经皮胃镜下胃造瘘术的护理及护理配合

对52例行经皮胃镜下胃造瘘术(PEG)的病人进行充分的术前准备,术中密切配合、严密观察病情、做好心理护理及术后指导,结果52例病人均操作成功。认为PEG是安全有效的微创手术,正确、规范、有预见性的护理可减轻病人痛苦、控制手术意外、减少手术并发症。     

经皮胃镜下胃和小肠造瘘术

目的探讨经皮胃镜下胃和小肠造瘘术建立肠内营养的方法。方法30例患者经皮胃镜胃造瘘术（PEG）采用Pull法，3例小肠造瘘术（PEJ）在PEG基础上，用异物钳钳夹胃腔内小肠造瘘管，推送胃镜将其送至Trize韧带以下。结果PEG成功率为100％，通过改良胃镜下直接置管方法，3例PEJ全部一次放置成功，4例局部有活动性出血，5例局部有分泌物及红肿，经相应处理缓解，末出现严重并发症。结论PEG简单，安全，可行；PEJ的改良方法可一次使小肠造瘘管到达空肠，有一定应用价值。     

经皮内镜胃造瘘术与手术胃造瘘术的临床对比研究

目的比较经皮内镜胃造瘘（PEG）与手术胃造瘘的优缺点。方法应用经皮内镜胃造瘘18例与手术胃造瘘29例作对照,比较两者在手术时间、并发症（胃壁造口处出血、造瘘口渗漏、造口感染）的发生率。结果18例PEG时间（18±5．1）min,较手术胃造瘘时间（112±14．5）min明显缩短（P〈0．05）。PEG术组发生造口处感染1例,手术胃造瘘发生瘘口渗漏2例、胃壁造口处出血1例、造口感染3例,PEG术组手术并发症较手术胃造瘘组明显减少（P〈0．05）。结论PEG比手术胃造瘘手术时间短,术后并发症少,但不能完全替代手术胃造瘘术。     

经皮内镜下胃造瘘术

１９９４年９月－１９９５年２月共行经皮内镜下胃造瘘术３７例，全部成功，平均手术时间为１５分钟，仅６例出现局部皮肤炎症反应，无任何严重发症。结果表明：经皮内镜下胃造瘘术安全、便捷、有效，为患者提供了一个不需剖腹手术安放胃造瘘管的新方法，颇具推广价值，本文也对操作经验及注意事项进行了总结。     

内镜引导下经皮胃造瘘术的应用及护理

[目的]探讨内镜引导下经皮胃造瘘术的应用,总结护理措施。[方法]对30例病人行经皮胃造瘘手术,同时加强护理。[结果]30例病人手术均成功,未发生严重的护理合并症。[结论]加强内镜引导下经皮胃造瘘术的护理是手术成功的保证。     

脑卒中患者经皮胃镜胃造瘘术行管饲的护理

总结17例脑卒中患者经皮胃镜胃造瘘术行管饲的护理。造瘘前对患者进行心理护理及相关知识宣教,造瘘后对出现或潜在的护理问题制定行之有效的护理措施,密切观察病情变化及创口情况并做好护理,正确进行管饲,加强并发症的观察及护理,可提高患者生活质量。     

内镜下经皮胃造瘘术在危重症患者的应用疗效观察

目的探讨内镜下经皮胃造瘘术在危重症患者的应用策略和疗效。方法选择收治的行胃造瘘术的危重症患者66例,其中内镜下经皮胃造瘘术32例,作为研究组,传统胃造瘘术34例作为对照组。比较两组在麻醉方式、手术时间、管饲起始时间、手术前后患者一般指标改变,术后并发症、住院时间等情况。结果①两组患者均顺利完成手术,无死亡病例,研究组患者在胃镜室局部麻醉下完成,对照组患者在手术室下行气管内插管全麻完成。②研究组手术时间、管饲起始时间明显低于对照组,两组差异有统计学意义(P<0.01)。③两组患者手术1个月后体重、血红蛋白、白蛋白较手术前均明显提高(P<0.05),两组比较无统计学差异(P>0.05)。④两组患者术后并发症发生率、住院时间无统计学差异(P>0.05)。结论内镜下经皮胃造瘘术操作时间短,管饲起始时间快,可在胃镜室局部麻醉下完成,疗效及并发症发生率均与传统胃造痿术相似,值得临床推广应用。     

