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Most people do not want it to be obvious that they are wearing a catheter bag. The factors to consider are ease of access and the desire to hide any possible bulging as the bag fills. You also need to be careful that your clothes do not constrict the flow of urine in the drainage tube, perhaps when you sit down. Using dots of velcro tends to be easier than two strips of velcro particularly for fly openings on trousers or waistbands of women's skirts (Pain, McLellan, and Gore, 2003) Develop comprehension: Record captions for pictures. Allow pupils to match the correct Talking Point to the correct picture. This could make a fine game! Unless the doctor gives special instructions, the gastrostomy device can usually be used straightaway to give your child medicines – if your child took regular medicines by mouth or through the NG tube, a different format may be prescribed to be given through the gastrostomy. The nurses will test the gastrostomy a few hours after the procedure, first with a small amount of water and if everything is fine, next with a small amount of feed. If there are no problems, the amount of feed given will gradually be increased. Steenblik M, Hilden K, Fang JC. A retrospective correlation of percutaneous feeding tube stoma length in sitting and supine positions compared with body mass index. Nutr Clin Pract. 2012;27(3):406-9.
Support pupils in positions of responsibility: Pupils can record the messages that they are asked to take to other classrooms or school staff. They can then play them on the way so that they are more reliable and independent in delivering the right message to the right person. Drawstring belts on pyjamas, trousers and skirts can be difficult to tie. Remove the drawstring at the waist and replace with elastic o The tube should remain under moderate tension for 24 hours to promote good adaptation of the stomach wall to the abdominal wall. (Fresenius insertion guideline) As well as the risks of the general anaesthetic, formation of a gastrostomy can cause damage to the foodpipe, stomach or nearby structures. Careful measures are taken to manage these risks. If you are concerned about the risks to your child please discuss with the team performing the procedure. The “When” in PEG replacement encompasses when it is safe to replace a PEG tube after initial placement and also how long an existing tube will function before deterioration resulting in malfunction occurs. After initial placement the PEG stoma tract begins to mature in 1-2 weeks and is usually well-formed in 4 weeks (Figure 1,2). This process may take longer in patients with impaired wound healing (ascites, malnutrition, immunosuppressive medications or states, diabetes, obesity). Therefore, PEG replacement after initial placement can be safely performed as soon as 4-6 weeks in most patients. It may need to be longer (up to 3 months) in higher risk patients as described above. 5 If a tube is inadvertently removed or has a complication requiring replacement before stoma tract maturation, confirmation of correct placement with one of the methods explained later in this article in the “How” of PEG placement is mandatory. 3
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required for unscheduled replacements. Appropriately trained non-physicians (i.e. nurses) or patients, can safely and far more economically replace established PEG tubes in the home setting. The HOW of PEG Replacement o The PEG will not be used for the first 6 hours after the procedure. You will also have to remain nil by mouth for 6 hours after the procedure. A pants aid is a wire frame over which pants or a slip petticoat is fitted. The feet are put through the frame and leg holes of pants and the underwear pulled up to the knees from where they can be reached by hand.
If you have a nasogastric tube as a method of feeding you should not have any feed down it for at least six hours (preferably overnight) before the procedure. This is granulation tissue and is common. Call your health care provider if the tissue bleeds, grows in size, or if fluid or pus leaks. Fluid leaks around the button: Do not drink anything starting 2 hours before your scheduled arrival time. This includes water. Things to remember
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Before going to the operating theatre, you will meet the doctor who will explain the operation in detail, discuss any worries you may have and ask you or your child to give permission for the operation by signing a consent form.
Take the B elevator to the 2 nd floor. Turn right and enter the Endoscopy/Surgical Day Hospital Suite through the glass doors. What to expect If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s a charge for this service, and you’ll need to provide transportation. It’s OK to use a taxi or car service, but you still need a responsible care partner with you. Agencies in New York A combination of the two – for instance, bolus fields during the day and a continuous overnight feed A special liquid feed containing all or most of the nutrients needed is used with the gastrostomy. There is no need to add flavouring to the feed as it is delivered directly into the stomach. Liquidised or pureed food should not be given through the gastrostomy. Some children can continue to eat regular food by mouth, using the gastrostomy to ‘top up’ their nutrient levels, but this depends on the reasons why the gastrostomy is required.
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After the initial device, you and your child will be able to choose whether to have the same device again or change it to a balloon device – either a low-profile button or a tube held in place with a water-filled balloon. If your child is continuing with a Freka® PEG, they will need to have this replaced under general anaesthetic, but balloon devices can often be inserted while your child is awake. If the jejunal port is not being used, you should flush this more frequently, between six and twelve hourly. Before the procedure it is important that your stomach is empty. Please do not eat or drink anything for at least six hours (preferably overnight) before the procedure. If you have not had a gastrostomy previously, you may have to wait several hours to have any fluids through the GJ device. Before the GJ is used and while the feeds are being introduced, you will have an intravenous infusion (drip) of fluids.
Your community dietitian will arrange further deliveries of feed and other equipment once you are at home.It is equally important to keep having food and drink until those times to keep you well-hydrated, so you may need to wake during the night. If you do not follow these instructions exactly, the operation may be delayed or even cancelled. If you have nothing to put in the stoma, replace the old button and tape it down. This will keep the stoma open until you can seek medical attention. Percutaneous Endoscopic Gastrostomy (PEG) – Information and Care guidelines for patients and carers
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