Nurse-Assisted Percutaneous Endoscopic Gastrostomy Tube Placement Is a Safe Procedure in Adult Patients.

The percutaneous endoscopic gastrostomy (PEG) procedure is normally carried out by two doctors. Preliminary experience has suggested that this procedure may be accomplished with the same safety level using one doctor and a specially trained endoscopy nurse. The aim of the study was to assess the immediate outcome and 30 days' procedure-related morbidity following nurse-assisted percutaneous endoscopic gastrostomy (NA-PEG) in an unselected population of adult patients. Retrospective, nonconsecutive analysis of NA-PEG procedures were registered between 2008 and 2014. Demographic data, indications, and early and late procedure complications were registered. During the study period, a total of 222 nonconsecutive adult patients had a NA-PEG placement. Neurologic (56%) and malignant diseases (35%) were the major indications for the PEG placement. The NA-PEGs were performed by six specially trained endoscopy nurses. NA-PEG-related overall morbidity was 24%, and all complications were minor. No procedure-related mortality occurred. When NA-PEG was compared with standard PEG placement literature, there was no increase in the number of complications, and the types of complications were similar. Despite being performed in patients with multiple co-morbid conditions, NA-PEG was a safe procedure with no mortality and minor complications. We suggest that NA-PEG should be used on a larger scale with the intention of saving time and medical costs.

Treatment resistant gastric antral vascular ectasia in a patient undergoing haemodialysis.

Gastric antral vascular ectasia (GAVE) is an important cause of upper gastrointestinal bleeding and has a high prevalence in patients with renal insufficiency. We report the first documented case of a 52-year-old patient on haemodialysis with GAVE refractory to repeated endoscopic argon plasma coagulation (APC) therapy and highlight the difficulties in its management. We recognise the need for further studies to investigate the optimal management of this condition and suggest alternative treatment strategies to be considered in patients with APC refractory GAVE, such as endoscopic band ligation and changing dialysis modality.

Ansiedad en gastroscopias: comparación de dos intervenciones de enfermería en gastroscopias sin sedación / Anxiety in gastroscopies: comparison of two nursing interventions in endoscopy without sedation

Existe disparidad en las percepciones que las enfermeras de endoscopias tenemos sobre la intervención de enfermería idónea en gastroscopias sin sedación. Algunas enfermeras piensan que el aporte de información es suficiente para reducir la ansiedad, mejorar la tolerancia y satisfacción, mientras otras defienden que además es necesario un entrenamiento conductual y un refuerzo positivo durante la prueba. Los objetivos de esta investigación fueron comprobar las diferencias que se producían en el estado de ansiedad del paciente entre las dos intervenciones de enfermería, así como en la tolerancia y su satisfacción. Se incluyeron 109 pacientes que acudieron vía ambulatoria a realizarse una gastroscopia sin sedación. Se dividieron en dos grupos, el experimental, con una intervención basada en información, entrenamiento conductual y refuerzo positivo durante la exploración y el control, con una intervención basada en la información. La ansiedad se evaluó con el test STAI-estado y con parámetros psicofísicos en diferentes momentos del proceso. Los datos se analizaron con medidas repetidas de análisis de la variancia que aportaron los siguientes resultados: la puntuación del STAI disminuyó más en el grupo experimental (p=0,035). La tolerancia fue mejor en el grupo experimental (p= 0,008), la satisfacción del paciente fue igual en los dos grupos (p=0,5) la diferencia en los valores de tensión arterial sistólica, diastólica y frecuencia cardíaca fue igual en los dos grupos (p=0,085, p=0,690, p=0,984) Las investigaciones experimentales son posibles en enfermería para obtener evidencias científicas sobre la idónea práctica clínica. Es posible mejorar la tolerancia de la gastroscopia y disminuir la ansiedad debida al procedimiento, con una intervención de enfermería centrada en el aspecto cognitivo y conductual de la persona (AU)

