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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. PHYSICIANS: 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. IMPRESSION: Successful placement of a 14 French Wills-Oglesby gastrostomy tube. PLAN: 1. Patient to be admitted under the TAMC ENT service for surgery on 23 October 2013. 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.