Nutricia Flocare BENGMARK PEG/J Manual Del Usuario página 67

For PEG placement:
For postpyloric feeding:
More detailed information can be found in the Instructions For Use for the Flocare
Preparation of the Flocare
After initial placement of the Flocare
• Cut-off PEG tube at 35-cm marking.
• Pull external retention disc over the tube, but do not fix the tube in the disc yet.
• Place quick release clamp on the tube.
• Lubricate the inner-lumen of the PEG tube with approx. 10 ml water, using a syringe.
A. Endoscopic placement:
1. Insert the guide wire completely into the jejunal tube. Withdraw the guide wire about 10-20 cm, and then push
the guide wire until it reaches the end of the tube. Attach the handle of the guide wire (C) firmly to the ENFit
Connector (D).
2. Lubricate the stretched jejunal tube with water to facilitate intubation.
3. Push the antenna tip (B) of the jejunal tube through the PEG CH 18 until the tip is visible in the stomach.
If necessary add some extra water through the PEG CH 18 tube.
4. Grasp the antenna-tip with the endoscope forceps (fig. 1) and with help of the endoscope guide the tube
through the pylorus. The tube tip should be positioned as far down the small intestine as possible, preferably
beyond the Treitz ligament (fig. 2).
5. Keep the tube tip in place with the forceps, whilst withdrawing the endoscope (withdrawal of the endoscope
approximately 30 cm is possible) (fig. 3).
6. Whilst the tube is still held by the forceps, withdraw the guide wire about 25 cm from the tube. Now the spiral
will begin to form. With the forceps still in place, move the blue jejunal tube forward further into the small
intestine (fig. 4).
7. Finally remove the endoscope, the forceps and the guide wire cautiously (fig. 5) being careful not to move the
tube backwards at the same time.
8. Detach the ENFit connector from the Y-connector by unscrewing the turquoise ring (J) on top of the
Y-connector (fig. 6).
9. Unscrew the separate red ring (I) from the Y-connector and move it over the PEG CH18 (fig. 7).
10. Connect the Y-connector to the PEG CH18 by fitting the red inner shaft (H) tightly into the PEG tube. Screw the
separate red ring (I) into the Y-connector to fixate the Y-connector on the PEG tube (fig. 8)
11. Cut the ENFit connector from the jejunal tube (5 cm above the Y-connector) (fig. 9). If necessary, check the
position of the tip of the tube endoscopically, to rule out any dislocation at this time.
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CONTRAINDICATIONS
- Severe coagulation disorders (e.g. haemophilia)
- Severe ascites and severe gastritis
- Ileus
- Anorexia nervosa and severe psychoses
- Acute pancreatitis and acute peritonitis
- When it is impossible to bring the anterior part of the stomach against the
abdominal wall (subtotal gastrectomy, ascites, hepatomegaly, etc.)
- Marked peritoneal carcinomatosis
- Extensive tumor infiltration in the area of the punction site
- Intestinal absorption failure
- Paralytic ileus
- Acute abdomen
INSTRUCTIONS FOR USE
PEG CH 18
®
PEG CH 18, with the endoscope still in stomach:
®
PEG.
®
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13/05/15