Removal of PEG Tube Placement of Duodenal Tube

PEG Tube Removal

A PEG tube can easily be removed when no longer needed (Fig. 4.39). It is recommended that the internal bumper be removed endoscopically. After the gastro-scope is inserted, the tube is loosened and the bumper is snared. Next, the external portion of the tube is cut and the tube is retrieved endoscopically. Once the tube has been cut, it can easily be retrieved with a snare or with a biopsy forceps, which is passed into the hole of the bumper and then opened. Bumpers that are not retrieved endoscopi-cally are usually passed spontaneously.

Tubes that have been in place for less than 10 days should not be removed due to the risk of peritonitis. Solid foods should be withheld for at least 24 hours after tube removal. An overgrown bumper cannot be removed endoscopically (Fig. 4.40).

Fig. 4.39 Endoscopic removal of a PEG tube a The tube is carefully advanced into the stomach from the outside and encircled with a snare b The snare is tightened on the tube

Fig. 4.39 Endoscopic removal of a PEG tube a The tube is carefully advanced into the stomach from the outside and encircled with a snare b The snare is tightened on the tube

c The tube is cut from the outside and retrieved with the endoscope

c The tube is cut from the outside and retrieved with the endoscope

■ Placement of a Duodenal Tube

Feeding tubes can be placed endoscopically within the duodenum (Fig. 4.41). Duodenal tube placement may be necessary in intensive care patients and in ventilated patients with gastric atony that would preclude correct tube placement by a different route.

Fig. 4.40 Overgrown bumper. The tube cannot be removed endoscopically

Fig. 4.40 Overgrown bumper. The tube cannot be removed endoscopically

The procedure is technically simple. First the endoscope is advanced into the duodenum. Next a guide wire is passed down the working channel and placed deep in the duodenum. The endoscope is then withdrawn while the wire is simultaneously advanced to maintain its position in the duodenum. The endoscope is removed, leaving the proximal end of the wire protruding from the mouth. The wire is rerouted through the nose before attaching it to a feeding tube.

The nonendoscopic photos on duodenal tube placement in Figure 4.41 are presented with the kind permission of Mr. Horst Wesche DGPh et al. of Hanover.

$ Fig. 4.41 Placement of a duodenal feeding tube b The endoscope is advanced deep into

— a The patient is intubated and ventilated. A gastric drainage tube is the duodenum also visible. The bite guard is inserted, and the endoscope is passed

c A guide wire is passed down the working channel of the endoscope d View of the guide wire in the duodenum

While the endoscope is withdrawn, the wire is carefully advanced so that it remains in position

f The endoscope is removed, leaving the guide wire extending from the mouth e

k The ends of the tube now project from the nose and mouth in a U l The guide wire has been inserted and extends from the rerouting shape. The guide wire is inserted tube, which is visible in the right nostril

m The reroute is completed by withdrawing the tube and guide wire through the nose

The feeding tube is advanced over the extracorporeal part of the guide wire. At this time the guide wire must be secured at the nose to prevent dislodgment

o The feeding tube has been advanced over the guide wire but is still outside the body. The guide wire projects from the end of the tube

The end of the guide wire is grasped, and thefeeding tube is carefully threaded over the transnasal guide wire into the gastrointestinal tract n p

q The feeding tube has been advanced into the duodenum. The guide wire is still inside the tube

The wire has been removed, leaving the feeding tube in a functional position within the duodenum. Tube placement should still be checked radiographically, however r

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