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Tube Feedings Formulas and Methods
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Gastrostomy tube insertion carries a risk of hemorrhage, gastric perforation, aspiration and mortality. These risks increase with advanced age and illness. Pneumoperitoneum and enteral feeding peritonitis can occur as complications of gastrostomy tube insertion.
Gastrointestinal Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Gareth Davies, Chris Black, Keeley Fairbrass
If long-term (>2 weeks) enteral feeding is required, or where there is risk of aspiration (e.g. after a stroke), it is often preferable to insert a percutaneous endoscopic gastrostomy (PEG) (Figure 10.23). Very occasionally, the feeding tube is placed in the jejunum. A radiological technique may be required for gastrostomy (e.g. if the oesophagus is obstructed by a tumour).
Nutrition for children with chronic diseases and syndromes
Published in Judy More, Infant, Child and Adolescent Nutrition, 2021
If tube feeding continues to be necessary for a longer period of time (about 6 weeks or more), gastrostomy feeding may be used (Martínez-Costa et al. 2019). A gastrostomy is formed which requires a minor surgical procedure: a short tube is passed directly through the child’s skin and stomach wall and into the stomach. It is held in position with a plastic clamp or a button with a small inflatable balloon that sits inside the stomach. The feeding tube can then be connected directly to the gastrostomy device without having to go via the nose/mouth. When this form of feeding is no longer needed, the gastrostomy device can be removed and the small hole in the skin and stomach wall will close over and heal. A tiny scar may be the only indication that this route of feeding was ever used.
How people living with motor neurone disease and their carers experience healthcare decision making: a qualitative exploration
Published in Disability and Rehabilitation, 2022
C. Paynter, S. Mathers, H. Gregory, A. P. Vogel, M. Cruice
All participants were asked if they had considered a feeding tube. Participants experiencing dysphagia and/or weight loss reported the decision to proceed with PEG was straightforward; “[Name] was losing weight. So it was clear it was going to be an issue and do it sooner rather than later…It wasn’t anything that we needed to think about” (C06). One participant accepted a gastrostomy despite not wanting “invasive tubes” drawing a distinction between a feeding tube and a breathing tube despite the percutaneous insertion of both interventions. For participants asymptomatic for dysphagia, planning for gastrostomy was more complex and varied. The context being that the specialist MND clinic offers patients with deteriorating respiratory function early PEG placement. This allows for insertion under sedation. Later in the disease, gastrostomy insertion may be less safe, performed with less sedation or may no longer be possible. Participants without dysphagia symptoms often waited until disease progression forced a decision, or else relied heavily on healthcare professionals to guide that decision; “[The clinical team] are all saying well, you should have it [PEG] done while you can. So I went with their advice” (P12). One participant declined PEG.
Current practices and barriers in gastrostomy indication in amyotrophic lateral sclerosis: a survey of ALS care teams in The Netherlands
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2022
Remko M. Van Eenennaam, Willeke J. Kruithof, Esther T. Kruitwagen-Van Reenen, Leonard H. van den Berg, Johanna M.A. Visser-Meily, Anita Beelen
Stimulating patient choice in gastrostomy may help to promote patient readiness to make a decision. Patients may desire to postpone decision-making or even decline gastrostomy and this should be respected by physicians while exploring the patient’s choice and pointing out the benefits of (timely) placement (2). Meanwhile, dietary changes and supplementation can be explored to provide nutritional support before and after gastrostomy indication (5, 15, 29). However, physicians in our survey would have preferred patients not to postpone decision-making because this can lead to emergency placements, more complications, and possibly a negative effect on survival. Some respondents also reported finding it difficult to accept patients’ autonomy when they declined gastrostomy. There is a delicate balance between patient choice and higher risk of complications and it is recommended that physicians discuss this dilemma with the patient (5). Additionally, cognitive impairments and especially frontotemporal dementia can impair decision-making capacity in ALS (30) and affect patient readiness; however, this was only mentioned by one respondent as a potential barrier.
Dietary management of infants and young children with feeding difficulties and unsatisfactory weight gain using a nutritionally complete hypercaloric infant formula. practical considerations from clinical cases
Published in Postgraduate Medicine, 2021
Małgorzata Matuszczyk, Paulina Mika-Stępkowska, Agnieszka Szmurło, Marcin Szary, Mirosław Perlinski, Jarosław Kierkuś
The girl was referred for a nutritional consultation at the Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics to determine further feeding plan. Due to the medical history, available test results, observed gastrointestinal symptoms, the girl’s age and current body weight, she was qualified for surgical insertion of gastrostomy with Nissen fundoplication. The procedure was performed without any complications. Feeding via gastrostomy was started 6 hours after surgery, initially with a 20-mL serving (1/3 of the target serving). Due to the previously observed problems of small weight gain and lack of tolerance of recommended diet’s volume, breast milk was partially replaced with a high-energy polymeric formula (1 kcal/1 mL). Feeding by gastrostomy was recommended as per the following scheme: 4 × 50 mL of expressed breast milk plus 3 × 50 mL high-energy polymeric formula per day. Feeding plan provided approximately 280 kcal/day (130 kcal/kg body weight/day). Additionally, gastrostomy care competencies were discussed with parents.