There is a disparity between nurses about the ideal role of nurses in endoscopies without sedation. Some nurses think that providing information to the patient is sufficient to reduce anxiety and improve tolerance and satisfaction, while others believe that behavioral training and positive reinforcement during the procedure are also necessary. The objectives of this study were to test the differences that are produced in the patient’s state of anxiety between the two types of nursing intervention, as well as in the patient’s tolerance and satisfaction. The study included 109 outpatients who had an endoscopy without sedation. They were divided into two groups, the experimental group who received nursing support based on information, behavioral training and positive reinforcement during the procedure, and the control group, who received nursing support based solely on information provided about the procedure. Anxiety was evaluated with a STAI-state test and with psychophysiological parameters at different moments during the process. The data was analyzed with repeated measures of analysis of the variance, which resulted in the following: the STAI score decreased more in the experimental group. Tolerance was greater in the experimental group, patient satisfaction was equal in the two groups, and the difference in the levels of systolic and diastolic blood pressure and heart rate was equal in the two groups. Experimental investigations are useful in nursing to obtain scientific evidence about the ideal clinical practice. It is possible to improve the tolerance of gastroscopy and reduce anxiety due to the procedure, with the intervention of the nurses centered in the cognitive and behavioral aspects of the person (AU)

[Percutaneous endoscopic gastrostomy (PEG): overview and nursing care].

The dramatic increase in the elderly population in Taiwan has made dysphagia an increasingly prevalent problem in long-term care. While tube feeding is mandatory for patients unable to take food orally, this approach increases recurrent aspiration pneumonia and malnutrition risks. Percutaneous endoscopic gastrostomy (PEG) is currently the most effective and prevalent approach to enteral nutrition. This article introduces the definition, indications, contraindications, complications, advantages and disadvantages of PEG and its clinical nursing care protocols. The author hopes that this narrative description of a nurse's experience providing appropriate nursing care to a PEG patient will help enhance reader understanding of PEG care.

What to know and how to get to know? A fieldwork study outlining the understanding of knowing the patient in facilities for short-term stay.

AIM: To report a descriptive study of nursing in facilities for short-term stay aiming to outline what 'knowing the patient' means in an endoscopic outpatient clinic. BACKGROUND: 'Knowing the patient' is indispensable to the effort of tailoring nursing to the individual patient's needs. Structural changes in the practice environments, however, reduce the amount of time a nurse spends getting to know the patient. Despite recent years' focus on the subject, no uniform description of 'knowing the patient' in facilities for short-term stay exists. DESIGN: A fieldwork study influenced by practical ethnographic principles was performed in a high-technology endoscopic outpatient clinic during 2008-2010. METHODS: Data were collected using participant observation for 12 weeks and semi-structured interviews with eight patients and four nurses. FINDINGS: Findings were summarized into two categories 'What to know?' and 'How to get to know?' The former concerned practical issues in relation to gastroscopy and was described in terms of the patient's level of anxiety, wish for medication and previous experiences. The latter 'How to get to know?' concerned instruments employed in getting to know the patient and was described in terms of the use of communication and sensing. CONCLUSIONS: 'Knowing the patient' in the endoscopic outpatient clinic was understood in a very practical sense. Conversation and the use of the eyes and physical touch enabled a situational awareness. It helped tailor nursing to the patient's needs and allowed the nurse to treat every patient as a unique individual.

Gastrostomía endoscópica percutánea: una actualización sobre indicaciones, técnica y cuidados de enfermería / Endoscopic percutaneous gastrostomy: an update on the indications, technique and nursing care

Existen numerosas alteraciones y enfermedades en que se ve disminuida o impedida la capacidad de deglución del paciente a pesar de poseer un sistema digestivo funcionante. En estos casos, la colocación de una sonda de gastrostomía percutánea (conocida por su acrónimo en inglés PEG) se constituye en el método de elección para procurar la alimentación enteral al paciente institucionalizado o en su ámbito domiciliario de manera segura y eficaz durante largos periodos. Por su sencillez, seguridad, fácil manejo y bajo coste, la PEG ofrece claras ventajas frente a otras técnicas de alimentación, especialmente frente a la sonda nasogástrica y la nutrición parenteral, si bien requiere unos sencillos y precisos conocimientos y la aplicación de cuidados que eviten la escasa incidencia de complicaciones. La colocación de una sonda de PEG podría contemplarse en: a) de modo temporal en pacientes con cuadros potencialmente reversibles; b) en enfermedades irreversibles para las que se espera una supervivencia prolongada (mayor de 6 meses), y c) en enfermedades terminales y debilitantes con expectativa de vida relativamente prolongada, casos en los que la indicación e implementación de la técnica deberán ser individualizadas y consensuadas. La formación específica de los profesionales y cuidadores encargados de manejar estos dispositivos garantiza su uso continuado y minimiza el riesgo de complicaciones. En este trabajo se revisan las indicaciones de la colocación de una sonda de PEG, su técnica y los cuidados más adecuados que proporcionar a los pacientes portadores por parte del profesional sanitario y de sus cuidadores (AU)

