Authors (including presenting author) :
HO CW(1), Ada Chan WY(1), Kara Lau KY(1), Tang CN(1)
Affiliation :
(1) Department of Surgery, Pamela Youde Nethersole Eastern Hospital
Introduction :
Patient who has a Percutaneous Gastrostomy (PEG) requires tube change. Most often, tube confirmation in the stomach needs gastric fluid aspiration and checks by pH test. Most often, the pH is largely affected by medications and low output of gastric fluid. Complications of PEG include the wrongly placement of PEG tube and mal-positioned balloon.
Objectives :
This paper is the first local report, describes our experience to change the PEG tube under application of USG.
Methodology :
Conventionally; before 2019, new tube was blindly inserted through the gastrostomy down to the stomach. And then, gastric fluid was aspirated for pH test. PEG balloon was inflated if the pH was “strongly acidic”. But the tube could not be accurately confirmed in stomach for medications (Eg. Antacid or Proton Pump Inhibitors) and low output of gastric fluid which altered the pH value.
In 2019, we recruited 29 gastrostomy patients for tube change 15 (USG group): 14 (Conventional group). The probe entirely guided the enteral access until the tube down to the stomach. The balloon was inflated and visibly confirmed in the stomach, down below the muscle plane. Next the tube balloon accurately positioned below the anterior stomach wall.
Result & Outcome :
Ease of application and technical success were analyzed. In application, the confidence level reported 0.72 (USG) versus 0.98 (conventional). In technical success, it was far below to 0.63 (USG) versus 0.82 (conventional). But it was agreed that the USG allowed a better visualisation safe procedure on the enteral access and accuracy placement of the inflated balloon. The satisfaction level in terms of new nursing advances; quality and safe scored 0.87 and 0.95 respectively. It is the first local nursing report using USG in gastrostomy care. The expectedly low confidence level in “Ease of Application” and “Technical Success” in USG approach, because of the new nursing advances. Truly; it is a safe and real-time visualized practice compared with gastric fluid aspiration for pH test. USG is highly operator dependent, learning session should be highly recommended in near future.
