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IR Percutaneous G-Tube Placement

PROCEDURE: Percutaneous Gastrostomy Tube Placement.

MEDICATIONS: Versed 2 mg IV; fentanyl 100 mcg IV; Clindamycin 900 mg IV.
Medications provided by a dedicated sedation nurse who was present throughout
the case which lasted greater than 30 minutes.


PROCEDURE DESCRIPTION: Following informed consent, the patient was placed in
the supine position on the angiographic table. A nasogastric tube was placed.
The patient was prepped and draped in the usual sterile fashion. Air was
insufflated through the nasogastric tube to achieve moderate distention of the
stomach. The puncture site was anesthetized with 1% lidocaine. A 5 mm skin
incision was made with a scalpel and tissues were bluntly dissected. Two
T-fasteners were placed after percutaneous gastric entry with a 17G needle and
an 0.038 inch wire was inserted and coiled in the fundus of the stomach. Serial
dilatation of the tract was made with Teflon dilators. The gastrostomy tube was
inserted over the wire, and its distal tip placed in the fundus of the stomach.
The pigtail was locked and positioning confirmed with contrast injection. The
catheter was sutured in place with 2-0 Prolene and connected to a drainage bag.
The T-fasteners were secured at the skin exit site. The patient tolerated the
procedure well without immediate complication.

Successful placement of a 14 French Wills-Oglesby gastrostomy tube.

1. Patient to be admitted under the TAMC ENT service for surgery on 23 October
2. Return to IR clinic in one week for T-fastener removal.
3. Once G-tube cleared for use, flush tube TID and before/after each use with
20ml water and with 40ml water after each use.
4. All medications should be converted to liquid or IV form. No pills (crushed
or otherwise) should be sent through the tube due to their propensity to clog.