There are numerous conditions and pathologies in which the patient's swallowing ability is diminished or prevented despite having working digestive system. These are the fundamental requirements for the placement of a percutaneous gastrostomy tube (PEG) as a method of choice to provide safe, effective, and prolonged enteral nutrition for the patient at home or when admitted to hospital. Due to its simplicity, safety and low cost, PEG offers several advantages over other feeding techniques, particularly nasogastric tube and parenteral feeding, although it does require simple and accurate knowledge and application of care that ensures low incidence of complications. The placement of a PEG tube should be contemplated in several clinical situations: a) for temporal use in those patients with potentially reversible diseases; b) in non-reversible diseases in which a long survival (of more than 6 months) is foreseeable, and c) in patients affected of terminal and debilitating illnesses in whom a relatively long survival is probable. In these last cases the indication and implementation for PEG should be individualized and agreed jointly. The appropriate training of care professionals and familiar supporters in charge of the patients carrying a PEG tube ensures its continuous functioning and reduces the risk of complications. This paper aims to review the indications and appropriate care for patients carrying a PEG tube and presents the most accurate care that should be provided by both the professional health carers and caregivers (AU)

[Endoscopic percutaneous gastrostomy: an update on the indications, technique and nursing care]. / Gastrostomía endoscópica percutánea: una actualización sobre indicaciones, técnica y cuidados de enfermería.

There are numerous conditions and pathologies in which the patient's swallowing ability is diminished or prevented despite having working digestive system. These are the fundamental requirements for the placement of a percutaneous gastrostomy tube (PEG) as a method of choice to provide safe, effective, and prolonged enteral nutrition for the patient at home or when admitted to hospital. Due to its simplicity, safety and low cost, PEG offers several advantages over other feeding techniques, particularly nasogastric tube and parenteral feeding, although it does require simple and accurate knowledge and application of care that ensures low incidence of complications. The placement of a PEG tube should be contemplated in several clinical situations: a) for temporal use in those patients with potentially reversible diseases; b) in non-reversible diseases in which a long survival (of more than 6 months) is foreseeable, and c) in patients affected of terminal and debilitating illnesses in whom a relatively long survival is probable. In these last cases the indication and implementation for PEG should be individualized and agreed jointly. The appropriate training of care professionals and familiar supporters in charge of the patients carrying a PEG tube ensures its continuous functioning and reduces the risk of complications. This paper aims to review the indications and appropriate care for patients carrying a PEG tube and presents the most accurate care that should be provided by both the professional health carers and caregivers.

Cuidados del pacientecon gastrostomíaendoscópica percutánea / Care of the patient with percutaneous endoscopic gastrostomy

Múltiples procesos patológicos pueden producir alteraciones nutricionales,que se pueden abordar de diversa manera según las circunstancias decada paciente con el objetivo común de que sus necesidades calóricas seancubiertas.La alimentación por vía enteral es una alternativa cuando no es posibleutilizar la vía oral, pero el aparato digestivo sigue manteniendo su funcionabilidad.Para utilizar esta vía es necesario insertar una sonda, quedandouno de sus extremos al exterior y el otro en uno de los distintostramos del tubo digestivo.En este artículo se describe la técnica de alimentación enteral mediantegastrostomía endoscópica percutánea o tubo PEG, las indicaciones de suuso, las complicaciones potenciales y los cuidados específicos del pacientepara asegurar el buen funcionamiento de la técnica y evitar o detectar precozmentesus complicaciones (AU)

Several pathological processes can cause nutritional imbalances, whichcan be addressed in several ways depending on the circumstances ofeach patient, with the same objective of covering his/her caloric needs.Enteral feeding is an alternative when it is not possible to administer foodorally but the digestive system continues to function. In order to usethis route it is necessary to insert a feeding tube, one of its ends remainingoutside the body and the other in one of the different segments ofthe digestive tube.This article describes the enteral feeding technique via percutaneousendoscopic gastrostomy or PEG tube, its indications of use, potential complicationsand the specific care of the patient to ensure the technique’sproper functioning and to avoid or promptly identify its complications (AU)

A systematic review of prophylactic antimicrobials in PEG placement.

