Safety and Effectiveness of Percutaneous Endoscopic Gastrostomy May Be Improved by Proper Pre- and Post-Positioning Management of Elderly Patients with Multimorbidity
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
PEG Positioning and Follow-Up of Patients with PEG in HEN
2.2. Data Analyses
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Before the PEG positioning | The assessment of indications and contra-indications for PEG positioning | Indications: life expectancy greater than 30 days, normal gastrointestinal function, previous administration of enteral feeding by a nasogastric tube for at least 30 days, written informed consent by the patients or legal administrators Contra-indications: deep metabolic changes, organ failure, ascites, severe and uncorrectable coagulopathy, sepsis, inflammation of the gastric or abdominal wall, conditions that may alter abdominal trans illumination (obesity, previous laparotomies) [21] |
A day before PEG positioning | Suspension of any anticoagulant therapy Enema administration the night before PEG placement Fasting from the night before PEG placement Hair removal from the epigastric area Anesthesia visit ECG report Blood count and coagulation (data relating to a period not exceeding 48 h) Antibiotic prophylaxis one hour before the PEG placement Prompt pump inhibitor one hour before the PEG positioning | |
PEG positioning | Perioperative actions | Cleaning of the oral cavity Skin disinfection and asepsis of the abdominal insertion site Sedation |
PEG placement | Pull technique with 20 Fr tubes | |
After the PEG positioning | Post placement | Gastrostomy in drainage for 24 h Only intravenous hydration Monitoring of vital parameters (blood pressure, heart rate, diuresis, body temperature) and of the volume and quality of gastric drainage for 24 h, every 3 h Blood count test In the absence of complications, the administration of enteral nutrition within 24 h after the PEG positioning |
Patients at the Moment of PEG Positioning (n = 136) | Patients Treated with HEN (n = 88) | |
---|---|---|
Gender; Absolute frequencies (%) *⸸ | 74 (54.41%) F; 62 (45.59%) M | 56 (63.64%) F; 32 (36.64%) M |
Age, mean ± SD ^ | 81.34 ± 9.19 | 81.90 ± 9.26 |
Reasons for hospitalization, Absolute frequencies (%) * | 71 (52.17%) PEG positioning, 65 (47.83%) Other | 50 (56.81%) PEG positioning, 38 (43.19%) Other |
Albumin, Absolute frequencies (%) * | 9 (6.82%) < 2.5 g/dL; 127 (93.18%) ≥ 2.5 g/dL | 1 (1.14%) < 2.5 g/dL; 87 (98.86%) ≥ 2.5 g/dL |
Diseases, Absolute frequencies (%) * | ||
Dementia ⸸ | 74 (54.14%) | 54 (61.36%) |
Other neuro | 9 (13.43%) | 34 (38.63%) |
Cardio | 20 (14.70%) | 12 (13.63%) |
DM2 | 22 (16.17%) | 10 (11.36%) |
Multimorbidity; Absolute frequencies (%) * | 108 (79.41%) Yes; 28 (20.59%) No | 68 (77.28%) Yes; 20 (22.72%) No |
BMI, mean ± SD ^ | 20.90 ± 2.99 | 21.16 ± 2.95 |
Undernourished; Absolute frequencies (%) *⸸ | 75 (55.00%) Yes; 61 (45.00%) No | 42 (47.73%) Yes; 46 (52.27%) No |
Pressure Ulcers, Absolute frequencies (%) *⸸ | 50 (36.84%) Yes; 86 (63.16%) No | 40 (45.45%) Yes; 48 (54.55%) No |
Aspiration pneumonia; Absolute frequencies (%) * | 15 (10.71%) Yes; 121 (89.29%) No | 8 (9.09%) Yes; 80 (90.91%) |
Length of hospital stay; Median (min, Max) ^ | 4 days (min 1; max 70) | 3 days (min 1; max 70) |
Absolute Frequencies (%) | |
---|---|
HEN-related complications | 394 (100.00%) |
PEG-related | 278 (70.56%) |
| 90 (22.84%) |
| 188 (47.71%) |
Gastrointestinal | 112 (28.43%) |
Metabolic | 4 (1.01%) |
Complications | PEG-Related Complications/Complications | Patients with PEG-Related Complications/Tot Patients | |
---|---|---|---|
| |||
Buried bumper | 12 | 4.32% | 5.88% |
| |||
PEG tube occlusion | 6 | 2.16% | 8.82% |
PEG tube deterioration | 22 | 7.91% | 26.47% |
PEG tube breakage | 22 | 7.91% | 14.70% |
PEG tube dislocation | 36 | 12.95% | 23.53% |
Granulation tissue | 82 | 29.50% | 29.41% |
Peristomal site infection | 84 | 30.21% | 38.23% |
Redness | 2 | 0.72% | 2.94% |
Stoma enlargement | 12 | 4.32% | 14.71% |
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Orlandoni, P.; Jukic Peladic, N. Safety and Effectiveness of Percutaneous Endoscopic Gastrostomy May Be Improved by Proper Pre- and Post-Positioning Management of Elderly Patients with Multimorbidity. Nutrients 2024, 16, 2893. https://doi.org/10.3390/nu16172893
Orlandoni P, Jukic Peladic N. Safety and Effectiveness of Percutaneous Endoscopic Gastrostomy May Be Improved by Proper Pre- and Post-Positioning Management of Elderly Patients with Multimorbidity. Nutrients. 2024; 16(17):2893. https://doi.org/10.3390/nu16172893
Chicago/Turabian StyleOrlandoni, Paolo, and Nikolina Jukic Peladic. 2024. "Safety and Effectiveness of Percutaneous Endoscopic Gastrostomy May Be Improved by Proper Pre- and Post-Positioning Management of Elderly Patients with Multimorbidity" Nutrients 16, no. 17: 2893. https://doi.org/10.3390/nu16172893