Dubagunta Srinivasan, Still Christopher D, Kumar Arvind, Makhdoom Zahoor, Inverso Nicholas A, Bross Ronald J, Komar Michael J, Mulhisen Lisa, Rogers Joanne Z, Whitmire Susan, Whilden Bethann
Department of Gastroenterology/Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA.
Nutr Clin Pract. 2002 Apr;17(2):123-5. doi: 10.1177/0115426502017002123.
Enteral feeding through the percutaneous endoscopic gastrostomy (PEG) tube is usually initiated about 12 to 24 hours after insertion of the tube. There have been earlier studies evaluating the efficacy of early initiation of enteral feedings that had encouraging results. However, delayed initiation of feeding following PEG placement continues to be practiced widely. We believe that feeding can be done earlier without any increase in associated morbidity or mortality and with obvious reduction in the need for parenteral nutrition and healthcare costs. We evaluated a protocol to initiate enteral nutrition 4 hours after the PEG tube insertion with subsequent discharge of the outpatients on the same day. We conducted a prospective study to assess the efficacy of early initiation of PEG feeding. We enrolled 77 patients in our study who were having PEG tubes placed for enteral feeding. Only patients who had a PEG placed for gastric venting procedures were excluded from our study. During the course of our study, no patient had to be excluded for the latter reason. Patients were evaluated by the physician performing the procedure, 4 hours after the tube was inserted. Their vital signs were checked, and a thorough abdominal examination was performed. Minimal tenderness around the PEG site was the most frequent finding. Otherwise, all the patients had a benign abdominal examination. The tube was flushed with 60 mL of sterile water. Following the examination, orders were given to restart the feedings. These patients were followed for a 30-day period to evaluate complications associated with PEG tube placement and early initiation of PEG feeding. There was one case of aspiration pneumonia (1.3%) and one death that was attributed to the underlying disease out of our 77 patients. Early initiation of enteral feeding after PEG tube placement can be successfully completed with a systematic protocol and close observation. Not only was this protocol found to be safe, it can also have significant cost savings by eliminating the need for inpatient hospitalization for the procedure.
经皮内镜下胃造口术（PEG）置管后，通常在置管12至24小时后开始肠内喂养。早期有一些研究评估了早期开始肠内喂养的效果，结果令人鼓舞。然而，PEG置管后延迟开始喂养的做法仍被广泛采用。我们认为可以更早开始喂养，而不会增加相关的发病率或死亡率，并且能明显减少肠外营养的需求和医疗费用。我们评估了一项方案，即在PEG置管后4小时开始肠内营养，随后让门诊患者在同一天出院。我们进行了一项前瞻性研究，以评估早期开始PEG喂养的效果。我们的研究纳入了接受PEG置管以进行肠内喂养的77例患者。仅将因胃减压手术而进行PEG置管的患者排除在我们的研究之外。在我们的研究过程中，没有患者因后一个原因而被排除。在置管4小时后，由实施该操作的医生对患者进行评估。检查他们的生命体征，并进行全面的腹部检查。PEG部位周围轻微压痛是最常见的发现。否则，所有患者的腹部检查结果均正常。用60毫升无菌水冲洗管道。检查后，下达重新开始喂养的医嘱。对这些患者进行了为期30天的随访，以评估与PEG置管和早期开始PEG喂养相关的并发症。在我们的77例患者中，有1例发生吸入性肺炎（1.3%），1例死亡，死亡原因是基础疾病。通过系统的方案和密切观察，PEG置管后早期开始肠内喂养可以成功完成。不仅发现该方案是安全的，而且通过消除该操作的住院需求，还可以显著节省成本。
