|Nale 13). It is essential to comply with the hospital policy on informed consent. Provide written information to back up any discussion with the family. There are a large variety of peg/rig devices on the market. Some are designed to be removed under ga and others by traction, the main difference being the internal fixation device. If a child is admitted with a peg/rig, it is important to establish what type is in situ. All the external parts of the tube are replaceable, thus in the event of any parts becoming damaged it is easy to correct the problem. If the child is admitted for an elective insertion of a peg/rig device it is usually a two-day admission. They are often already on enteral feeding via naso-gastric tube. The dietitian must be made aware of the childâ€™s admission (rationale 14). If the child is not on enteral feeds at the time of admission but the intention is to commence enteral feeds post peg/rig insertion, the admission should be of long enough duration to facilitate adequate training of the family and to set up home enteral feeding prior to discharge (including the involvement of the local dietician) (rationale 15). â please see section on discharge planning for home enteral feeding. Gastrostomy insertion: post-operative carethe child will have had a general anaesthetic (ga) for this procedure. buy viagra online viagra online cheap generic viagra viagra without a doctor prescription http://howtosmudge.com/pjn-cheap-generic-viagra-online-bn/ buy viagra buy viagra online buy viagra online cheap viagra online viagra online Follow guidelines for post-operative observations of temperature, pulse, respirations, blood pressure and observation of the surgical wound. Follow the post-operative plan as written in the operation notes/care pathway (rationale 16). The type of device, size, make and lot number should be recorded in the medical and nursing records (rationale 17). Inspect the stoma site for signs of redness, swelling or pus formation and check that the gastrostomy tube is secure (rationale 18). Ensure adequate pain relief is administered (rationale 19). Analgesia is often given in theatre, both systemically and locally. During the procedure the stomach is inflated with air, which may cause some discomfort post-operatively. The stomach should be decompressed by attaching a syringe or bolus feed set to the peg adaptor and releasing the clamp to allow excess gas to be released (rationale 20). Alternatively, the surgeon may request that the tube is left open and attached to a drainage bag for a period of time. Check the childâ€™s health record on return to the ward for specific instructions. On the childâ€™s return to the ward check that the external fixation plate is secure, and that it is not too tight or too loose (rationale 21). On return to the ward, there may be dry blood on the skin arou.||
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