Preventive medical checkup

meDicum offers you:

… placement of PEG tubes carried out in cooperation with the company Nutricia, the most up-to-date products hence being used.

Special meDicum offer:

  • the method can be carried out as an out-patient intervention with a doctor's appointment at short notice

  • the method may be carried out under sedoanalgesia or under anaesthesia by an experienced surgeon and an anaesthesia-team

What is carried out on location:

  • the PEG tube is placed by an experienced team

  • after-treatment and position monitoring

  • changing of tubes

  • PEG tube care: PEG tube leakages and/or dislocations as

well as PEG tube blockages will be taken

care of.

PEG tube = Percutaneous endoscopic gastrostomy

In percutaneous endoscopic gastrostomy, a feeding tube is inserted in the stomach by means of gastroscopy. The aim is to feed a patient directly via the stomach, whereby persons suffering from a severe dysphagia can be fed.

What is the purpose of a PEG tube?

The PEG tube enables the supply of mushy food, enteral feeding, and the feeding of liquids to persons suffering from dysphagia. This method enables both short-term and long-term feeding – in most cases for more than 6 weeks – of persons who take in too little food. For short-term artificial feeding, the nasogastric tube is used more often.

Possible causes of dysphagia:

  • neurologic disorders (after apoplexy, craniocerebral injury, dementias)

  • inflammatory, scarring constrictions or tumours of the pharynx or of the gastric tube

  • long-lasting coma

  • other diseases which require extended facial surgeries, e.g. after severe injuries

  • physical and/or mental disabilities

  • poor general state of health

Prerequisites:

The motility as well as the resorption of the gastro-intestinal tract must be largely normal, and the metabolic state must be stable.

As a rule, a PEG tube cannot be placed in case of

  • blood-clotting disorders

  • local infections of the skin in the area of the site to be punctured

  • peritonitis

  • peritoneal carcinomas

  • large amounts of liquid collected in the stomach (ascites)

  • acute stomach ulcer

  • ileus

  • inflammation of the pancreas (acute pancreatitis)

For placing a PEG tube, there must be a defined medical indication.

Before placing a tube, attention must be paid to the following:

  • clotting state

  • acid secretion inhibitors must be discontinued 3 days before the intervention

  • blood-diluting drugs must be discontinued 7 days before the intervention (Marcoumar, Plavix, Thrombo Ass etc.)

Carrying out the PEG:

In most instances, the so-called “pull” method using a thread is employed. This intervention is mostly carried out under sedoanalgesia, i.e. using an agent that is sedating and makes you drowsy, and at the pucture site a local anaesthetic is applied.

At first, a gastroscopy is carried out in which the gastroscope is pushed via the mouth and the oesophagus into the stomach. For unfolding and for a better view within the stomach, the latter is slightly inflated with air.

A suitable site is chosen for the tube, and under sterile conditions and with local anaesthesia, a thread is placed from the outside into the stomach via a hollow needle. With the help of the gastroscope, the thread is pulled into the mouth via the oesophagus. The feeding tube is connected to the thread and, thus, is introduced into the stomach and partly pulled to the outside through the abdominal wall.

A disc at the end of the feeding tube prevents the latter from being entirely pulled out through the abdominal wall. A second, external disc prevents the tube from sliding into the stomach.

After application of the PEG tube, a check-up gastroscopy is carried out for checking the position of the tube and also for recording the latter.

Approximately six hours after application of the PEG, the tube may be flushed for the first time with lukewarm liquid (water or tea). In most cases, artificial feeding can be started the following day.

With an appropriate care, the PEG tube can be used for months without any complications occurring.

Complications which may occur:

  • wound infection

  • injury to inner organs

  • Due to an insufficiency of the tube channel, contents of the stomach may get into the abdominal cavity. Resulting complications: peritonitis

  • haemorrhages

  • pneumonia as a consequence of the aspiration of saliva, gastric juice or tube feeding formula

  • gastrocolic fistula

Tube care:

A tube should always be handled with the utmost hygienic care.

  • Even if tube feeding is interrupted, patency of the tube must be ensured. This is enabled by flushing the tube daily.

  • Before and after each drug application, flushing with approximately 20 to 50 millilitres of lukewarm water, still water, fennel tea or camomile tea is also required. Cooler temperatures often are sensed as unpleasant, and temperatures which are too hot may damage the sensitive gastric mucosa.

  • Acidic liquids, such as fruit teas or juices, must not be used since they may cause the protein of the tube feeding formula to flocculate and, thus, block the tube. Neither should milk be supplied via the tube.

  • While the tube feeding formula is being administered and approximately for one hour thereafter, the upper part of the patient's body should be kept in an elevated position.

If the tube is blocked, it must by no means be forcibly cleared or flushed under high pressure. This could cause a perforation of the tube and an injury to the patient.

External skin care around the tube:

After application of the PEG tube, the dressing should be changed daily for approximately 10 days. As soon as the wound has nearly healed, changing of the dressing twice per week will be sufficient. From this time onward, showering and bathing is allowed without any restrictions.

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