Batch Peg Initial with airSlate SignNow

Peg initials field

patience required feeding tubes when they're unable to meet their nutritional needs orally or by mouth those patients can include patients with neurologic disorders such as strokes or neuromuscular disorders trauma and surgical patients or patients with malnutrition or any or patients with dysphasia the patient that we perform the PEG tube procedure on today was unfortunate 24-year old male who had a vertebral artery dissection resulting in a suitable vascular accident and dense left hemiparesis and dysphasia his dysphasia is likely to continue for weeks if not months and he obviously requires nutrition during that period the percutaneous endoscopic gastrostomy feeding to procedure itself starts with prepping the patient's abdomen to make a sterile field passing the endoscope through the mouth and performing a routine upper and a complete upper endoscopy examination then the stomach is insulated with air one important complication we like to avoid is traversing the transverse colon when we place the PEG tube we attempt to decrease this complication by insulating the stomach well and then using good finger indention and transillumination so now I just make a skin incision right where I raised my wheel then make my skin incision again I make it a little bit smaller than the actual tube itself lights again and I make again make sure I still have a great finger indention and in transillumination then I go with my second syringe [Music] then you put the wire through and snare it get closer to it those alright go ahead pull out either bumper I think it's fine to use a lot of people like the round bumper but I tend to like the t bumper just gives us a little less obtrusive and we just attached the peg to the snare just loop it through and then it's well lubricated then we just pull it through you're going to make a smaller skin incision so it makes a little bit tougher to pull it through or requires a little more tug to pull it but I think there's less bleeding around the site when you get to do it that way and you can use the the measurement markings on the peg to give you some idea of how tight to make the the bumper the outer bumper and I always I always document where we set the marking at so at the outer bumper it's about at three and a half centimeters and I think the patient's got a little bit of a hematoma and the in the wall of the stomach and so you can use the bumper to to help tamponade that okay it's good so the other thing that we do after we get done just to make the patient more comfortable we sucked Arab but the scope but we also will just open up the peg and let the air out that way - that way again just for patient comfort I was Lee at the leg you have to open up your c-clamp as well that went here is the tummy's not quite as distended then we dress it [Music]