Nutritional Support Access Devices (Adult)

Enteral Nutrition

Nasoduodenal and Jejunal Tubes
Percutaneous Gastrostomy (PEG), Jejunostomy (PEJ) Tubes and Buttons

• Safadi BY, Marks JM, Ponsky JL. Percutaneous Endoscopic Gastrostomy: An Update. Endoscopy 30(9):781-789,1998 This comprehensive review describes the indications for and the various techniques for PEG placement, including endoscopic, radiologic, and surgical. Complications of PEG and PEJ are briefly discussed, as are button gastrostomies.
• Shike M, Latkany L. Direct Percutaneous Endoscopic Jejunostomy. Gastrointest Endosc Clin N Am 8(3):569-580,1998 This review discusses the indications for jejunal feeding and describes the techniques for both conversion of a PEG to a PEJ as well as direct PEJ placement.

Complications of PEG and PEJ
a. Infectious

1. Skin
2. Peritonitis

b. Viscus Perforation
c. Colocutaneous Fistula
d. Tube Migration
e. Hemorrhage

• Shapiro GD, Edmundowicz SA. Complications of Percutaneous Endoscopic Endoscopy. Gastrointest Clin N Am 6(2):409-422,1996 This comprehensive review describes the various major complications of a PEG including aspiration, peritonitis, migration, perforation, gastrocolocutaneous fistula, hemorrhage, necrotizing fascitis, and tumor implantation. Minor complications including wound infections, tube deterioration, leakage, and complications of removal or replacement are also discussed
• Enterostomy Care

 

Parenteral Nutrition

Catheter Types
Catheter Complications

a. During Insertion
b. Occlusion

1. Thrombotic
2. Non-Thrombotic

c. Infections

Catheter Care

• Buchman AL. Handbook of Nutritional Support . Philadelphia: Williams and Wilkins, 1997, 186pp. This comprehensive review of nutritional support techniques details the techniques of catheter insertion and possible complications, catheter types including Hickman, Broviac, Groshong and percutaneously-inserted central catheters (PICCs), care of these catheters to prevent infection and thrombosis, diagnosis and treatment of catheter occlusion, diagnosis and treatment of exit site and tunnel infections, as well as catheter sepsis, and catheter care. Enteral feeding tube types and occlusion of feeding tubes is discussed. Complications of PEG/PEJ’s are described.