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Kim SH, Choi BG, Ok JS, Chun HJ, Lee HG. Policresulen to treat hypergranulation tissue around drainage tubes. J Wound Care 2023; 32:S11-S14. [PMID: 38063298 DOI: 10.12968/jowc.2023.32.sup12.s11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To evaluate the efficacy of policresulen for the treatment of hypergranulation. METHOD This was a retrospective study of patients with percutaneous catheters. Inpatients from two hospitals and those from outpatient clinics were included. Approximately 2ml of 50% policresulen solution was applied to hypergranulation tissue, which was then immediately pressed with gauze for 1-3 minutes using light pressure. When haemostasis was achieved and the granulation tissue size decreased, the procedure was terminated. RESULTS A total of eight patients (four females and four males) were included in this study. Effective haemostasis was achieved in all patients. The size of the hypergranulation tissue decreased with policresulen treatment, and resolved completely in one patient. There were no complications. Hypergranulation tissue recurred in one patient. Haemostasis was successfully achieved after repeated procedures. CONCLUSION The findings of this study showed policresulen to be an inexpensive, easy treatment for hypergranulation at catheter insertion sites.
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Affiliation(s)
- Su Ho Kim
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul, Korea
| | - Byung Gil Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul, Korea
| | - Jung Suk Ok
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul, Korea
| | - Ho Jong Chun
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul, Korea
| | - Hae Giu Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul, Korea
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Blinman T, Hiller D. Troubleshooting the pediatric gastrostomy. Nutr Clin Pract 2023; 38:240-256. [PMID: 36785522 DOI: 10.1002/ncp.10958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/02/2022] [Accepted: 01/07/2023] [Indexed: 02/15/2023] Open
Abstract
Gastrostomy tubes benefit patients but also introduce hazards and costs. Most of these costs tend to be administratively invisible, but clinically expensive. Nurses, residents, emergency physicians, surgeons, and others routinely manage complaints about gastrostomy tubes or sites, and the time and effort costs are enormous. Despite widespread use of gastrostomy tubes and the large "cost of ownership," scant instruction guides practitioners on troubleshooting the panoply of tube-related problems. Instead, clinical folk-wisdom leaves staff disarmed, resorting to lore or maladaptive work-arounds that are futile or even harmful. But tubes and gastrostomies fail in predictable ways. This guide reviews commonly used gastrostomy tubes and how they are placed. Routine care of these tubes both in the immediate postoperative period and long-term is detailed. Then, specific gastrostomy tube complications and their principle-based countermeasures are described, organized by presenting complaint. Throughout, specific clinical pitfalls are called out along with their remedies. The aim is to demystify these devices and dispel myths that lead to error.
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Affiliation(s)
- Thane Blinman
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dennis Hiller
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Boeykens K, Duysburgh I, Verlinden W. Prevention and management of minor complications in percutaneous endoscopic gastrostomy. BMJ Open Gastroenterol 2022; 9:bmjgast-2022-000975. [PMID: 35851280 PMCID: PMC9297220 DOI: 10.1136/bmjgast-2022-000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022] Open
Abstract
Background Percutaneous endoscopic gastrostomy (PEG) was developed by Ponsky-Gauderer in the early 1980s. These tubes are placed through the abdominal wall mainly to administer fluids, drugs and/or enteral nutrition but can also be used for drainage or decompression. The tubes consist of an internal and external retention device. It is a generally safe technique but major or minor complications may arise during and after tube placement. Method A narrative review of the literature investigating minor complications after PEG placement. Results This review was written from a clinical viewpoint focusing on prevention and management of minor complications and documented with real cases from more than 21 years of clinical practice. Conclusions Depending on the literature the incidence of minor complications after gastrostomy placement can be high. To decrease associated morbidity, prevention, early recognition and popper management of these complications are important.
