Construction and validation of an educational booklet on care for children with gastrostomy.

OBJECTIVES: to describe the process of construction and validation of an educational booklet on care for children with gastrostomy, directed to caregivers. METHODS: a methodological study developed in five stages: bibliographic survey; situational diagnosis; illustration, layout, design and text construction; expert validation and Flesch-Kincaid Readability calculation; validation with the target audience. Content Validity Index and Suitability Assessment of Materials were applied for expert analysis. RESULTS: the Content Validity Index obtained overall score of 0.93. In the Suitability Assessment of Materials score, the booklet scored 85.2%. It presented a satisfactory readability percentage, with an overall score of 72%, and was consistent with caregivers' assessment in the validation with the target audience, considering the explanatory technology, important and adequate. CONCLUSIONS: the developed educational booklet was considered valid for use by caregivers, thus contributing to the maintenance of best practices in care for children with gastrostomy.

Providing optimal nursing care for patients undergoing enteral feeding.

Enteral feeding is defined as the intake of food directly into the gastrointestinal (GI) tract. Enteral feeding tubes can also be used to administer medicines. Patients who may require enteral feeding include those who are unconscious, or those with neurological swallowing disorders, upper GI obstruction, GI dysfunction or malabsorption. There are several routes that can be used for enteral feeding including gastrostomy, post-pyloric, nasogastric, continuous pump and bolus feeding. When undertaking enteral feeding, nurses and other healthcare professionals should be aware of the potential complications such as tube blockage and infection. This article examines the various enteral feeding routes, discusses the administration of medicines, and details the common complications associated with enteral feeding.

A grounded theory study of the perceptions and meanings associated with gastrostomies among parents of children with palliative needs.

BACKGROUND: There is few literature on the difficulties and different meanings of gastrostomy tubes (GST) for parents of children with palliative needs, and what specific palliative care teams contribute to this process. AIM: To explore the process of information in the decision of performing a gastrostomy and the meanings that parents of children with palliative needs build around them. DESIGN: Semi-structured interviews which were transcribed and analysed using Grounded Theory. SETTING/PARTICIPANTS: Parents and caretakers of children admitted in Paediatric Palliative Care Unit of Madrid Autonomous Community (Spain) whose children bore a gastrostomy device. RESULTS: Two core categories arise ('Fight' and 'The child as a life-meaning generator'). In all the cases, the child supplied the meaning to go on, and the Palliative Care Unit (CPU) helped in the daily care of the child and solving problems derived from the handling of the GT. CONCLUSIONS: It is necessary to improve the process of giving bad news and to introduce models of health care that focus on parents and child as the center of palliative care. It is also necessary to develop educational programs that enable continuity of care at home for children with palliative needs.

Creative and sensitive production of care-educational technology for families of children with gastrostomy / Producción sensible y creativa de tecnología cuidativo-educativa para familias de niños con gastrostomía / Produção sensível e criativa de tecnologia cuidativo-educacional para famílias de crianças com gastrostomia

Abstract Objective: To describe the production process of a care-educational technology for families of children with gastrostomy based on the models of Hildegard Peplau and Paulo Freire. Method: Descriptive and qualitative research, carried out from October 2016 to February 2017 in three health units and a residential unit in São Luís, MA, Brazil. Thirteen family members participated. Were used from the creative method sensitive to dynamic body knowledge, semi-structured interview and observation. Thematic analysis. Results: From the problem situations that emerged from the corpus, the contents of the technology were constructed, and decoding in subtopics. The technology is of the printed type (booklet), titled The child and his gastrostomy: a guide for families and caregivers. Contains 24 pages and nine content topics, with texts and images. Conclusion: Social evidence that favored the production of a technology that is sensitive to reality, which, after being validated, will help families emerged. Implications for practice: The booklet can be used in the teaching and assistance activities of the families.

