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Gastrostomy, also known as percutaneous endoscopic gastrostomy or PEG, consists of placing a small flexible tube, known as a probe, from the skin of the belly directly to the stomach, to allow feeding in cases where the oral route cannot be used .
The placement of a gastrostomy is usually indicated in cases of:
- Stroke;
- Cerebral hemorrhage;
- Cerebral palsy;
- Tumors in the throat;
- Amyotrophic lateral sclerosis;
- Severe difficulty in swallowing.
Some of these cases can be temporary, as in stroke situations, in which the person uses the gastrostomy until he can eat again, but in others it may be necessary to keep the tube for several years or even for a lifetime.
This technique can also be used temporarily after surgery, especially when it involves the digestive or respiratory system, for example.
10 steps to feed through the probe
Before feeding the person with a gastrostomy tube, it is very important to place them seated or with the head of the bed elevated, in order to prevent food from rising from the stomach into the esophagus, causing a feeling of heartburn.
Then, follow the step-by-step:
- Examine the tube to ensure that there are no kinks that could impede the passage of food;
- Close the tube using the clip or bending the tip, so that air does not enter the tube when the cap is removed;
- Open the probe cover and place the feeding syringe (100ml) in the gastrostomy tube;
- Unfold the probe and slowly pull the plunger out of the syringe to draw in the liquid that is inside the stomach. If more than 100 ml can be aspirated, it is recommended to feed the person later, when the content is less than this value. The aspirated content must always be placed back in the stomach.
- Re-bend the probe tip or close the tube with the clip and then withdraw the syringe;
- Fill the syringe with 20 to 40 ml of water and put it back in the probe. Unfold the probe and press the plunger slowly until all the water enters the stomach;
- Re-bend the probe tip or close the tube with the clip and then withdraw the syringe;
- Fill the syringe with the crushed and strained food, in the amount of 50 to 60 mL;
- Repeat the steps to close the tube and place the syringe in the probe, taking care not to leave the tube open;
- Gently push the syringe plunger, slowly inserting the food into the stomach. Repeat the necessary times until administering the amount recommended by the doctor or nutritionist, which usually does not exceed 300 ml.
After administering all the food through the probe it is important to wash the syringe and fill it with 40 mL of water, putting it back through the probe to wash it and prevent the pieces of food from accumulating, blocking the tube.
These precautions are very similar to those of the nasogastric tube, so watch the video to observe how to always keep the tube always closed, preventing air from entering:
How to prepare the food for the probe
The food should always be well ground and also do not contain very large pieces, so it is recommended to strain the mixture before putting it in the syringe. The diet plan should always be guided by a nutritionist to ensure that there are no vitamin deficiencies and, therefore, after the placement of the tube, the doctor can refer to consultations with the nutritionist. Here are some suggestions for what the probe feed should look like.
Whenever it is necessary to administer medication, the tablet must be crushed well and mixed in the food or water to be administered. However, it is advisable not to mix drugs in the same syringe, as some may be incompatible.
How to care for the gastrostomy wound
In the first 2 to 3 weeks, the gastrostomy wound is treated by a nurse at the hospital, as more care is needed to avoid infection and even constantly assess the location. However, after being discharged and returning home, it is necessary to maintain some care with the wound, to prevent the skin from becoming irritated and causing some type of discomfort.
The most important care is to keep the place always clean and dry and, therefore, it is advisable to wash the area at least once a day with warm water, clean gauze and neutral pH soap. But it is also important to avoid clothes that are too tight or to put creams with perfumes or chemicals in place.
When washing the wound area, the probe should also be rotated slightly, to prevent it from sticking to the skin, increasing the chances of an infection. This movement of rotating the probe must be done once a day, or according to the doctor's guidance.
When to go to the doctor
It is very important to go to the doctor or hospital when:
- The probe is out of place;
- The probe is clogged;
- There are signs of infection in the wound, such as pain, redness, swelling and the presence of pus;
- The person feels pain when being fed or is vomiting.
In addition, depending on the material of the probe, it may also be necessary to return to the hospital to change the tube, however, this period must be agreed with the doctor.