2. -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
3. ABSOLUTE: RELATIVE:Gastric varices AscitesTotal gastrectomy Partial gastrectomyUncorrectable coagulopathy CoagulopathyOverlying colonInability to pass anasogastric tubePERCUTANEOUS GASTROSTOMYCONTREINDICATIONS
4. • Informed consent• NG tube placement• 300 ml oral barium in the evening• Intravenous access• Analgesia• GlucagonPERCUTANEOUS GASTROSTOMYPREPARATION
5. •Major:-Major infection and septicemia -Perforation-Hemorrhage -Aspiration -Dislodgement of the tube.Minor:-Wound infection-Dislodged or leaking tubePERCUTANEOUS GASTROSTOMYCOMPLICATIONS
6. PERCUTANEOUS GASTROSTOMYT-fasteners• T-fasteners
7. • Mark the position of lefthepatic lobe by ultrasoundand injection of 1 mg ofglucagonPERCUTANEOUS GASTROSTOMYFIRST STEP
8. • Gastric distension byinjection of air in the NGtubePERCUTANEOUS GASTROSTOMYSECOND STEP
9. PERCUTANEOUS GASTROSTOMYTHIRD STEP• Gastroplexy using the T-fastener
10. • Injection of contrast toensure the right position ofthe needle inside thestomachPERCUTANEOUS GASTROSTOMYVERIFICATION
11. • Using a guidewire tointroduce inside the needlePERCUTANEOUS GASTROSTOMYSeldinger Technique
12. • Of the orifice by guide( 9F,14F, 16F ) or using ofBaloonPERCUTANEOUS GASTROSTOMYDILATATION
13. • Control the position ofumbrellaPERCUTANEOUS GASTROSTOMYAT THE END

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