Administration of nutrition and drugs via percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy or PEG is a designation for placing a feeding set over the abdominal wall in the stomach. The introduction of PEG is approached especially in cases where longer-term administration of enteral nutrition is expected (longer than 6-8 weeks), such as in neurological disease with swallowing disorders or tumors of the upper gastrointestinal tract.

Nutrition regimen
When administering enteral nutrition to the percutaneous endoscopic gastrostomy, a bolus (dose) method using a Janett syringe i preferred, which is more natural for the stomach than the continuous method (used to administer nutrition to the intestine)

Nutrition composition
Rather, polymeric or nutritionally defined nutrition is used to apply enteral nutrition to the stomach, in which nutrients are preserved in their original form. It therefore contains intact proteins (especially casein), polysaccharides and lipids (especially long chain triglycerides). In the past, cooked mixed foods were commonly used. Nowadays, due to the fact that it is not sterile and it cannot ensure full value in terms of energy content, macronutrients and micronutrients, it has been abandoned.

Procedure for increasing the nutritional benefits
For the first 24 hours after the probe is inserted, the patient receives only tea. The next day, the nutrition begins in the amount of 50 ml after two hours. If the patient's nutrition is well tolerated, we continue to increase the bolus volume by 50-100 ml per day. The goal is 250-400 ml of nutrition at 2 to 3 hour intervals. The last daily dose is given approximately 2 hours before bedtime, followed by a night break. If the patient is combined with enteral nutrition food intake per os (usually liquid or slurry form) should be maintained separated by about 1 to 1.5 hours.

Basic principles of administration
Before feeding, it is necessary to check that the stomach is not full - if the patient has full stomach, a raised abdomen or after opening the set, the stomach contents flow out, the application must be postponed. It is important to rinse the probe with 30- 50 ml of tea or boiled water before and after feeding. Acidic solutions (fruit juices, mineral water, etc.) cannot be used for rinsing due to possible coagulation of the food leading clogging of the probe It is also recommended that the patient sit or have at least an elevated upper body during nutrition and remain in this position for an additional 30-60 minutes after stopping administration. This reduces the risk of aspiration. After completion, it is necessary to close the set so that nutrition or gastric juices cannot escape

Medication to PEG
In situations where drugs cannot be administered orally, the drugs are administrated to PEG. A more suitable variant are drugs in the form of drops or syrup, which we dilute with water or tea- The tablets must be crushed very carefully to avoid clogging of the probe. Dissolve the obtained powder in a small amount of tea or boiled water, then suck in Janett's syringe and inject into the probe. It must be rinsed before and after application of the drugs. If the drugs in the probe come into contact with food or substances that could cause clotting (such as mineral water, fruit juices or other drugs), the probe may become clogged.

Introduction of PEG
https://www.youtube.com/watch?v=YjkZ6mQJ4JU

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