guidelines to avoid
clogging and maintain tube patency.
• Flush the feeding tube with water every 4-6 hours during
continuous feeding, anytime the feeding is interrupted,
before and after every intermittent feeding, or at least
every 8 hours if the tube is not being used.
• Flush the feeding tube before and after medication
administration and between medications. This will
prevent the medication from interacting with formula and
potentially causing the tube to clog.
• Use liquid medication when possible and consult the
pharmacist to determine if it is safe to crush solid
medication and to mix with water. If safe, pulverize the
solid medication into a fine powder form and dissolve the
powder in warm water before administering through the
feeding tube. Never crush enteric-coated medication or
mix medication with formula.
• Avoid using acidic irrigants such as cranberry juice
and cola beverages to flush feeding tubes as the acidic
Publicidad
