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59 Cards in this Set

  • Front
  • Back

why are stents not inserted if there is a stricture more distal in the GI tract

because a stent higher up will not resolve digestion problems

what are indications for GI stents



presence of malignancy


relieve pressure from tumor outside esophagus


presence of fistula between esophagus and trachea

why would an esophageal stent be needed for a patient with malignancy

if there is malignancy, esophagus stent placement allows for palliative care or nutritional support before treatment

why would an esophageal stent be needed for a patient with a tumour outside their esophagus

A stent could push a displaced esophagus back into place and the push the tumor away to clear passage way

why would it be necessary to place a stent in an area with a fistula

stent allows blockage of fistula preventing possibility of possible aspiration

what are contraindication of stent insertion

coagulopathy (blood clotting disorder)


pt not well enough for procedure


peritoneal seeding (Ca of abdo that has spread to the peritoneum as sm seedings


obstruction of stomach or small bowel


presence of high strictures close to vocal cords

what equipment in used in stent placement

done in IR suite under fuoro with similar equipment to as other IR procedures

what are the most common stents in esophageal stenting

self expanding stents

what are self expanding stents made of

metallic with plastic (teflon) coating

what size are self expanding stents

16-18F with expanded diameter of 16-24mm

why are self expanding stents ideal for esophageal stenting

they are retrievable, have antireflux option where a one way valve reduces the likelyhood of reflux after the procedure

what are the two types of stents available

covered


uncovered

what are the benefits of using an uncovered stent

decreased chance of migration or movement but increased chance of blockage from growing tumors that can invade walls of stents

what are the benefits of covered stents

almost no chance of tumor invasion


often first choice

what design element reduces the risk of migration

a small partial covering on the inside of the stent

why would an esophageal stent be removed after a short period of time

if a benign structure is present and only temporary dilation is required (6-8wks)


when pt tolerance is questionable


after surgery to improve pt nutrition postop


if fistula is present and requires time to heal

what exam must be done before stent placement and why

a modified swallow or other contrast exam of the upper GI tract to define length and severity of stricture

describe the procedure for esophageal stent placement

pt in lateral pstn with conscious sedation


catheter suitable for oral ingestion inserted down esophagus


placement confirmed with contrast


stiff guidewire passed through stricture into gastric antrum


stent delivery device passed over wire and across stricture


stent deployed by pulling back outer sheath under fluoro

what follow up is done for esophageal stent placement

follow up contrast study may be performed to confirm placement and assess function

what is the postprocedural care for esophageal stents

pt restarted on oral fluids and progress to a low residue diet (food without fiber)

what dietary advice is given to the patients

take small bites


chew well


take plenty of fluid with meals


consume fizzy drinks to allow air to escape stomach


treat reflux with medication

what are the complications of esophageal stents

haemorrhage


chest pain


migration of stent


perforation


death

where is a colonic stent placed

in a stricture of the large bowel when the patient has been diagnosed with malignancy

stent may serve to be a....?

prelude to delayed surgery


preventative easure to avoid further blockage


palliative measure for pts with inoperatable Ca due to mets and high risk of death from surgery

what are contraindications to a colonic stent

perforation


uncooperative patient


right colic lesion

how is a right colic lesion best treated

with ileocolonic anastomosis surgery

why is a stent not placed if there is a right colic lesion

because the ascending colon can be tortuous and if an attempt is made there is a high risk of perforation and a chance the rad will not be able to move the guidewire or catheter all the way along the bowel to reach the lesion

what are complications of colonic stents

perforation


migration of stent


reobstruction of colon



where are enteral feeding tube insertions commonly done

in the IR suite

who are enteral feeding tube insertions done for

pts who require long term enteral feeding and are unable to swallow due to pathology (neurological damage or tumors)

where can the enteral feeding tubes be inserted to

in the stomach (gastrostomy)


@ the stomach/jejunum (gastrojejunostomy)


in the jejunum (jejunostomy)

what does the placement depend on

existing history

why are Gtubes preferred when possible

because the stomach will still be involved in digestion even though the tube is used for feeding

what are indications for G tube placement

pt rneeds nutrition support after biliary surgery


dysphagia due to CVA, Ca, dementia, or trauma


small bowel disease short gut syndrome, Crohns


anorexia


gastric decompression: gastroparesis, ileus, obstruction caused by malignancy

what do patients not require with a G tube that they would for other feeding tubes

a feeding pump

when are J tubes a good option

for patients who are more likely to experience reflux, aspirate, or have delayed emptying of stomach

what are indications for Jtubes

pt requires feeding after stomach or duodenal surgery



what are cons to J tubes

need feeding pump


known to clog more often than G tube


needs to be flushed with water after feeding

under what circumstances are GJ tubes placed

when patient is no longer able to tolerate G tube



how is a patient switched from a Gtube to a GJ tube

existing feeding tube is passed further along GI tract at the junction of the stomach and small bowel

how are indications for GJ tube insertion categorized

by relative or absolute

what is an absolute indication

a definite indication where there is pathology involving the GI tract

what is a relative indication

another area of the body is affected requiring intervention of the GI system

what are some examples of absolute indications

previous total gastroectomy


gastric carcinoma


uncorrectable coagulopathy


non functional GI tract

what are examples of relative indications

ascites


gastric varices


peritoneal dialysis


inability to insert G tube


previous complex abdominal surgery

Where are J tubes inserted and why

in the endoscopy department or OR because the jejunum is a very mobile structure and is difficult to localize with fluoro

what are the tech's responsibilities for tube placement

have all of pts previous images available for rad to view


set up sterile tray


prepare sterile field


operate fluoro equipment

what is on the sterile tray for tube insertion

10mL 1% lidocaine


18G needle


T fastener to adhere the catheter to the patient


stiff wire (amplatz)


dilator (6-12F)

how do catheters differ in tube placement

in their shape that anchors onto the stomach eg pigtail, mushroom, or balloon

what will a patient requiring a J or NJ tube already have

and NG tube

describe the procedure or tube placement

pt needs IV access for pain medication


pt given one dose of antibiotic before procedure to prevent infection


rad checks pstn of liver with US


rad insufflates stomach to place it below the rib cage, liver, and colon


needle inserted midway between lesser and greater curvature of stomach


catheter (G/GJ tube) inserted to desired location

how much air is used to insufflate the stomach

250-400ccs

why is the needle inserted half way between the greater and lesser curvature of the stomach

to avoid all major vessels

where is the end of a G tube placed

toward the fundus of the stomach

where is the end of the GJ tube placed

toward the duodenum allowing easy conversion to J tube

what is the post procedure for tube placement

tube placed in gravity overnight

why is a tube placed in gravity

to permit it to sit freely below the patient's stomach allowing residual gastric secretions to flow out of the body

what indicates that something may be wrong

large amounts of residuals visible after several hours may indicate bowel motility or inappropriate position

when can tube feeding comence

when there is no residuals present