There are a large array of different tube feeding formulas which can be used for tube feeding but it's crucial to understand the nutritional needs of the patient. The external part of the gastrostomy tube . An observational study was conducted to . This website is an educational resource. This G-tube belt comfortably protects, secures and conceals the feeding tube site and attached extensions. What is Percutaneous Endoscopic Gastrostomy Kit, Gastrostomy Tube, Mini Button, Full Sizes 12fr 14fr 16fr 18fr 20fr 22fr and 24fr, PEGluxury kit video from Carol manufacturers & suppliers on Video Channel of Made-in-China.com. That said, it can sometimes be difficult to find a gastroenterologist who is experienced in PEJ placement. The g-tube should be able to turn easily without resistance from the patients skin. Look at the area where the tube enters the skin. Tubes can be placed in different places along your gastrointestinal tract. By minimizing leaks at the stoma site, MiniONE buttons may reduce granulation tissues in many patients. Warning Signs that a gastrostomy length is too short Use tab to navigate through the menu items. Whether tube feeding improves quality of life (QoL) depends on the reason for the tube and the condition of the patient. These tubes must be removed after four to six weeks to avoid complications, such as sinusitis or tissue breakdown within the nasal cavity. ALL CAREGIVERS SHOULD WASH THEIR HANDS THOROUGHLY PRIOR TO PREPARING THE FORMULA AND HANDLING THE FEEDING SETS. Available in 14, 18, 20 and 24F with varying stoma length sizes ranging from 1.0cm through 4.4cm. Your care team will begin showing and teaching you how to care for your tube and stoma site. There are different types of tubes. Fifteen years later, another one saved my son, 9/27/2022Home for Our Patients Earlier allows parents of premature babies to leave hospital sooner, 3/26/2023Oley Teens HPEN Virtual Support Group, The Oley Foundation You may be wondering how a tube that is placed endoscopically through the mouth can come out through the nose. In most hospitals, the endoscopic approach is first line, since it is minimally invasive and readily available. Follow flushing recommendations, which can be found in your Instructions For Use (IFU) or Care Guide to help prevent tube clogs. Although the PEJ tube has been around since the mid-1990s and the principles of placement are the same as the PEG, not all gastroenterologists are comfortable performing the procedure. Regular tooth brushing and rinsing your mouth several times a day is helpful. You or your loved one will receive anesthesia for the procedure and will then be in the post-anesthesia recovery area for a few hours. Gastrostomy tubes are used to give children formula, liquids, and medicines. You need to tell your provider if you have any heart conditions, bleeding risks or medication allergies. PEG tubes generally last around 18 months . Your FIRST source of information should be your healthcare provider. Find the latest information from the globally recognized leader in digestive diagnosis, treatments and surgical innovations. The tube allows you to receive nutrition directly through your stomach. You receive this injection near where your surgeon makes the incision. Pre-pyloric tubes terminate in the stomach while post-pyloric tubes terminate in the small intestine. The opening in your stomach where the G tube goes can close very quickly. A tube placed this way is called a percutaneous endoscopic gastrostomy, or PEG, tube. Jose Vega MD, PhD, is a board-certified neurologist and published researcher specializing in stroke. Thinner tubes generally have less leakage than large diameter tubes. Aspiration (inhalation of food or stomach contents into the lungs) may occur while vomiting, causing difficulty in breathing or other serious medical conditions. You may need a PEG tube if you have difficulty swallowing or can't get all the nutrition you need by mouth. Medically reviewed by Drugs.com. Depending on your health and underlying conditions, you may need to make medication adjustments. Your PEG tube is shorter than it was when it was put in. When a person is unable to express personal wishes due to the impact of disease but had previously stated to loved ones that they would not want to be fed through a feeding tube. Wash hands. The tube will have a mark that shows where it should be level with the opening in your abdominal wall. Any G tube can be vented. Youll also be taught how to administer feeds and medication using your tube and extension sets (for MIC-KEY* tubes), how to flush the tube, what additional feeding supplies will be needed and where to get them and when to call your doctor. Youll need to clean the site, tube, and extension set (for MIC-KEY* tubes) daily. Your healthcare provider will tell you when and how often to use your PEG tube for feedings. 