Practice management of a multidisciplinary team caring for the child undergoing percutaneous gastrostomy tube placement

Abstract

Purpose to discuss, in a panel discussion format, the practice management of a multidisciplinary team caring for a child undergoing percutaneous gastrostomy tube (PGT) placement in interventional radiology (IR). Background Many children require a gastrostomy for nutritional supplementation and gastric decompression. Although the operative gastrostomy, first described in 1837 by Egeberg, is one of the oldest abdominal operations in continuous use, percutaneous gastrostomy, introduced by Sacks and Glotzer in 1979, has gained popularity. Currently, at The Children's Hospital of Philadelphia, the IR team performs more than 90 percutaneous gastrostomy procedures yearly. Methods The team, which includes gastroenterology nurse practitioners and physicians, radiology nurses, technologists, nurse practitioners, and interventional radiologists, ensures comprehensive care of the child as it relates to PGT placement. This team systematically evaluates appropriateness of the requested procedure; schedules the procedure with sedation or anesthesia according to patient needs; prepares the patient and family for 24-hour admission and care needs; performs the physical examination with a complete history; performs the procedure with ultrasound and fluoroscopic guidance; evaluates and manages intra- and postprocedure sedation needs, pain control, and complications; initiates enteral nutrition; remains appraised of feeding advancement and tolerance; and follows up for immediate and long-term complications and plans for primary tube change to skin level device when appropriate. Results Each year, more than 90 children successfully undergo percutaneous gastrostomy under fluoroscopic guidance in the IR department. Less than 1% of the patients referred to the service are not eligible for PGT and require a surgical consult. Conclusions Multidisciplinary pediatric teams can provide a service to children for successfully undergoing percutaneous gastrostomy.