PUG for CC/EM

percutaneous ultrasound gastrostomy; an alternative to PEG or PRG

 

PUG is a point-of-care (as opposed to operating room) procedure for inserting gastrostomy tubes which can be quickly and easily performed by non-surgical providers.  It employs readily available medical devices such as ultrasound, feeding tubes, guide-wires and dilators. 

Depending on your institution, consults for PEG procedures can lead to delays in care, along with additional time spent on care coordination. PUG enables prompt feeding tube placement, at the bedside. PUG eliminates the inefficiencies in clinical practice, and puts the power into the hands of the critical care physician.  PUG is not the first time procedures have been moved from an operating suite to the bedside - e.g., percutaneous tracheostomy. PUG utilizes your existing training on point-of-care ultrasound.

 
Coaptation.png

Step 1

Following orogastric placement of the balloon catheter, bring the external magnet into the field to achieve coaptation. Introducing fluid into the balloon catheter then enables ultrasound visualization.  

 
Ultrasound Confirmation.png

Step 2

Using standard ultrasound techniques, find a safe gastrostomy tract, avoiding organs and vasculature. With the external magnet, make minor placement adjustments as needed. Target balloon with needle under ultrasound guidance. 

 
Gtube Placement.png

Step 3

Once the needle is placed, insert the guidewire and retract the balloon/guidewire pairing in tandem out through the mouth. Place the gastrostomy tube over the guidewire using standard PUSH technique. Dilate and secure gastrostomy tube. [cadaver image shown]