S09C89 - GI Procedures and Devices

Question 1

NGT

Answer 1

-use for massive GIB or for obstruction (not for ileus)

Question 2

Blakemore tube

Answer 2

• only good for esophageal variceal bleeding

- attach proximal end to helmet with a face guard that pt wears to secure traction on the balloon

Question 3

Paracentesis

Answer 3

• lower quadrants is safest approach (avoid liver)

- use Z-tracking technique

Question 4

G/J-tube complications

Answer 4

• purulent drainage from stoma, local hydrogen peroxide unless cellulitis present
• leakage from stoma, carefully replace with larger tube
• tube occlusiion, irrigate, replace
• dislodged tube, gently replace, confirm placement with xr
• PTX
• bacteremia, consider feeding tube as source of sepsis
• bleeding from tract
• bleeding from granuloma bulidup - local silver nitrate
• infx of surrounding skin, consult, pull tube, IV Abx
• nec fasc, MRI, surgical debridement
• peritonitis, examine for fistula, consult, Abx
• pulm aspn of feedings, reduce rate, consider J-tube
• n/v/d, reduce flow, 1/2 strength, stop feeds
• GERD, reduce rate, 1/2 strength, consider J-tube
• obstruction, stop feed, NPO, admit
• gastric outlet obstruction, reposition tube
• volvulus, perforation, fistula - consult
• lyte abnormalities, change feed, increase free water
• GIB, endoscopy

Question 5

Feeding tubes dislodged

Answer 5

• takes 2-3w for a tract to mature, DO NOT replace a tube with an immature tract
• if tract mature and size of tube not known, start with a 16F or 18F G-tube or foley catheter
• can flush with 10cc saline and watch on US to confirm placement
• J-tube usually 8-14F, if a foley is used to replace the tube DO NOT inflate the balloon