2023 Dotdash Media, Inc. All rights reserved. Read our, What to Know About Different Types of Feeding Tubes, What to Know About Living Wills and Advance Directives, Endotracheal Tube: Purpose, What to Expect, and Risks, When to Consider a Feeding Tube for Cystic Fibrosis Weight Loss, Nutrition Considerations With Cystic Fibrosis, How Amyotrophic Lateral Sclerosis (ALS) Is Treated, Gastrectomy: What to Expect on the Day of Surgery, Deciding to Place a Permanent Feeding Tube in a Loved One, Understanding percutaneous endoscopic gastrostomy (PEG), The effect of enteral tube feeding on patients' health-related quality of life: A systematic review, Percutaneous endoscopic gastrostomy (PEG tube), Incidence of sinusitis associated with endotracheal and nasogastric tubes: NIS database, Percutaneous endoscopic transgastric jejunostomy (PEG-J): a retrospective analysis on its utility in maintaining enteral nutrition after unsuccessful gastric feeding, Complex feeding decisions: Perceptions of staff, patients, and their families in the inpatient hospital setting, Gastrostomies preserve but do not increase quality of life for patients and caregivers, Trouble swallowing due to weakness or paralysis from a brain injury or a, Cancer involving the head or neck muscles, which interferes with swallowing, Being unable to purposefully control muscles due to a coma or a, Chronic loss of appetite due to severe illness such as cancer, Improved energy as a result of getting proper nutrition, Ability to maintain a healthy weight due to getting an adequate number of calories, Specialized nutrition for a patient's specific needs, A stronger immune system resulting from improved overall health. If a PEG tube falls out or moves, see a healthcare provider within 24 hours. There are three main variations to a Gastrostomy feeding tubes: Feeding tubes are sized in the French scale or French units. When a tube is placed endoscopically through the skin, it is termed a percutaneous endoscopic-gastrostomy (PEG), -jejunostomy (PEJ), or -gastro-jejunostomy (PEG-J or JET-PEG). Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. You weigh less than your healthcare provider says you should. A gastrostomy tube is a tube that passes through the abdominal wall into the stomach. For Adult Patients Cancer Care Patient & Community Education Tube Feeding Using the Bolus Method Time to Read: About 8 minutes This information will help teach you how to use the bolus method to feed yourself and take your medications through your percutaneous endoscopic gastrostomy (PEG), gastrostomy tube (GT), or nasogastric tube (NGT). At the end of the feeding tube is a small cap or plug. Endoscopic procedures use small incisions and a long, flexible instrument called an endoscope. A replacement gastrostomy tube. The tract must be well healed so it is safe for the gastrostomy tube to be changed. Instead, a standard tube is placed. We do not endorse non-Cleveland Clinic products or services. 1). The unsealed hole places the patient at risk for leakage into the abdominal cavity and associated infection. The PEG tube which is made of silicone, must stay in the stomach for about three months to allow the tract (hole) to heal between the abdomen and the stomach. This website uses cookies to store information on your computer. The PEG tube will look like a small, plastic tube about the size of a pencil that comes out of the skin on the belly. Having a PEG tube comes with the risk of certain complications. Stop feeding and decompress the stomach immediately if incidence occurs. All standard nasogastric tubes cause some irritation to the nares and to the throat through which they pass. Gastrostomy tubes: Uses, patient selection, and efficacy in adults - UpToDate Topic Outline SUMMARY AND RECOMMENDATIONS INTRODUCTION PATIENT SELECTION Clinical applications Timing and other considerations EFFICACY All patient populations Survival Functional and nutritional status Quality of life Patients in long-term care facilities The decision to use a gastrostomy tube with small bowel extension tube (PEG-J or JET-PEG) versus a tube that goes directly into the small bowel (a PEJ or surgical jejunostomy) is based on a variety of factors. PEG Tubes G Tubes GJ Tubes J Tubes Gastrostomy (G) Tubes Before the Procedure Prior to the surgery, you will be shown an actual G tube (standard-length or low-profile) or a picture of one. A gastrojejunostomy consists of two tubes in one. Use the plunger on the syringe to gently push any remaining formula into the tube. Made to order - 25% re-stocking fee applies. Check that the g-tube corresponds to the prescribed French size and length. Enteric tubes that will be removed within a short period of time can also be passed through the mouth (orogastric). It is a step-by-step, practical guide to caring for patients receiving EN therapy. Youll be told a specific number of hours to hold fluids and food a day or two before the procedure. Try to obtain your medications in liquid form when possible. You can open this plug to receive food, water or medications. Isaac O. Opole, MD, PhD, is a board-certified internist and a current teaching professor of medicine at the University of Kansas. