Photo Source: https://www.health.qld.gov.au/__data/as sets/pdf_file/0028/146557/gastro_05.pdf Hi, there! My name is Kalena Merghart and I am a Sodexo Dietetic Intern within the distance cohort. Currently, I am completing my clinical rotation at Riverside Community Hospital in California and have been lucky enough to observe multiple medical procedures over the past few months. One of the most memorable procedures I witnessed was the placement of a percutaneous endoscopic gastrostomy (PEG) tube during the advanced clinical portion of my rotation.
For those who are not yet familiar, PEG tubes are used as an alternative route for medications, liquids, and food for patients with difficulty tolerating oral intake. Thankfully, my clinical site is a teaching hospital and the operating MD was open to allowing me to observe the procedure. The patient was a young man who suffered a car accident and was no longer able to tolerate oral intake to meet nutritional needs. As I stood bedside, I watched two assistants prep the previously intubated patient for PEG tube placement with the MD on standby. Once the patient was prepped and ready, the MD placed an endoscope through the esophagus into the stomach. This portrayed images of the patient’s stomach onto a screen, which assisted the MD with inserting a small needle through the patient’s abdomen to meet the endoscope. A wire was then directed through the needle and pulled out through the patient’s mouth serving as a guided line for PEG tube placement. The PEG tube was then guided through the mouth into the stomach. I anticipated the next step would be to pull the PEG tube out from the stomach; however, the MD then grabbed a scalpel to ensure the incision was large enough for the tube to exit the abdomen. I grabbed the counter to resist my instinct to look away as the incision was made and the feeding tube was pulled through. It was clear this MD had performed many PEG tube placements over the years and had become comfortable enough to portray natural choreography-like motions with each step. I continued to stand bedside in amazement of the finesse the surgeon displayed over about a 10-minute time span.
This moment was by far one of the most unexpected and appreciated moments experienced during my clinical rotation. For every patient thereafter, I was not only familiar with the purpose and functions of a PEG tube, but I was able to better understand the complete process of PEG tube placement and use from start to finish.
For those who are not yet familiar, PEG tubes are used as an alternative route for medications, liquids, and food for patients with difficulty tolerating oral intake. Thankfully, my clinical site is a teaching hospital and the operating MD was open to allowing me to observe the procedure. The patient was a young man who suffered a car accident and was no longer able to tolerate oral intake to meet nutritional needs. As I stood bedside, I watched two assistants prep the previously intubated patient for PEG tube placement with the MD on standby. Once the patient was prepped and ready, the MD placed an endoscope through the esophagus into the stomach. This portrayed images of the patient’s stomach onto a screen, which assisted the MD with inserting a small needle through the patient’s abdomen to meet the endoscope. A wire was then directed through the needle and pulled out through the patient’s mouth serving as a guided line for PEG tube placement. The PEG tube was then guided through the mouth into the stomach. I anticipated the next step would be to pull the PEG tube out from the stomach; however, the MD then grabbed a scalpel to ensure the incision was large enough for the tube to exit the abdomen. I grabbed the counter to resist my instinct to look away as the incision was made and the feeding tube was pulled through. It was clear this MD had performed many PEG tube placements over the years and had become comfortable enough to portray natural choreography-like motions with each step. I continued to stand bedside in amazement of the finesse the surgeon displayed over about a 10-minute time span.
This moment was by far one of the most unexpected and appreciated moments experienced during my clinical rotation. For every patient thereafter, I was not only familiar with the purpose and functions of a PEG tube, but I was able to better understand the complete process of PEG tube placement and use from start to finish.
