patience required feeding tubes when
they're unable to meet their nutritional
needs orally or by mouth those patients
can include patients with neurologic
disorders such as strokes or
neuromuscular disorders trauma and
surgical patients or patients with
malnutrition or any or patients with
dysphasia the patient that we perform
the PEG tube procedure on today was
unfortunate 24-year old male who had a
vertebral artery dissection resulting in
a suitable vascular accident and dense
left hemiparesis and dysphasia his
dysphasia is likely to continue for
weeks if not months and he obviously
requires nutrition during that period
the percutaneous endoscopic gastrostomy
feeding to procedure itself starts with
prepping the patient's abdomen to make a
sterile field passing the endoscope
through the mouth and performing a
routine upper and a complete upper
endoscopy examination then the stomach
is insulated with air one important
complication we like to avoid is
traversing the transverse colon when we
place the PEG tube we attempt to
decrease this complication by insulating
the stomach well and then using good
finger indention and transillumination
so now I just make a skin incision right
where I raised my wheel
then make my skin incision
again I make it a little bit smaller
than the actual tube itself lights again
and I make again make sure I still have
a great finger indention and in
transillumination then I go with my
second syringe
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then you put the wire through and snare
it get closer to it
those
alright go ahead pull out
either bumper I think it's fine to use a
lot of people like the round bumper but
I tend to like the t bumper just gives
us a little less obtrusive and we just
attached the peg to the snare just loop
it through and then it's well lubricated
then we just pull it through
you're going to make a smaller skin
incision so it makes a little bit
tougher to pull it through or requires a
little more tug to pull it but I think
there's less bleeding around the site
when you get to do it that way
and you can use the the measurement
markings on the peg to give you some
idea of how tight to make the the bumper
the outer bumper and I always I always
document where we set the marking at so
at the outer bumper it's about at three
and a half centimeters and I think the
patient's got a little bit of a hematoma
and the in the wall of the stomach and
so you can use the bumper to to help
tamponade that okay it's good
so the other thing that we do after we
get done just to make the patient more
comfortable we sucked Arab but the scope
but we also will just open up the peg
and let the air out that way - that way
again just for patient comfort
I was Lee at the leg you have to open up
your c-clamp as well that went here is
the tummy's not quite as distended then
we dress it
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