What is the two-person approach for percutaneous endoscopic gastrostomy (PEG) tube placement?

Updated: Dec 13, 2018
  • Author: Gaurav Arora, MD, MS; Chief Editor: Danny A Sherwinter, MD  more...
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Answer

Percutaneous endoscopic gastrostomy (PEG) tube placement is best completed by a two-person team that includes an endoscopist and a "skin person" to handle the nonendoscopic portions of the procedure (the skin person can be a physician or a physician's assistant). One approach to this procedure is shown in the video below.

Placement of percutaneous endoscopic gastrostomy (PEG) tube. Procedure performed by Reuben Garcia-Carrasquillo MD, ColumbiaDoctors, New York, NY. Video courtesy of ColumbiaDoctors (http://www.columbiadoctors.org).

Ensure that the patient has been fasting for at least 4 hours, preferably longer, especially if bowel obstruction is present.

A first-generation cephalosporin (eg, cefazolin 1 g) should be administered intravenously to reduce the risk of infection at the insertion site (see the image below). [15] If the patient is allergic to penicillin, an alternate antibiotic can be given for gram-positive coverage. If the patient is already taking antibiotics for another indication, additional antibiotics are not needed (but broad-spectrum gram-positive coverage should be ensured).

Regarding tube-site infections, most catheter-rela Regarding tube-site infections, most catheter-related infections involve local cellulitis, as shown here, with erythema and tenderness. These infections frequently respond to local wound care and oral antibiotics.

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