Experiences with peg interventions on somato-mentally seriously retarded patients

Children's Home maintained by the self government of Eger specialized to nurse somato-mentally seriously retarded patients. Considerable proportion of patients, who are not able to be fed orally, and also suffering from swallowing disorders, till this time had been fed via nasogastric tube was put in at every meal.

Method: After visiting and examining we selected the patients needed PEG implantation. We performed regular PEG implantation after antibiotic prophylaxis, endotracheal intubation, narcosis and power-driven respiration. 24 hours later feeding was started with tea and other drinks, and widened with PEG nutriments the day after. In two cases PEG was needed to be replaced with balloon-drain in narcosis too.

Results: Till this time 13 patients have gone through the intervention. Patients were observed for 2–5 days in hospital after PEG implantation. One patient 48 hours later because of serious pneumonia and an other with late onset diffuse peritonitis 10 days later has died. One patient 4 days later showed parabdominal suppuration could be cured with traditional treatment. We could not carry out the intervention in one patient because of pneumonia. In the case of one patient we found stomach was anatomically situated high up in the deformed thorax under the ribs, was the reason this patient did not get PEG.

Difficulties: Intubation and narcosis is difficult due to respiratory disorders and serious deformation of thorax, neck and head are present nearly all of the cases. After narcosis had been performed, PEG implantation was of no trouble. Gastric and abdominal wall thickness often of a few millimeters made easier to point out the position of the punction.

Conclusion: PEG intervention on these patients is of high risk. The implantation can furthermore be carried out only in narcosis, which increases morbidity.