Why too late for PEG?

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campdiva

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I have read a number of different threads where people of referenced waiting to late for a feeding tube or it being to late to get a feeding tube now, etc. Why is that? What makes it too late to get one?

Thanks!
 
From what I have read, I believe that it is when the PALS breathing has become too compromised to withstand the anesthesia.
 
The key with most everything with PALS is to get it BEFORE you need it, from the ALS Association:

As with all surgery, there are risks, especially where there is general anesthesia combined with breathing problems. For this reason, it's better to get the PEG sooner rather than later, preferably when FVC [forced vital capacity] is more than 50%. This doesn't mean it can't be done if breathing is below that number, but there is more risk.
 
My dad passed from Bulbar Palsy/ALS June 2009. When they put in my dad's PEG, they had to do the surgery very quick, He had Bulbar/ALS, They were afriad they would not be able to get the breathing tube out with his throat muscles not working. It's sure is better tohave it in place before you need it. You can still eat but it is there for a back up. It used to take my dad hours to eat, then he would start coughing. This way was quicker and he could go on to what ever. He even staryted to put back on some weight. One thing to remember is, his insurance company would not cover the surgery unless he could not eat at all, to my this was cruel. We could not let them know dad could eat apple sauce, ice cream ect.. One thing I learned with the PEG, when the tube got cloudy, put some coke a cola in it. I guess the acid in the soda cleans it right out.
 
Some of the main reasons I am aware of:

1. aneasthetic depresses breathing and the patient may end up in respiratory failure
2. patients using bipap 24/7, who can not use nasal pillows - the procedure which involves lowering something throught the mouth into the stomach can not be done (mouth 'blocked')
3. patients unable to lie flat on their back (i am told it can be done standing up too)
4. patient generally unwell - other medical issues


There is another procedure RIG which I think can be done instead of PEG.

Dani
 
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