Gastrostomy

• Surgical creation of a gastric fistula through the abdominal

wall, necessary in some cases of cicatricial stricture of the
esophagus for the purpose of introducing food into the
stomach.
Percutaneous endoscopic gastrostomy (PEG)
• A feeding ostomy. PEG tubes are inserted through the
esophagus into the stomach with the aid of an endoscope
and then pulled through a stab wound made in the
abdominal wall.
Nasogastric
• the nostril to the nasopharynx and to the stomach
 Gastrointestinal Tubes
• Can be inserted via
– Nose
– Stomach
• Many types can be inserted by nurses, but some
of the larger, longer or multiple lumen tubes must
be inserted by physicians or nurses with advanced
training
 Enteral Access devices
• Access can be achieved via various routes
– Nasogastric = inserted thru 1 of nostrils down
nasopharnyx to alimentary tract (may also go mouth
down but causes gagging++ and discomfort, more often
in premies)
– Nasoenteric inserted same as Nasogastric but extends
down into upper small intestine (used with those with
high risk of aspiration)
– Gastrostomy, Jejunostomy = for longer term and placed
via placement thru abd wall into stomach (gastrostomy)
or into jujumen (Jejunostomy)
 NG tubes
• Used with
– Pts with intact gag & cough reflexes
– Pts with adequate gastric emptying
– Short term use
 Inserting a NG tube
• If rubber tube used, place on ice for 5-10 mins to stiffen
tube
• Make sure guide wire if present is secured in position
• Measure distance (NEX)
• Use only water soluble lubricant
• Have pt sit upright, head back
• Once tube at throat (gag) have client tilt head forward
and swallow
• NEVER, NEVER, EVER FORCE A TUBE DOWN
Obtaining the NEX
(nose, earlobe and
xiphoid)

Some tubes may be

pre-measured but
this may not
correlated exactly
with the
measurement
obtained
 TO CONFIRM PLACEMENT OF NG
• Placement most reliably confirmed by x-ray
• Can also aspirate for stomach contents or auscultate
air insufflation
1. Aspirate for stomach contents = attach syringe to
tube and apply gentle pressure. If contents return,
tube is in place
2. Air insufflation = attach syringe, place stethoscope
over pt’s epigastric region. Inject about 15-20ml of
air and listen for “whoosh”
3. Ask pt to talk = if cannot talk, tube may be coiled in
throat or passed through vocal cords
 Pt with NG tube
• Will require
– Inspect nose for discharge and irritation
– Clean nostril and tube
– Apply water soluble lubricant to nostril if area dry,
crusted
– Frequent mouth care (q2h) as client will be NPO
 NG problem solving
• Pain or vomiting after insertion = indicates tube is
obstructed or incorrectly placed
• Not draining = may be obstructed or needs to
repositioned then checked again for placement
• If pt displaying signs of distress (gasping, coughing,
cyanotic) remove tube immediately
 Nurses responsibility
• Assess gastric contents
– Color
– Consistency
– Odor
– Amount
• Irrigate tube before and after meds/feeds
• Check GI function by auscultation for bowel sounds
 Enteral Feeding & Meds
• Long Term Support accomplished by creating a an opening
into:
– Gastrostomy (opening into stomach)
– Jejunostomy (opening into jejunum)
• Methods of feeding includes:
– PEG (Percutaneous endoscopic gastrostomy)
– Surgical or laproscopically placed gastrostomy tube
• More & more PEG’s are popular as can be safely inserted &
removed at bedside or in OPD
To insert requires (by a physician)
– local anesthesia,
– passage of endoscope into stomach,
– a small incision or stab wound thru the skin of the
abdomen
– pushing a cannula thru the incision
– insertion of guide wire thru cannula
– introduction & placement of PEG
 Before feeds with PEG’s or NG
• NG placement should be confirmed:
– After insertion
– Before beginning meds or feeds
– At regular interval during a continuous feed
• With NG’s and New PEG’s anticipate:
– Measuring of residual before each feed
– Measuring residual done to evaluate absorption of last
feed (ie. Is there undigested formula from a previous
feed)
If residual is more than last infusion or 150 ml,
hold feeding for 1 hour and recheck.
For continuous feeds, check residual q4-6 hours
• Assess bowel sounds prior to each feeding or for
continuous feeds, q4-8h
• Monitor for abdominal distention (would indicate
intolerance to previous feed)
• Monitor for diarrhea, constipation or flatulence (lack
of bulk may cause constipation. Hypertonic or
concentration of formula may cause diarrhea or
flatulence)
 Nursing care
• Elevate head at least 30 degrees during feed and 1 hr
following
• Tube must be flushed before and after feeds, med admin or
aspiration for patency
• Delivery sets must be changed q 12-24hrs or according to
policy
• Opened cans must be stored according to manufacturer’s
directions
• Clean skin and stoma area at least daily, should be qshift
• Mouth care q2-4 hours