Patients who need prolongednutritional support include:*Head, Neck and esophagealcarcinoma*Bowel decompression*Some neurologic disease*Swallowing disorders andesophageal strictures*Chronic conditions such ascystic fibrosis andcongenital heart diseasePERCUTANEOUS GASTROSTOMYINDICATIONS
    ABSOLUTE: RELATIVE:Gastric varices AscitesTotal gastrectomy Partial gastrectomyUncorrectable coagulopathy CoagulopathyOverlying colonInability to pass anasogastric tubePERCUTANEOUS GASTROSTOMYCONTREINDICATIONS
  • Informed consent• NG tube placement• 300 ml oral barium in the evening• Intravenous access• Analgesia• GlucagonPERCUTANEOUS GASTROSTOMYPREPARATION
    Major:-Major infection and septicemia -Perforation-Hemorrhage -Aspiration -Dislodgement of the tube.Minor:-Wound infection-Dislodged or leaking tubePERCUTANEOUS GASTROSTOMYCOMPLICATIONS
  • PERCUTANEOUS GASTROSTOMYT-fasteners• T-fasteners
  • Mark the position of lefthepatic lobe by ultrasoundand injection of 1 mg ofglucagonPERCUTANEOUS GASTROSTOMYFIRST STEP
  • Gastric distension byinjection of air in the NGtubePERCUTANEOUS GASTROSTOMYSECOND STEP
  • PERCUTANEOUS GASTROSTOMYTHIRD STEP• Gastroplexy using the T-fastener
  • Injection of contrast toensure the right position ofthe needle inside thestomachPERCUTANEOUS GASTROSTOMYVERIFICATION
  • Using a guidewire tointroduce inside the needlePERCUTANEOUS GASTROSTOMYSeldinger Technique
  • Of the orifice by guide( 9F,14F, 16F ) or using ofBaloonPERCUTANEOUS GASTROSTOMYDILATATION
  • Control the position ofumbrellaPERCUTANEOUS GASTROSTOMYAT THE END


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