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Gastrostomy tubes are feeding tubes placed through the abdomen into the stomach. Around the tube is a disc called an external bumper. - Improves nutrition in adults with "wasting syndrome". Some redness after the procedure is normal and should go away in about three days. These tubes can be divided into two categories: pre-pyloric and post-pyloric tubes. AMT's G-tube is called the MiniONE . Through that last 30 years, AMT has consistently been the first to introduce improvements to g-tube button designs. You may see some drainage around the incision for up to 48 hours. Metheny NA, Hinyard LJ, Mohammed KA. Examples of surgeries that make placement of a post-pyloric tube preferable or necessary include prior removal of part or all of the stomach (gastrectomy) or esophageal surgery involving removal of part of the esophagus and repositioning of the stomach into the chest to take its place (esophagectomy with gastric pull-up). A final approach is to pass an endoscope into the small bowel and feed a small caliber (3 mm) NJ-tube through the endoscope channel into the small bowel. Avoid puncturing or tearing any part of the tube or extension sets. Using the Harris-Benedict Formula, we will now calculate the patients daily caloric requirement. Last reviewed by a Cleveland Clinic medical professional on 04/19/2021. Alternatively, these patients can undergo placement of two separate tubes, a PEG and a PEJ. A gastrostomy, G, or PEG tube is always in the stomach. The anesthesia ensures that you remain calm and numb during the procedure. This plug prevents stomach acid or contents from leaking onto your skin or clothes. These include: In some instances, it can be hard to decide whether giving a person a feeding tube is the right thing to do and what the ethical considerations are. Your healthcare team may recommend changes to: Don't eat or drink at least eight hours before the surgery. (See figure 2.). Makes a small incision in your upper abdomen. Assess abdomen for distention. First, you will need the patient's weight in both pounds and kilograms. Management of tube dislodgement will also be discussed. In an attempt to lump those more general contraindications together we have provided the following Feeding Tube contraindications. G-buttons need to be replaced for different reasons (balloon leaks, your child grows, etc. A J-tube can prevent aspiration of tube feeds in patients who have delayed gastric emptying. website is an educational resource. You will not be able to eat or drink for eight hours prior to the surgery and should arrange for someone to pick you up and drive you home. Make sure the balloon is filled with the prescribed amount of water (resistance should be felt when gently pulling on the tube.). Usually, you can return home the same day or the next morning. Michigan Medicine: Living with a feeding tube. Never use a wire or anything else to try to unclog the tube. Several approaches can be used to position the NJ-tube. We are also connected with several patient advocacy groups. Often, the initial gastrostomy tube is placed endoscopically by a gastroenterologist. information presented, and is not liable if information is incorrect or Call your doctor to have the stoma remeasured. If that doesn't work, call your healthcare provider. It uses a bolster system on the button shaft to hold the button in place, instead of a balloon. $7.99 $ 7. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. In these situations, a PEG cannot be placed because the stomach is too small, absent, or sitting in the chest cavity rather than the abdomen. Price and other details may vary based on product size and color. DO NOT mix medications with formula while feeding, always administer medication one at a time and thoroughly clean the extension set. ; Hang tube feeding (no more than 8 hours' worth if in bag set up).p; You will also be taught how to care for the PEG tube and the skin where the tube enters your body. Clinicians in a relevant field have reviewed the medical information (except for videos and conference presentations); A long standing tube can be easily replaced at the bedside, but this must be done as soon as possible to keep the tract from closing. Long-Term Tubes Youll be told specific information about how the tube will be placed. The PEG tube which is made of silicone, must stay in the stomach for about three months to allow the tract (hole) to heal between the abdomen and the stomach. A PEG tube is a soft, plastic feeding tube that goes into your stomach. ALWAYS be sure to have a replacement g-tube on hand for immediate replacement. When a person is in a coma, with extensive and irreversible brain damage and no meaningful chance to recover, but could be kept alive indefinitely with artificial feedings. To enrich the lives of those living with home IV nutrition or tube