AIM: To establish whether prophylactic systemic antimicrobials reduce the risk of peristomal infection in placement of percutaneous endoscopic gastrostomies. BACKGROUND: Percutaneous endoscopic gastrostomies, placed surgically through the anterior abdominal wall, maintain nutrition in the short or long term. Those undergoing percutaneous endoscopic gastrostomy placement are often vulnerable to infection. The increasing incidence of methicillin-resistant Staphylococcus aureus contributes an additional risk to the debate surrounding antibiotic prophylaxis. The aim of antimicrobial prophylaxis is to establish a bactericidal concentration of an antimicrobial drug in the patient, during placement. DESIGN: Systematic review. METHODS: We searched the Cochrane Wounds Group Specialised Register (July 2006); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2); handsearched wound care journals, relevant conference proceedings and bibliographies of publications identified, and contacted manufacturers and distributors of percutaneous endoscopic gastrostomy products. Randomised controlled trials were selected evaluating the use of prophylactic antimicrobials for percutaneous endoscopic gastrostomy placement, with no restrictions for language, date or publication status. Both authors performed data extraction and assessment of study quality. Meta-analysis was performed where appropriate. RESULTS: Ten eligible randomised controlled trials were identified evaluating prophylactic antimicrobials in 1100 patients. All trials reported peristomal infection as an outcome and a pooled analysis resulted in a statistically significant reduction in the incidence of peristomal infection with prophylactic antibiotics (pooled OR 0.31, 95% CI 0.22-0.44). The relative reduction in risk of infection for those given antibiotics was 19% with the need to treat 5.8 patients to prevent one infection - NNT. CONCLUSIONS: Administration of systemic prophylactic antibiotics for percutaneous endoscopic gastrostomy placement reduces peristomal infection. RELEVANCE TO CLINICAL PRACTICE: The nurse's role in endoscopy is expanding rapidly and demands that practice is based on the best available evidence. This systematic review seeks to make a contribution to best practice in percutaneous endoscopic gastrostomy placement.

Confocal laser endomicroscopy: in vivo endoscopic tissue analysis.

In today's fast-paced world of instant messaging, high-speed Internet, and cell phones, patients want results of procedures in the same high-speed fashion. The development of the new technique of confocal laser endomicroscopy and the restructuring of the endoscope may enable quick procedure results to be delivered. First used in Germany and Australia for research and now available for clinical use, confocal laser endomicroscopy has been approved by the Food and Drug Administration for marketing and clinical use in the United States. This article provides the gastroenterology nurse with information about how the confocal laser endomicroscope works, assisting with the procedure, and pre- and postprocedure patient instructions.

An investigation into the information received by patients undergoing a gastroscopy in a large teaching hospital in Ireland.

The purpose of this article is to examine the information received by patients undergoing a gastroscopy. The growing number and complexity of day-case endoscopy increases the need for quality patient information. Provision of patient information reduces anxiety, increases knowledge, improves cooperation during endoscopy and increases compliance with discharge instructions. The study used a descriptive survey with convenience sampling (response rate 66%, N = 137). Patients received most of the standard procedural information (how and why the procedure is carried out), but they received considerably less sensory information (information regarding what they would hear, feel, smell, etc.). In addition, age and gender appeared to affect the amount of information received. Older patients received more procedural information than younger patients, and male patients received more information than female patients. The nurse was the main source of information. The majority of patients (>80%) received adequate information and were satisfied with the information received. Patients also received most of the information verbally on the day of the procedure rather than before admission. This study identified the need for patient information leaflets. The role of the nurse and the effect of age and gender on information provision are important considerations for healthcare professionals.

The effect of an information brochure on patients undergoing gastrointestinal endoscopy: a randomized controlled study.

OBJECTIVE: The aim of the present study was to test the potential beneficial effects of an information brochure on undergoing a gastrointestinal endoscopy for the first time. The information provided was based on self-regulation theory, and patients could restrict themselves to reading the summary only. METHODS: Patients were randomly assigned to an experimental group receiving the brochure at least 1 day before the gastroscopy (N=47), or to a control group not receiving the brochure (N=48). RESULTS: The results show that all experimental subjects, except one, fully read the brochure. Those receiving the brochure experienced less anxiety before the gastroscopy and, afterwards, they reported greater satisfaction with the preparation for it. With regard to coping style there were some small moderating effects into the direction expected: low blunters (those not seeking distraction under impending threat) as compared to high blunters showed extra reduced anxiety after reading the brochure. They also tended to read the brochure more often. High monitors (those seeking information under impending threat) receiving the brochure showed reduced anxiety during the gastroscopy as compared to low monitors (tendency). CONCLUSION: We conclude that providing patients with the developed brochure constitutes an efficient, beneficial intervention. PRACTICE IMPLICATIONS: The brochure could easily be implemented in standard practice without the necessity to take the patient's coping style into account.