Percutaneous endoscopic gastrostomy (PEG): the role and perspective of nurses

Aims and objectives. To study the perspectives of nurses on (i) the process of decision‐making regarding the placement of feeding gastrostomies, (ii) their role in the process, (iii) the impact this participation has on them personally and (iv) gastrostomy placement in general. Background. The decision to commit patients to long‐term feeding using a gastrostomy tube can be very difficult, particularly when the anticipated benefits are uncertain. Strategies to improve such decision‐making are required. Nurses are in an excellent position to provide valuable insights regarding this decision‐making and their increased participation in this process might substantially improve it. Design. A cross‐sectional, exploratory design using in‐depth semi‐structured interviews and a self‐administered questionnaire. Methods. In‐depth semi‐structured interviews with 17 nurses experienced in percutaneous endoscopic gastrostomy decision‐making were undertaken and analysed. Results. Individuals making decisions regarding feeding gastrostomy placement were observed to be insufficiently informed regarding the device and the ramifications of its placement. Nurses were perceived to play an important, although underused, role in decisions to commit patients to long‐term feeding. Participation in the making of these decisions may be stressful to nurses, particularly when the only result anticipated is the sustaining of a life of poor quality. Sixteen nurses reported that they would not want to have a gastrostomy for themselves if they were unable to maintain some quality of life. Strategies that could improve decision‐making were suggested. Conclusions. Decision‐making could be improved by providing better information to decision makers. A team‐orientated approach and more active dialogue with regard to care planning among health professionals, especially between doctors and nurses is needed. Effective decisions regarding feeding gastrostomy placement require adequate resources, especially sufficient time for caregivers to communicate effectively with those who must make these decisions. Relevance to clinical practice. The role of nurses in decision‐making regarding commitments to long‐term feeding using gastrostomy tubes could be effectively augmented.     

Ostomies of the digestive tract. PEG (percutaneous endoscopic gastrostomy

After reviewing the antecedents of an PEG Percutaneous Endoscopic Gastrostomy Probe, the authors analyze the indications for its usage, the possible complications and the care procedures which the entire process for a PEG requires and the subsequent at home follow up patient care. Finally, the authors evaluate some recommendations to bear in mind so that this entire procedure is convenient for the patient and so that the patient's quality of life improves.     

Antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG): a prospective randomized clinical trial

BACKGROUND AND STUDY AIMS: The most frequent complication reported for percutaneous endoscopic gastrostomy (PEG) is peristomal wound infection which occurs in as many as 30 % of patients. In the studies published so far, the question of whether antibiotic prophylaxis reduces the incidence of peristomal wound infection has remained controversial. We therefore conducted a prospective, randomized trial to determine whether antibiotic prophylaxis can reduce the incidence of peristomal wound infection associated with PEG. PATIENTS AND METHODS: During a 2-year-period a total of 347 patients (251 men, 96 women; mean age 60.2+/-5) were included in our study. In all cases, a 9-French gauge Freka gastrostomy tube was inserted using the "pull" technique. The patients were randomly assigned to three different treatment groups (group 1, antibiotic prophylaxis with 2 g cefotaxime; group 2, antibiotic prophylaxis with 4g piperacillin plus 0.5g tazobactam; group 3, no antibiotic prophylaxis). For a period of one week after gastrostomy, the peristomal area was evaluated using a wound score. According to the score, peristomal infections were classified as being of degree I-IV. Infections of up to degree III were regarded as minor, while an infection of degree IV was defined as a severe complication. RESULTS: PEG tubes were successfully placed in 336/347 patients (97 %). Of the 336 patients, 29 were excluded because of incomplete follow up (dropout rate 9%). Cases included were: in group 1, n = 101; in group 2, n = 100, and in group 3, n = 106. There was no mortality related to PEG insertion. There were five instances of severe complications (1.6%). Patients who received antibiotic prophylaxis had mean daily combined wound scores that were significantly lower than those of patients without antibiotic prophylaxis (P < 0.01). The control group (no antibiotic prophylaxis) exhibited significantly more peristomal wound infections of degree III (n = 8) than antibiotic prophylaxis group 1 (n = 0, P < 0.001) or antibiotic prophylaxis group 2 (n = 1, P < 0.012). Three patients in group 3 (no antibiotic prophylaxis) and one patient in group 2 developed peritonitis. CONCLUSIONS: Severe wound infections requiring medical or endoscopic intervention are very rare events after PEG insertion. Antibiotic prophylaxis significantly reduces the risk of peristomal wound infection associated with PEG insertion. Antibiotic prophylaxis, therefore, is to be recommended as a general measure in percutaneous endoscopic gastrostomy.     

Current microbiology of percutaneous endoscopic gastrostomy tube (PEG tube) insertion site infections in patients with cancer

Purpose  

Percutaneous endoscopic gastrostomy (PEG) is frequently used to provide enteral access in cancer patients who are unable to swallow. Infection is an important complication in this setting. Current microbiological data are needed to guide infection prevention and treatment strategies.