1 How is gastrostomy done?

This operation is carried out to obtain the outer opening in the stomach. In this gastrostomy can be carried out either under local anesthesia, or under general anesthesia, when the patient feels that he is in a deep sleep and does not realize what is happening around. When gastrostomy is performed under local anesthesia, the patient is awake, but one part of his body has no sensitivity.

To perform the installation of gastrostomy, a short surgical procedure with a duration of no more than half an hour is necessary. When gastrostomy is performed, the surgeon makes a hole( stoma), which approximately has a diameter in a conventional pencil. During this, a cut of the skin and stomach occurs, which is then well mounted to the wall of the abdominal cavity. Then the L-shaped tube is inserted into the stoma. This tube, which can be made from various materials, is fixed in place thanks to a special disk or balloon. A water-filled balloon has a valve inside it, which makes it possible to get inside the food, but do not go back out.

You can obtain the required hole in two ways. During the first method, an endoscope is used, which is inserted into the mouth and the esophagus is passed through. The stomach during the endoscopic percutaneous procedure is specially inflated with air. Light from the endoscope allows the surgeon to make a cut in the right place of the stomach. When gastrostomy is performed according to the second method, the presence of an endoscope is not provided. A small incision is instead made from the left external side of the stomach through the abdominal cavity.

Insert a flexible gastrostomy tube, which is usually made of rubber or polyvinyl chloride, into the stomach. Around the tube, the stomach is tightly and well-stitched so that there is no outward flow of the contents of the stomach.

It depends on the general health and age of the patient what time after the operation of gastrostomy it should be observed by specialists in a medical institution. It happens that some patients can return home after several days of hospitalization, however, as a rule, the period lasts longer. Usually, stomach and stomach healing occurs in about 8-10 days.

2 Advantages and disadvantages of the

method The main advantage of gastrostomy is a simple and, most importantly, safe introduction of food into the stomach, since using a gastric probe can cause the following problems:

• requires special skills;
• difficulties with probe placement;
• risk of exposure to the airway of the probe;
• Risk of ingestion of food.

Because of all these moments gastrostomy is the most convenient way of feeding a person, in case of his severe condition.

However, this method of feeding has its own disadvantages. During feeding through the gastrostomy, there is no contact of food with the receptors of the tongue, so the information in the brain simply does not come. Because of this, different neural connections of the central system begin to work more slowly. As a consequence, a person can gradually lose some abilities, the risk of mental disorders increases, and the patient gradually becomes only a functioning body. However, for a person to fully and normally eat, one must sacrifice his intellectual state.

In addition, it is necessary to perform constant care of the feeding tube, since the stoma has a mucous membrane, and penetration of gastric juice into it can lead to adverse effects.

It is worth saying that the gastrostomy tube itself costs a minimum of $ 40, while it is not always possible to purchase it in a small city. Therefore, instead of a special tube, a Foley catheter is often used, used to drain cavities, as well as delivering drugs to them. Since this catheter is a tube, it has 3 outlets at one end: the first for drug administration, the second for drainage of cavities with various antiseptic solutions or delivery of liquid food into the stomach, and the third for pumping with furacilin solution, saline solution or cuff airat the other end for insertion of the catheter into the cavity).

Foley catheter can be used as a gastrostomy tube, however, it often causes many problems with its use.

3 Correct installation of

gastrostomy tube. It is quite easy to install the tube, however, it is necessary to follow the sequence of actions. The gastrostomy tube itself is a tube, as well as a fixation ring. These products can have a different structure, including those that are used after surgery using an endoscope.

The installation of the balloon tube is started from the control cylinder filling with water or physiological solution. To the tube tightly fixed, enough 8-9 ml. In order to identify a possible marriage, it is necessary to check the ball, since in case of a puncture it will be impossible to use a gastrostomy tube.

In the case of the tightness of the cylinder, the liquid from it is taken out and inserted into the stoma tube by approximately 40-50 mm. After that, again fill the cylinder with liquid in the required volume and check the strength of the fastening by pulling the tube toward you. The degree of strength in this case should be well felt.

At the very end of the unit, when using gauze sterile wipes, the hole is closed and then the ring is tightened. Sometimes it happens that the fixation ring is weakened, then it should be simply glued with adhesive plaster.

4 Feeding through gastrointestinal tract

To the discharge period about 1.5 weeks after the operation, the number of feedings is reduced, and the volume of food can reach about 2 liters per day. The food is injected through a funnel attached to the outer end of the gastrostomy tube. This action can be learned by the patient himself, or by resorting to the help of relatives.

The following products can be introduced through the tube:

• fruit and vegetable purees;
• fish and meat broths;
• milk, kefir, kissels;
• rubbed porridge and soup;
• raw egg;
• yogurts;
• compote, tea and kissels.

Food for a patient who feeds through the tube should not be cold and hot, just a little warmed up.

Today you can buy mixtures that are specifically designed for enteral nutrition. All of them have a balanced composition of vitamins, microelements and nutrients.

As a rule, after adaptation it is necessary to spend 5-6 feedings per day. In this case, the volume of one portion, depending on the patient's condition, should be on the order of 250-350 ml. These specialists call bolus nutrition.

Sometimes this type of nutrition is poorly tolerated by patients, especially by bedridden heavy patients. In this case, they resort to continuous feeding: by means of a pump or a special dispenser, the introduction of the food mixture occurs slowly and continuously.

Both before and after each feeding procedure, the tube must be washed with saline or clean water. If a patient has a permanent tube, then it must necessarily be closed with a special stopper after feeding.

If the patient is able to chew on his own, it is recommended that he chew a little food to increase gastric secretion and get a taste sensation.

It is necessary to periodically treat the skin around the opening with antiseptics to avoid possible maceration( wetting).