Resumen Objetivo: Describir el proceso de producción de una tecnología curativo-educativa para familias con niños gastrostomizados, a partir de los modelos de Hildegard Peplau y Paulo Freire. Método: Estudio descriptiva, cualitativo, realizado entre octubre 2016 y febrero 2017, en tres unidades de salud y una unidad domiciliar en São Luís, MA, Brasil. Participaron 13 familiares. Método creativo-sensible a la dinámica cuerpo saber, entrevista semiestructurada y observación. Análisis temático. Resultados: De las situación-problema emergidas del corpus, se construyeron contenidos de la tecnología, con la descodificación en subtemas. La tecnología es tipo impresa (cartilla), titulada El niño y su gastrostomía: una guía para familias y cuidadores. Contiene 24 páginas y nueve temáticas, con textos e imágenes. Conclusión: Emergieron evidencias sociales que favorecieron el desarrollo de una tecnología sensible a la realidad que, después de comprobada, ayudará a las familias. Implicaciones para la práctica: La cartilla se puede utilizar en las actividades de enseñanza y asistencia de las familias.

Resumo Objetivo: Descrever o processo de produção de uma tecnologia cuidativo-educacional para famílias de crianças com gastrostomia a partir dos modelos de Hildegard Peplau e de Paulo Freire. Método: Pesquisa descritiva, qualitativa, realizada entre outubro de 2016 a fevereiro de 2017 em três unidades de saúde e uma unidade domiciliar em São Luís, MA, Brasil. Participaram 13 familiares. Utilizou-se do método criativo sensível à dinâmica corpo saber, a entrevista semiestruturada e observação. A análise foi temática. Resultados: Das situações-problema que emergiram do corpus, foram construídos os conteúdos da tecnologia, com descodificação em subtemas. Tecnologia do tipo impressa (cartilha), intitulada A criança e sua gastrostomia: um guia para famílias e cuidadores. Contém 24 páginas e nove tópicos de conteúdo, com textos e imagens. Conclusão: Emergiram evidências sociais que favorecem a produção de uma tecnologia sensível à realidade, que após validação, ajudará as famílias. Implicações para a prática: A cartilha poderá ser utilizada nas atividades assistenciais e de ensino.

Clinical Practice Guidelines for the Nursing Management of Percutaneous Endoscopic Gastrostomy and Jejunostomy (PEG/PEJ) in Adult Patients: An Executive Summary.

Enteral nutrition (EN) is the introduction of nutrients into the gastrointestinal tract through a tube placed in a natural or artificial stoma. Tubes may be passed into the stomach (gastrostomy) or the jejunum (jejunostomy) in patients who cannot obtain adequate nourishing via oral feeding. Following placement, nurses are typically responsible for management of gastrostomy or other enteral tube devices in both the acute and home care settings. This article summarizes guidelines developed for nursing management of percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEJ) and gastrojejunostomy (PEGJ) tubes, developed by the Italian Association of Stoma care Nurses (AIOSS-Associazione Italiana Operatori Sanitari di Stomaterapia) in collaboration with the Italian Association of Endoscopic Operators (ANOTE-Associazione Nazionale Operatori Tecniche Endoscopiche) and the Italian Association of Gastroenterology Nurses and Associates (ANIGEA-Associazione Nazionale Infermieri di Gastroenterologia e Associati). The guidelines do not contain recommendations about EN through nasogastric tubes, indications for PEG/PEJ/PEGJ positioning, composition of EN, selection of patients, type of tube, modality of administration of the EN, and gastrointestinal complications.

Nurse-Assisted Percutaneous Endoscopic Gastrostomy Tube Placement Is a Safe Procedure in Adult Patients.

