PEG placement

I finally was able to witness a PEG placement this morning. The decision to place the PEG was a fairly controversial one for the elderly women who received it. She had a will drawn up in 1988, in which she had indicated that she was not interested in "aggressive" nutrition therapy. Currently, the patient is mildly demented and unable to convey her wishes and help us out with the interpretation of "aggressive." She has been here for nearly two weeks and hadn't been able to take anything po. While the hospital would normally interpret her will to mean no PEG, her daughter (the POA) feels differently. There have been two ethics committee meetings involving the family, and finally the decision was made to place a PEG.

The patient seemed very uncomfortable during the procedure. She is unable to verbalize or communicate at all, but she spent most of the prepping period moaning whenever someone touched her in any way. The procedure itself was fairly brief. The patient was put at ease, as best as possible, and given some mild sedatives. It was really interesting to see the inside of the GI tract through the endoscopy. I was surprised at how clean and smooth this woman's esophagus and stomach were considering her age. Once the stomach was located, an incision was made into the abdominal wall, the PEG tube was fed through the mouth and brought out through the incision site, and secured into place. All in all things went fairly smoothly.

The case really made me consider what my wishes night be if I ever ended up in a similar situation. I still have yet to reach a decision on this.