- 作者：Rahul A. Sheth ; MD ; rsheth@partners.org" class="auth_mail" title="E-mail the corresponding author ; Brian Koottappillil ; BA ; Avinash Kambadakone ; MD ; Suvranu Ganguli ; MD ; Ashraf Thabet ; MD ; Peter R. Mueller ; MD
- 关键词：ICU ; intensive care unit ; PRG ; percutaneous radiologic gastrostomy
- 刊名：Journal of Vascular and Interventional Radiology
- 出版年：2016
- 出版时间：February 2016
- 年：2016
- 卷：27
- 期：2
- 页码：251-259
- 全文大小：568 K
Materials and Methods
A single-institution retrospective analysis of all percutaneous radiologic gastrostomy (PRG) placement and replacement procedures between January 2010 and July 2015 was conducted. A statistical model predicting the risk for catheter exchange for any reason and exchanges specifically for tube malfunction was created; a quality improvement plan to reduce catheter exchanges was designed and implemented in June 2014. The outcomes for subsequent PRG procedures from July 2014 through March 2015 were followed until July 2015.
Results
Between 2010 and June 2014, 1,144 primary PRG procedures and 442 replacement procedures were performed in 1,112 patients. Of the 442 exchange procedures, 289 were “rescue” procedures secondary to catheter malfunction. A quality improvement plan was implemented in June 2014 that encouraged primary gastrojejunostomy catheter and balloon-retained PRG catheter placement and placement of skin sutures in patients considered high risk for catheter dislodgment. From July 2014 through March 2015, 229 PRG catheters were placed, and 71 exchange procedures were performed through July 2015. There was a statistically significant decrease in the number of rescue exchanges performed secondary to catheter malfunction (P = .036).
Conclusions
Procedural and patient-specific risk factors for PRG complications were identified, and a statistical model to predict rates of minor complications was created. These findings were used to implement a quality improvement program that resulted in a decrease in PRG exchanges secondary to catheter malfunction.