Enteral Access Procedures

CHAPTER 10 Enteral Access Procedures







BACKGROUND


Nutritional support is an essential component of the treatment of critically and chronically ill patients. Patients who cannot meet their own nutritional needs through oral intake can be supported with parenteral (intravenous) or enteral (gastrointestinal tract) feeding. Parenteral feeding is an effective means of providing nutritional support to those patients who cannot be fed enterally and provides lifesaving therapy for patients with limited gastrointestinal tract absorptive capacity. The shortcomings of parenteral nutrition, however, have become increasingly evident as experience with this approach has grown; these include high rates of catheter-related, infectious, and metabolic complications as well as liver dysfunction. In contrast, enteral feeding is associated with fewer complications, is less expensive, and is not dependent on central venous access.


A number of options for enteral access exist; each has unique advantages and disadvantages. These include nasoenteric tubes, gastrostomy tubes, and jejunostomy tubes. Nasoenteric tubes, which include large-bore nasogastric tubes and small-bore nasoenteric tubes, can be placed at the bedside without the need for surgery and provide safe, short-term enteral access. Nasoenteric tubes are associated with several complications, including errors in tube placement (e.g., intracranial or intrabronchial intubations), sinusitis, nasal synechiae, and nasal alar necrosis. Surgically placed gastrostomy tubes (G-tubes) provide more durable, long-term enteral access and can be used for feeding or gastric decompression. In appropriate patients, they may be placed percutaneously with endoscopic assistance, obviating the need for larger open incisions. Jejunostomy tubes (J-tubes) are indicated in patients with contraindications to gastrostomy tube placement (e.g., patients undergoing a transhiatal esophagectomy) and patients with severe reflux or delayed gastric emptying. A variety of laparoscopic approaches to tube gastrostomy and jejunsotomy are in use, increasing the options further. This chapter focuses on the most common enteral access procedures: percutaneous endoscopic gastrostomy (PEG) tube placement and open approaches to tube gastrostomy and tube jejunostomy.







COMPONENTS OF THE PROCEDURE AND APPLIED ANATOMY





PEG Tube





May 26, 2018 | Posted by in GENERAL SURGERY | Comments Off on Enteral Access Procedures

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