The percutaneous endoscopic gastrostomy (PEG) procedure is normally carried out by two doctors. Preliminary experience has suggested that this procedure may be accomplished with the same safety level using one doctor and a specially trained endoscopy nurse. The aim of the study was to assess the immediate outcome and 30 days' procedure-related morbidity following nurse-assisted percutaneous endoscopic gastrostomy (NA-PEG) in an unselected population of adult patients. Retrospective, nonconsecutive analysis of NA-PEG procedures were registered between 2008 and 2014. Demographic data, indications, and early and late procedure complications were registered. During the study period, a total of 222 nonconsecutive adult patients had a NA-PEG placement. Neurologic (56%) and malignant diseases (35%) were the major indications for the PEG placement. The NA-PEGs were performed by six specially trained endoscopy nurses. NA-PEG-related overall morbidity was 24%, and all complications were minor. No procedure-related mortality occurred. When NA-PEG was compared with standard PEG placement literature, there was no increase in the number of complications, and the types of complications were similar. Despite being performed in patients with multiple co-morbid conditions, NA-PEG was a safe procedure with no mortality and minor complications. We suggest that NA-PEG should be used on a larger scale with the intention of saving time and medical costs.

Plan de cuidados a un paciente portador de una sonda de gastrostomía / Plan of care for a patient with a gastrostomy catheter

Se expone el caso de un paciente portador de sonda de gastrostomía por presentar neoplasia del seno piriforme que impide la deglución. Cuando el paciente fue derivado a la consulta presentaba irritación importante de la piel que rodeaba la sonda de gastrostomía debido a la emisión continua de jugos gástricos, así como por pérdidas de alimentación provocadas por la holgura excesiva del estoma y dolor continuo en la zona. Dicha situación no permitía descansar al paciente, generándole sentimientos de preocupación y desánimo. Utilizando los patrones de Marjory Gordon se valoró al sujeto, identificando los diagnósticos enfermeros según la taxonomía de la North American Nursing Diagnosis Association (NANDA), los resultados según la Nursing Outcomes Classification (NOC) y las intervenciones enfermeras oportunas, siguiendo la Nursing Intervention Classification (NIC), para que el paciente adquiriera las habilidades necesarias para el manejo de su sonda de gastrostomía, supiera cómo administrar adecuadamente la alimentación y los medicamentos a través de la misma y mantuviera la integridad de la piel periestomal (AU)

We present the case of a patient with gastrostomy due to neoplasia in the pyriform sinus that prevented swallowing. When the patient was referred, he presented a major irritation of the skin around the gastrostomy catheter, due to the continuous production of gastric juices, as well as food losses caused by the excessive width of the ostomy and continuous pain in the area. Said situation prevented the patient from resting, and generated feelings of concern and discouragement. The patient was assessed using Marjory Gordon's patterns, identifying nursing diagnoses according to the taxonomy by the North American Nursing Diagnosis Association (NANDA), outcomes according to the Nursing Outcomes Classification (NOC), and the adequate nursing interventions, following the Nursing Intervention Classification (NIC), so that the patient acquired the skills needed to manage his gastrostomy catheter, learning how to administer adequately food and medications through it, and maintaining the integrity of peristomal skin (AU)

Topical Corticosteroid for the Treatment of Hypergranulation Tissue at the Gastrostomy Tube Insertion Site: A Case Study.

Hypergranulation tissue formation around a gastrostomy tube insertion site is a common feeding tube-related complication that affects patients who receive long-term enteral nutrition. Some clinicians recommend use of a topical corticosteroid in patients with gastrostomy tube insertion site hypergranulation. However, documentation is scant regarding appropriate treatment for this condition. This case report describes a 67-year-old bedridden man with spinocerebellar degeneration who presented with hypergranulation at the site of the gastrostomy tube, inserted 1 week earlier. The tissue was raw and inflamed, with bleeding and exudation. The gastrostomy site was gently cleansed with gauze dampened with tap water, and topical 0.05% clobetasol propionate ointment was applied directly to the hypergranulation tissue twice daily. After 4 days of treatment, the hypergranulation tissue almost completely disappeared, redness markedly decreased, and bleeding and exudation ceased, with no recurrence observed during the 6 months of follow-up. This case study supports other reports that short-term corticosteroid treatment may be a safe, quick, noninvasive, and effective treatment for hypergranulation at the gastrostomy tube insertion site. Further studies are needed to evaluate the safety, effectiveness, appropriate dosage, and duration of topical corticosteroid for the treatment of hypergranulation tissue.

