CoapTech News

5 Ways To Improve Gastrostomy Patient Safety

Jul 18, 2018 6:13:35 PM / by Howard Carolan, MPH, MBA

A gastrostomy can be a life-saving medical procedure for critically ill patients, providing much-needed nutrition, but this popular procedure also involves inherent risks.

Ever since the first known successful gastrostomy was performed in 1875, physicians have been making a surgical opening in the abdomen and the stomach to insert a G-tube that delivers nutritional support. According to a 2014 article in the World Journal of Gastroenterology, “PEG tube insertion is usually considered a safe procedure,” but known complications include wound infection, peritonitis, stoma leakage, aspirational pneumonia, bowel perforation and necrotizing fasciitis.

Percutaneous Ultrasound Gastrostomy (PUG) offers a safer, ultrasound-guided procedure that provides tissue visualization, as opposed to standard visualization with conventional endoscopically-guided gastrostomy tube placement. PUG uses magnets help bring the planes of tissue together, so the ultrasound can guide the physician to identify the ideal site for G-tube insertion. PUG ultrasound visualizes the patient’s tissue in real-time, protecting vasculature and critical anatomy from accidental perforation during tract formation.

Gastrostomy risks can be mitigated through a strategic approach focused on boosting patient outcomes. Here are five important ways physicians can improve gastrostomy patient safety:

  1. Prevent blind sticks. A potentially catastrophic gastrostomy complication occurs when a physician or surgeon inadvertently punctures, damages or ruptures delicate organs like the small intestine or vascular structures like blood vessels. By reducing the risk of trauma to the bowel, viscera and surrounding vasculature, gastrostomy patient outcomes can be dramatically improved. PUG uses magnets help bring the planes of tissue together, and ultrasound guides the physician to identify the ideal site for G-tube insertion. Because PUG ultrasound visualizes the patient’s tissue in real-time, blind sticks are effectively eliminated.
  2. Minimize cross-contamination and infection from reprocessed equipment. When conducting a gastrostomy, it’s important to keep the risk of infection as low as possible in order to ensure patient safety. This is especially true with extremely sick, immunocompromised ICU patients needing gastrostomy. With traditional PEG tube insertion, medical equipment is reprocessed and re-used on hundreds or even thousands of patients. Non-disposable medical equipment always carries a risk of not being properly processed, which can result in dangerous infections. A disposable gastrostomy kit, like the PUMA-G device that is currently pending FDA approval, reduces the risk of cross-contamination and infection by integrating single-use catheters, magnets, tubes, needles and guidewires into the gastrostomy procedure.
  3. Reduce risks due to patient transport. Numerous studies have demonstrated that a significant number of medical errors can occur when a patient transitions from one healthcare provider, team or unit to another. Any time a patient is moved to a new environment, with a new team of providers, there are risks involved. Bedside gastrostomy eliminates the need for a critically ill patient be transferred to a surgeon or a specialist in the operating or endoscopy suite. Instead, the gastrostomy procedure can be conducted at a patient’s bedside by a critical care physician or an interventional radiologist, minimizing transportation-related risks.
  4. Eliminate communication risks between providers. Communication is key when it comes to ensuring patient safety. Medical studies have underscored the fact that communication is critical to delivering optimal care, reducing patient harm and improving patient outcomes. By streamlining the gastrostomy process and enabling critical care physicians to perform this procedure at a patient’s bedside, opportunities for miscommunication between providers and teams are dramatically reduced.
  5. Decrease anesthesia-related risks. A landmark study involving 10 academic medical centers and nearly 600,000 surgical patients in the United States determined that the anesthesia-related mortality rate is 64 deaths per 100,000 procedures. The study estimated that the number of anesthesia-related deaths in the United States is 5,100 annually. By reducing the duration and the level of anesthesia required, bedside gastrostomy has the potential to decrease the risks traditionally associated with anesthesia, including cardiac arrest and respiratory complications.

Physicians striving to improve gastrostomy patient safety can reduce the risk of the most common gastrostomy complications, from untoward bowel perforations via blind sticks to cross-contamination. Making strategic decisions about the best technology and approach for G-tube placement can help improve gastrostomy patient outcomes.

Howard Carolan, MPH, MBA

Written by Howard Carolan, MPH, MBA

Mr. Carolan has worked at the Johns Hopkins Armstrong Institute for Patient Safety and Quality (“A.I.”) and at the Johns Hopkins Center for Innovation in Quality Patient Care. At A.I. he served as lead Project Manager for development of “Emerge” in partnership with the Johns Hopkins Applied Physics Laboratory. Emerge is a transdisciplinary program based on Systems Engineering principles that designed and developed computer applications with clinicians for improving medical care and patient experience.