Assessment of complication rates based on time of feeding initiation in radiologically guided gastrostomy tubes: a retrospective study

PURPOSEWe aimed to assess the association between complication rate and time to feeding in a cohort of patients undergoing radiologically guided placement of gastrostomy tubes.METHODSA retrospective study was conducted of all patients receiving pull-type and push-type gastrostomy tubes placed by interventional radiologists between January 1st, 2017 and December 31st, 2018 at a single institution. Primary outcomes included procedural and tube-related complications per medical chart review with a follow-up interval of 30 days. Exclusion criteria were enteral nutrition delayed more than 48 hours, no feeding information, and tubes placed for venting (n=20). Overall, 303 gastrostomy tubes (pull-type, n=184; push-type, n=119) were included. The most common indications for placement included head and neck carcinoma for push-type tubes (n=76, 63.9%) and cerebral vascular accident for pull-type tubes (n=78, 42.4%).RESULTSIn a multiple regression analysis, there was no statistically significant association between complications and time to feeding (p = 0.096), age (p = 0.758), gender (p = 0.127), indication for tube placement (p = 0.206), or type of tube placed (p = 0.437). Average time to initiation of enteral nutrition was 12.3 hours for the pull-type and 21.7 hours for the push-type cohort (p 0.05).CONCLUSIONThere was no statistically significant correlation between time to feed and complications, suggesting that there is no clinical difference between early and late feeding following gastrostomy tube placement

Unconventional Central Access: Catheter Insertion in Collateral or in Recanalized Veins

Catheter hemodialysis is an unfortunate but necessary option for patients with end-stage kidneys. Patients on chronic catheter hemodialysis often slowly exhaust veins in the neck and chest, necessitating use of unconventional veins such as the femoral veins, translumbar inferior vena cava, hepatic veins, or recanalized or collateral veins. Recanalized or collateral veins are an attractive option because using these veins preserves the limited remaining access sites. Patients favor this approach because catheter care is simplified; catheters inserted in these veins appear identical to catheters inserted in the internal or external jugular veins