Respuesta de los autores: español o inglés en la comunicación científica / Authors' reply: Spanish or English in scientific reporting

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Percutaneous Endoscopic Gastrostomy: A Practical Overview on Its Indications, Placement Conditions, Management, and Nursing Care.

Percutaneous endoscopic gastrostomy (PEG) feeding represents the most effective and safest option for feeding patients with an impaired or diminished swallowing ability, despite having a functioning digestive system. The use of PEG has evolved to be useful in many situations beyond degenerative neuromuscular disorders, with an increasing body of evidence supporting the advantages of PEG tubes in oncologic and pediatric patients. Risk factors for complications after PEG tube placement include acute and chronic conditions associated with malnutrition and several organic disorders. Patients suitable for PEG tube placement should be individually identified to implement the advantages of this technique while minimizing risk events. The safety of placing a PEG tube in patients under antithrombotic medication has been investigated, as well as the advantages of antibiotic prophylaxis in reducing peristomal infection. Evidence supports the safety of early feeding after placement, thus resulting in lower costs. Percutaneous endoscopic gastrostomy-related complications are rare and mostly prevented by appropriate nursing care. Best medical practice and nursing care will ensure optimal performance leading to a wider acceptance, and greater utility of PEG by healthcare professionals, patients, and caregivers. This review aims to update knowledge relating to PEG tube indications, placement, management, and care in order to reinforce PEG feeding as the most valuable access for patients with a functional gastrointestinal system who have abnormalities in swallowing mechanisms.

Avaliação de famílias de crianças e adolescentes submetidos à gastrostomia / Family evaluation of children and adolescents submitted to gastrostomy

O estudo objetivou conhecer a estrutura, funcionamento e desenvolvimento da família, identificar redes de apoio social no cuidado à criança e ao adolescente gastrostomizado, e descrever dificuldades e facilidades enfrentadas nessa experiência. Utilizou-se o Modelo Calgary de Avaliação Familiar, como referencial teórico, tendo sido acrescido da entrevista semiestruturada como instrumento de pesquisa; a Análise de Narrativa foi o método seguido. O uso do dispositivo tecnológico afeta os cuidadores e sua rotina, e estabelece relacionamento de renúncia e doação para com o gastrostomizado. Existe dificuldade em aceitar que os filhos não se alimentam normalmente. Os principais contratempos foram referentes à falta de conhecimento e treinamento para os cuidados específicos no domicílio. Os apoios são limitados. Este estudo possibilitou compreender melhor a experiência dessas famílias e evidenciou que o uso de um dispositivo tecnológico traz melhoras à saúde da criança, porém é um processo difícil de ser aceito inicialmente.

The study aimed to understand the structure, operation and development families, to identify social support networks for the care of the child and adolescent submitted to gastrostomy, and to describe difficulties and facilities faced in this experience. We used the Calgary Family Assessment Model as theoretical reference, we added it to the semi-structured interview as research instrument; and we used Narrative Analysis as method. The uses of the technological device affect caregivers and their routines, and establish a relationship of renounce and donation with the gastrectomy patient. Difficulty was found to accept that their children are not fed normally. The main setbacks referred to the lack of knowledge and training for specific homecare. Support is limited. This study allowed better comprehension of experiences from families and showed that the use of a technological device brings benefits to the child's health, thus, it is a difficult process to be accepted at first.

As práticas de cuidado da família à criança com gastrostomia no contexto domiciliar / Family care practices toward children with gastrostomy in the home context

