Gastrostomy Care - A Guide to Practice - Tapa blanda

The insertion of a feeding tube into the stomach was once a complex surgical procedure that was inaccessible to any people. However, since the replacement of the open surgical procedure with an endoscopic technique in the early 1980s, tube feeding has become an option for many more people. Since the development of the endoscopic procedure, the number of gastrostomy tubes being inserted has increased significantly. For example, from 1990/91 until 1995/96, the number of gastrostomy tube insertions in public hospitals in Victoria (Australia) increased by a staggering 685% (DHS 1997). As the nurse manager of a residential aged-care unit, I had firsthand experience of this increase in the use of astrostomy tubes. Before 1993 I had not cared for a person with a gastrostomy tube; two years later, more than half of the people in our unit had a gastrostomy tube. Providing appropriate care for these people was a challenge¿given that most staff members in the unit had no formal training in caring for people with a gastrostomy tube. Furthermore, we were unable to locate any comprehensive training programs or texts to assist us to update our skills. There was therefore an immediate need to develop guidelines for health professionals in the care of a person with a gastrostomy tube. It also became apparent that there was a need to develop these guidelines in a manner that supported patients by providing them with information and involving them in informed choices with regard to their tube feeding. These guidelines had to take account of the fact that tube-feeding decisions are often complicated by the emotional states of the person and his or her family. Moreover, there is often confusion regarding the evidence about tube feeding and the roles of health professionals in the decisionmaking process. In addition, there is variability in the outcomes of tube feeding. For some people, tube feeding has clear benefits; it can provide nutritional support during recovery from an acute illness, or it can allow people to be discharged home more promptly. However, for a significant number of people, the benefits of tube feeding are less obvious. In 1995, in response to these concerns, Ann Cassar (then a dietitian at Melbourne Extended Care and Rehabilitation Service) established a multidisciplinary working party to develop practical guidelines for staff. These guidelines were refined over a number of years before being used to develop a training program for staff in the unit.The training program was so well received by staff members that a decision was made to offer the program to health professionals across the state of Victoria in conjunction with the National Ageing Research Institute. A series of forums on the ethical implications of tube-feeding decisions was also developed and conducted. These forums generated passionate debate. The overwhelming interest in both the training program and the ethics forums confirmed the need for this book.