BackTable Vascular & Interventional Ep. 471 All Things Enteral Access Part 1 from Dr. Peter Bream
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Aug 8, 2024 Dr. Peter Bream, a former Professor at UNC and now an interventional radiologist, dives deep into enteral access techniques. He discusses a variety of tubes like NG and G-tubes and innovative methods such as Balloon-Assisted Gastrostomy. The conversation also covers handling complications and ensuring patient comfort during procedures. Bream shares personal experiences, safety measures, and the importance of post-procedure care, making this a fascinating resource for both medical professionals and curious listeners.
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NG Tube Placement Tip
- For difficult NG tubes, use a guidewire and angled catheter like an MPA or Comfy Bernstein.
- Inject air or contrast to help navigation, especially in challenging cases.
G-Tube Evolution
- The standard of care for G-tube placement has evolved from pigtail catheters to balloon-tipped or pull-type tubes.
- Pigtail catheters, while historically significant, had higher clogging and dislodgement rates.
Dialysis Catheter Change
- Dr. Bream successfully transitioned his institution from using two catheters for temporary dialysis to a single trialysis catheter.
- This change, despite seeming obvious, took 12 months of bureaucratic navigation.