DATE OF PROCEDURE: MM/DD/YYYY
INDICATION FOR PROCEDURE: Cerebellar tumor resection complicated by postoperative hydrocephalus and recurrent aspiration pneumonia with inability to initiate oral feedings without significant aspiration.
DESCRIPTION OF PROCEDURE: Prior to the procedure, 3 mg of Versed and 25 mcg of fentanyl were given intravenously. The patient was laid in a prone position. Betadine was used to clean the anticipated target area in the epigastric region. The abdomen was thoroughly examined and noted to be free of scars and was soft with favorable appearance to proceed.
The adult gastroscope was inserted into the mouth and advanced to the second portion of the duodenum. The mucosa was carefully examined in the duodenum, stomach, and esophagus. No significant lesions were noted. The scope was used to transilluminate the abdominal wall. A finger was placed on the patient’s abdomen and a pressure applied demonstrating adequate indentation of the stomach wall visualized via the endoscope.
The area was once again cleaned with Betadine solution. A sterile drape was placed over the patient. Five mL of lidocaine without epinephrine was drawn up in a syringe. A small wheal was placed in the patient’s skin for local anesthesia. The finder needle was inserted perpendicular to the skin at an angle previously noted to be appropriate as per this endoscopic visualization. Aspiration with injection of lidocaine was performed on a tract into the stomach. Bubbles were noted in the syringe upon reaching the stomach.
The finder needle was then withdrawn. The trocar catheter assembly was then inserted into the abdominal wall utilizing the same technique. Bubbles were aspirated upon reaching the stomach lumen. The blue wire was passed through the trocar into the stomach. A snare was passed down the endoscope and used to ensnare the blue wire. The scope and the wire were removed from the patient.
A small cut was made in the surface of the skin adjacent to the wire to allow for passage of the PEG tube. The wire was removed from the snare, and a wire was attached to the PEG tube and secured. The operator pulled the wire through the wall of the abdomen pulling the PEG tube down the esophagus into the stomach and out the abdominal wall as expected.
The gastroscope was reinserted and used to visualize placement of the PEG tube. The tube was noted to be in appropriate position. The tube was clipped and the appropriate holding devices put in place and clamped. The patient recovered without event.
ASSESSMENT: Successful placement of percutaneous endoscopic gastrostomy tube.
RECOMMENDATIONS:
1. One gram Ancef IV to be given upon arrival.
2. Okay to start using PEG tube in 4 to 6 hours.
3. Nutrition consult to help with tube feed directions.
4. Standard PEG tube instructions to apply.
