Percutaneous Cecostomy Insertion
- Ordering Information -
Return to Ordering Information ListEnterostomy Suture Anchor Set - (GIAS-100-CHAIT)
Components Diagram
| These recommendations are designed to serve only as a general guideline. They are not intended to supersede institutional protocols or professional clinical judgement concerning patient care. |
INTENDED USE
Used for anchoring the wall of a hollow viscus to the abdominal wall prior to introduction of interventional catheters. Supplied sterile in peel-open packages. Intended for one-time use.SUGGESTED INSTRUCTIONS FOR USE OF THE
ENTEROSTOMY SUTURE ANCHOR SET
- Insufflate the hollow viscus
with air through a nasogastric tube or enema balloon catheter. Use of glucagon to control
bowel peristalsis is recommended.
- NOTE: Ultrasound is useful in determining anatomic structures
before needle introduction. For gastrostomy, it is important to identify the liver,
spleen, and gallbladder before introduction. For cecostomy, identify the gallbladder and
urinary bladder before initial puncture.
- Localize the puncture site and administer local anesthesia with a 27 gage needle into the subcutaneous tissue and down to the peritoneum using fluoroscopic control. Attach a Luer slip 10 cc syringe, half filled with (full strength) 300 mgl/ml concentration contrast medium, to the 18 gage introducer needle. Make a small incision with a #11 blade at the entry site.
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| Figure 1 |
- Advance the introducer needle through the anterior abdominal wall and then, under
fluoroscopic guidance, rapidly thrust the needle another 2 to 3 cm into the air-filled
hollow viscus.
NOTE: Air should be freely aspirated. Injection of contrast medium under fluoroscopy must be performed to ensure proper needle position. (Figure 1)
- Remove the 10 cc syringe from the needle hub. Introduce the metal end of the loading
cartridge containing the two suture anchors into the base of the 18 gage introducer needle
and Luer lock into place.
NOTE: Make sure the cannula tip of the loading cartridge is seated within the hub of the introducer needle to prevent suture anchors from jamming. (Figure 2)
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| Figure 3 |
- Advance the distal tip of the Amplatz Ultra Stiff Wire Guide, then push the two anchors
out of the loading cartridge and through the 18 gage introducer needle into the hollow
viscus cavity. (Figure 3)
Confirm the suture anchors are within the hollow viscus.
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| Figure 4 |
- Disconnect the loading cartridge and
withdraw the blunt cannula over the wire guide to expose the suture ends. Discard the
cartridge and cannula.
Remove the 18 gage introducer needle over the wire guide and expose suture ends, maintaining slight tension on the suture to prevent bunching.
NOTE: Normally, the sutures are left in place for two weeks to enable the tract to mature. (Figure 4)
- With the wire guide still in position, apply light traction to the
sutures by attaching hemostats to secure the anterior wall of the hollow viscus against
the abdominal wall.
- The
wire guide may now be used to facilitate passage of fascial dilators and introduction of a
procedural catheter.
- While maintaining traction on the suture anchors, wrap the ends of the
suture around 2x2 gauze rolls and secure in place. Apply a standard wound dressing around
the insertion site.
NOTE: The suture anchors may be left in place for two weeks while tract formation occurs. Cutting the suture end at the skin level releases the anchors into the organ allowing its passage via the gastrointestinal system.
ACKNOWLEDGEMENT
P. Chait, M.D., Department of Radiology, Hospital of Sick Children, Toronto,
Ontario.