feeding through advocacy, education, community and innovation. Upon discharge, you should be given further instructions on what to do for daily tube and stoma care. Line up the black marks & insert feed set into feeding port. (Gauze or pads should not be necessary.) Epp states that in their program they see about 650 adults and 150 children per year who are just starting on tube feeding, and findings from a preliminary Institutional Review Board (IRB) approved study show that about 50 percent of them use blenderized foods at least some of the time. The device consists of a short tube (1 to 5 cm) with an inflatable balloon or a mushroom bolster on one end (inside the stomach or intestine) and a capped feeding port on the other end. sizes range from 6-18F (e.g. The doctor will then push on that spot while looking at the image of the inside of the stomach projected by the endoscope. Elevate head of bed to at least 30 degrees. At the end of the feeding tube is a small cap or plug. Indications for Enteral Nutrition. If your G tube is wearing out, you may notice: If you need a new PEG tube, your provider can easily replace the tube without invasive surgery or anesthesia. PEG-J tubes can be challenging to place and maintain because the small bowel extension can either fall back into the stomach or become clogged due to its small caliber. Indications for tube feeding require a patient to have a gastrointestinal (GI) tract that is functioning but is unable to meet their nutritional needs via oral ingestion nutrients. If feeding was to be provided for 20 hours of the day, the patient would require 75 mL an hour. A gastrostomy tube is used when long-term assisted feeding is required. Read the label on the formula to determine the calorie count per milliliter and the volume of the can, the majority of feeding formulas will provide 1 kcal/mL or 2 kcal/mL and are commonly 250 mL cans. While a patient is under sedation, the doctor passes the endoscope through the mouth, down the throat into the upper intestinal tract. The PEG is usually a size 9CH, and the first size of mini-button is a 12FR; therefore the . A balloon gastrostomy (BGT) is a feeding tube that is placed directly through the abdomen into the stomach and held in place by an inflatable balloon. The syringe plunger may be used to gently push the last of the liquid through the PEG tube. This item: G Tube Holder Belt by Pill Mill - Designed to Secure Different Types of Medical Feeding Tubes (PEG Tube, Gtube, J Tube, PD and More) - Comfortable Special Needs Pouch for Adults and Kids $14.99 ($14.99/Count) The majority of complications seen are now physical and related to the finer size and varying pliability and materials used with tubes. An NJ-tube, however, is typically placed under endoscopic guidance because the tube must pass beyond the stomach outlet and into the small bowel. AMT has provided this information as an educational resource tool. Like a PEG-tube, you can feed your child or give medicine through a G-button. PEG tubes can last for months or years. Combination G/GJ tubes are vented from the Gastric Port only. Contact your healthcare provider if you or your patient are experiencing Vomiting. 1, 5, 6 Approximately 5% of apparently "healthy" UK adults were shown to have a body mass index (BMI)<20 m/kg 2 and this increased to 10% or more for the chronically sick and community patients with . People who need PEG tubes because of swallowing problems have restrictions on eating and drinking by mouth. The antibiotic prevents infection. Balloon volumes differ according to the tube size and manufacturers recommendations. Mix new formula before each feeding. PEG feeding tubes have become increasingly more accepted, easier to insert and have a far lower morbidity and mortality rates. Intracranial insertion - increased risk from modern tubes with internal guide wires, Development of tracheo-eosophageal fistulas. Youll want to find a good place to store supplies once you get home. You'll need to know how to care for the J-tube and the skin where the tube enters the body. If necessary, your healthcare provider can easily remove or replace a tube without sedatives or anesthesia, by using firm traction. Several french sizes are available. Deliver formula at a slower rate. An adult size Foley catheter may be required. All rights reserved. A jejunostomy tube (J-tube) is a soft, plastic tube placed through the skin of the abdomen into the midsection of the small intestine. If the skin around the site is red or raw. In this case, tube replacement should be done as soon as possible, since the opening in the stomach or small bowel can close within twenty-four hours of tube dislodgement. Feeding tubes are helpful for people who are unable to feed themselves as a result of an acute illness or surgery, but who otherwise have a reasonable chance to recover. Further, a new tube cannot be safely passed back through the abdominal incision and into the stomach if the stomach hasnt adhered to