O desenvolvimento tecnológico permitiu o aumento da expectativa de vida de crianças com necessidades especiais de saúde. Neste contexto, a gastrostomia vem sendo utilizada com maior frequência em crianças que apresentam dificuldades e risco para se alimentar por via oral. O cuidado a crianças com gastrostomia exige demandas de cuidados peculiares e imprescindíveis à sobrevida que serão realizados pelos familiares cuidadores no domicílio. Neste sentido, esse estudo teve como objeto de investigação,o cuidado do familiar cuidador à criança com gastrostomia no contexto domiciliar. Como objetivos: conhecer como o familiar cuidador realiza os cuidados à criança com gastrostomia no cenário domiciliar; desvelar os desafios enfrentados pelo familiar cuidador na prática de cuidar da criança com gastrostomia no domicílio; e analisar as estratégias que mediaram às práticas de cuidar do familiar cuidador com crianças gastrostomia no domicílio. Os alicerces teóricos estiveram pautados nas concepções de cuidado de Collière e na educação problematizadora de Paulo Freire. Metodologia: pesquisa qualitativa desenvolvida por meio do método criativo sensível, com a implementação da dinâmica Corpo Saber no domicílio de crianças com gastrostomia com 16 familiares cuidadores. Para a análise dos resultados, utilizou-se a análise de discurso em sua corrente francesa. Os discursos dos familiares no processo de alimentar a criança com gastrostomia revelaram a necessidade de triturar os alimentos de modo a torná-lo mais liquefeito e assim administrá-lo com maior facilidade pela sonda, a preocupação com valor nutricional e o volume do alimentoa ser administrado. Acerca da administração dos medicamentos, apontaram a necessidade de triturar os medicamentos sólidos, a preocupação comos horários e a forma de administrá-los. Quanto aos cuidados com higienização abordaram questões relacionadas aos utensílios, dispositivo e à pele periestomal.

Technological development has led to an increase in life expectancy of children with special health care needs. Therefore, the gastrostomy has been used most often in children who have difficulties and risk to feed orally. The care for children with gastrostomy requires peculiar care demands essential to survival that will be carried out by family caregivers at home. Therefore, this study had as subject the care of caregivers to children with gastrostomy in the home context. Objectives: To know how the family caregiver performs the care of children with gastrostomy in a home scenario, reveal the challenges faced by family caregivers while taking care of children with gastrostomy at home and analyze strategies for that. The theoretical foundations were guided in the Colliére care concepts and the problem-based education of Paulo Freire. Methodology: qualitative research developed through the sensitive creative method, with the implementation of the dynamic "Corpo Saber" in the domicile, of children with gastrostomy, with 16 family caregivers. To analyze the results we used the speech analysis in its French chain. The speeches of the family in the process of feeding the children with gastrostomy revealed the need to grind food in order to make it more liquid and thus manage it more easily by the probe, the concern about nutritional value and food volume to be administered. About the drug administration identified the need to grind the solid drug, the concern about schedules and how to manage them. Thus, in caring for hygiene, discussed issues related to tools, device and the peristomal skin.

Blended food for enteral feeding via a gastrostomy.

A blended diet for enteral nutrition is defined as home-made everyday food blended to a smooth 'single cream' consistency. At present, blended food is not recommended as a first choice. However, the wishes of parents who prefer to use blended food for their child need to be respected, and hospice policy for Children's Hospice South West is to replicate home conditions as far as possible. Therefore guidelines have been created for use of a blended diet. However, benefits in physical and emotional health need to be balanced against risks of tube blockage, contamination and digestive upsets.

PEG tubes: dealing with complications.

A percutaneous endoscopic gastronomy tube can be used to deliver nutrition, hydration and medicines directly into the patient's stomach. Patients will require a tube if they are unable to swallow safely, putting them at risk of aspiration of food, drink and medicines into their lungs. It is vital that nurses are aware of the complications that may arise when caring for a patient with a PEG tube. It is equally important that nurses know how to deal with these complications or from where tc seek advice. This article provides a quick troubleshooting guide to help nurses deal with complications that can arise with PEG feeding.

Guidelines for routine gastrostomy tube replacement in children.

Endoscopic placement of a gastrostomy is the safest method of inserting a gastrostomy in children who are going to require full or supplemental enteral feeding for more than six weeks. Once a stoma tract has formed successfully following initial placement of a gastrostomy tube, the device can be changed to a balloon, button or non-balloon type. Community nursing teams often support a number of children with gastrostomies and their families, replacing the devices as necessary. Guidance for the safe insertion and replacement of balloon and button gastrostomies has been produced by the National Nurses Nutrition Group, the Patient Safety Agency and manufacturers, but standardised national guidelines are required.