Percutaneous Gastrostomy Tube Placement in Children

Introduction

Percutaneous gastrostomy tube placement is a medical procedure used to insert a feeding tube directly into the stomach through the abdominal wall. This procedure is often performed in children who have difficulty swallowing, eating, or absorbing nutrients due to various medical conditions.

Indications

The indications for percutaneous gastrostomy tube placement in children include:

• Neurological disorders (e.g., cerebral palsy, muscular dystrophy)
• Gastroesophageal reflux disease (GERD)
• Congenital anomalies of the mouth or throat
• Severe oral aversion or feeding difficulties
• Malnutrition or failure to thrive
• Chronic illnesses requiring long-term nutritional support (e.g., cancer, cystic fibrosis)

Preparation

Before the procedure:

• The child's stomach should be empty for at least 4-6 hours to reduce the risk of aspiration.
• Antibiotics may be administered to prevent infection.
• Sedation or general anesthesia is often used to minimize discomfort and anxiety during the procedure.

Procedure

The percutaneous gastrostomy tube placement procedure involves:

1. The child is positioned on their back, and the abdomen is cleaned and draped in a sterile manner.
2. A local anesthetic is injected into the abdominal wall to numb the area.
3. A needle is inserted through the abdominal wall and into the stomach under endoscopic guidance (using a flexible tube with a camera and light).
4. A guidewire is then inserted through the needle, and the needle is removed.
5. The gastrostomy tube is inserted over the guidewire and into the stomach.
6. The tube is secured in place using an internal bumper or balloon.

Post-Procedure Care

After the procedure:

• The child is monitored for any signs of complications, such as bleeding, infection, or respiratory distress.
• Pain management is provided as needed.
• The gastrostomy tube is flushed with water to ensure patency and prevent clogging.
• Feedings are typically started within 24 hours after the procedure, and the child's nutritional needs are assessed and adjusted as necessary.

Risks and Complications

Potential risks and complications of percutaneous gastrostomy tube placement in children include:

• Infection (e.g., peritonitis, abscess)
• Bleeding or hematoma
• Leakage around the tube site
• Gastrointestinal perforation
• Tube dislodgement or blockage
• Nutritional deficiencies or metabolic imbalances if feedings are not properly managed

Follow-Up Care

Regular follow-up appointments with the healthcare provider are necessary to:

• Monitor the child's nutritional status and adjust feedings as needed.
• Inspect the gastrostomy tube site for signs of infection or other complications.
• Address any concerns or questions the family may have regarding the child's care and management.