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Mahmoud ME, Aldaraan KZ, Hassab MH, Aljabr SF. Schistosoma ova found in gastrostomy site granulation tissue. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Johnson TW, RN SS, Epp L, Mundi MS. Addressing Frequent Issues of Home Enteral Nutrition Patients. Nutr Clin Pract 2019; 34:186-195. [DOI: 10.1002/ncp.10257] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Teresa W. Johnson
- Department of Kinesiology & Health Promotion; Troy University; Troy AL USA
| | | | - Lisa Epp
- Mayo Clinic; Rochester Minnesota USA
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León AH, Hebal F, Stake C, Baldwin K, Barsness KA. Prevention of hypergranulation tissue after gastrostomy tube placement: A randomised controlled trial of hydrocolloid dressings. Int Wound J 2018; 16:41-46. [PMID: 30160369 DOI: 10.1111/iwj.12978] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/16/2018] [Indexed: 11/26/2022] Open
Abstract
Hypergranulation tissue formation is a common complication after gastrostomy tube (G-tube) placement, occurring in 44%-68% of children. Hydrocolloid dressings are often used in the treatment of hypergranulation tissue but have not been studied for the prevention of postoperative hypergranulation tissue. An institutional review board (IRB)-approved, prospective, randomised study was performed in paediatric patients who underwent G-tube placement at a single, large children's hospital from January 2011 to November 2016. After placement, patients were randomly assigned to (1) standard postoperative G-tube care, (2) standard hydrocolloid G-tube dressing, or (3) silver-impregnated hydrocolloid G-tube dressing, and the incidences of postoperative hypergranulation tissue formation, tube dislodgement, infection, and emergency department use were compared. A total of 171 patients were enrolled; 128 patients (75%) had at least 4 months of follow up and were included in the analyses. Eighty-nine patients (69.5%) developed hypergranulation tissue during the postoperative period, with no significant differences in incidence among the three treatment arms. Of those who developed hypergranulation tissue, 46 (56%) visited the emergency department, compared with 6 of the 39 patients (19%) who did not develop hypergranulation tissue. Hydrocolloid dressings (standard or silver-impregnated) do not prevent the development of hypergranulation tissue or other complications after G-tube placement in paediatric patients.
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Affiliation(s)
- Astrid H León
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ferdynand Hebal
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Christine Stake
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Kerry Baldwin
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Townley A, Wincentak J, Krog K, Schippke J, Kingsnorth S. Paediatric gastrostomy stoma complications and treatments: A rapid scoping review. J Clin Nurs 2018; 27:1369-1380. [PMID: 29266535 DOI: 10.1111/jocn.14233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 01/12/2023]
Abstract
AIMS AND OBJECTIVES To provide a scoping review of the types of treatments used to address paediatric skin-related stoma complications specific to infection, hypergranulation and gastric leakage, and explore their effectiveness and indications for use. BACKGROUND Stoma-related complications can be a common occurrence for children with gastrostomy (G) and gastrojejunostomy (GJ) tubes. Nurses require guidance to inform decision-making of the broad spectrum of treatments used in clinical practice. DESIGN A scoping review using a rapid review approach. METHODS Working with a multidisciplinary health professional team, search terms were generated. A systematic search of CINAHL, MEDLINE and EMBASE databases was completed, coupled with an Internet search to identify relevant clinical practice guidelines and hand searching of citation lists. Eligible articles were peer-reviewed English publications, focused on paediatric populations aged 18 years and under, dating from 2002-2016 and described complications and treatment approaches related to G- and GJ-tube stomas. Pertinent information was extracted using a standardised template, and a narrative synthesis approach was used to analyse the data. RESULTS Twenty-five articles were included in this review. Study designs varied, and complication management was often a secondary focus. A broad spectrum of treatments was used to manage each complication type. There was a lack of consensus on lines of therapy; however, a stepwise approach was often used for complication management, particularly for infections. CONCLUSIONS The evidence on the comparative effectiveness of different treatment strategies of skin-related gastrostomy stoma complications in paediatric practice is sparse. Current evidence is generally limited to expert opinions. Future studies examining efficacy of treatments and their indications for use with children are warranted. RELEVANCE TO CLINICAL PRACTICE Effective management of skin-related stoma complications is important to maintain health and wellness among children who rely on G- and GJ-tubes for nutrition support.
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Affiliation(s)
- Ashleigh Townley
- Evidence to Care, Teaching & Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Joanne Wincentak
- Evidence to Care, Teaching & Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Kim Krog
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Julia Schippke
- Evidence to Care, Teaching & Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Shauna Kingsnorth
- Evidence to Care, Teaching & Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Strollo BP, McClave SA, Miller KR. Complications of Home Enteral Nutrition: Mechanical Complications and Access Issues in the Home Setting. Nutr Clin Pract 2017; 32:723-729. [DOI: 10.1177/0884533617734529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Brian P. Strollo
- Department of Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Stephen A. McClave
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Keith R. Miller
- Department of Surgery, University of Louisville, Louisville, Kentucky, USA
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Abdelhadi RA, Rahe K, Lyman B. Pediatric Enteral Access Device Management. Nutr Clin Pract 2016; 31:748-761. [DOI: 10.1177/0884533616670640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Ruba A. Abdelhadi
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Katina Rahe
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Beth Lyman
- Nutrition Support Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
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