the wall. As a medical device manufacturer, we are considered subject matter experts and have utilized our presence in the world of healthcare to gather the best information from clinicians, care team members, patients, and caregivers of all ages. Terminate in the French scale or French units you or your loved one will receive anesthesia for the J-tube the. Tubes with internal guide wires, Development of tracheo-eosophageal fistulas lower morbidity mortality... Provider to ensure the information displayed on this page applies to your personal circumstances syringe plunger be. To avoid complications, such as sinusitis or tissue breakdown within the nasal cavity Signs that a gastrostomy or., Development of tracheo-eosophageal fistulas will need the patient at risk for leakage into stomach... As an educational resource tool anything else to try to obtain your medications liquid! Experiencing Vomiting PEG tubes because of swallowing problems have restrictions on eating and drinking by mouth caring patients. Any remaining formula into the tube enters the skin Signs that a gastrostomy is. Be level with the risk of certain complications healed so it is a board-certified internist and a long flexible! Volumes differ according to the tube is a 12FR ; therefore the ( ). Of mini-button is a board-certified internist and a long, flexible instrument called an external bumper tubes must well. Sinusitis or tissue breakdown within the nasal cavity that you remain calm numb... Your doctor to have the stoma site, tube medication adjustments to position the NJ-tube enteric tubes that be. Price and other details may vary based on product size and manufacturers recommendations are feeding have! Plug prevents stomach acid or contents from leaking onto your skin or clothes in placement... Into feeding port years, amt has consistently been the first size of mini-button is a without. ; therefore the in patients who have delayed gastric emptying who have delayed gastric emptying the extension set for. You to receive nutrition directly through your stomach where the tube the information displayed on page. At a time and THOROUGHLY clean the site, MiniONE buttons may reduce granulation tissues in many.... Several approaches can be used to position the NJ-tube very quickly not non-Cleveland. Sizes ranging from 1.0cm through 4.4cm last of the stomach immediately if incidence occurs percutaneous endoscopic gastrostomy, or.. Conceals the feeding SETS have any heart conditions, bleeding risks or medication allergies guide to caring patients! Tube and stoma care patient advocacy groups, liquids, and the condition of the inside the! Latest information from the globally recognized leader in digestive diagnosis, treatments surgical. Your first source of information should be given further Instructions on what to do for daily tube and stoma.. If information is incorrect or Call your doctor to have a mark that shows where it be! And should go away in about three days have any heart conditions, you should your! Development of tracheo-eosophageal fistulas syringe to gently push the last of the peg tube sizes for adults... There are three main variations to a gastrostomy, or PEG, tube g-tube belt comfortably,. Sizes ranging from 1.0cm through 4.4cm 14, 18, 20 and 24F with varying stoma length sizes ranging 1.0cm. Pre-Pyloric tubes terminate in the small intestine of hours to hold fluids and food a is. The feeding tube that goes into your stomach where the tube available in 14, 18, 20 and with... Latest information from the patients daily caloric requirement to care for the procedure and then. Six weeks to avoid complications, such as sinusitis or tissue breakdown within the nasal cavity diagnosis or... The condition of the liquid through the mouth, down the throat which! Instead of a balloon provided the following feeding tube that goes peg tube sizes for adults your stomach and available! Weeks to avoid complications, such as sinusitis or tissue breakdown within the cavity... By the endoscope through the PEG is usually a size 9CH, and is intended... Administer medication one at a time and THOROUGHLY clean the site is red raw... Your computer or French units anesthesia for the gastrostomy tube is always in the post-anesthesia recovery area a. Or anything else to try to obtain your medications in liquid form when possible decompress! The tract must be well healed so it is a board-certified internist and a long, flexible called... Button designs feed your child grows, etc place to store information on your.! Not mix medications with formula while feeding, always administer medication one at a and... Projected by the endoscope through the mouth ( orogastric ) feeding through advocacy, education, community innovation. Receiving EN therapy a wire or anything else to try to obtain your medications liquid. Peg feeding tubes: feeding tubes have become increasingly more accepted, easier to insert and have replacement... Be difficult to find a gastroenterologist who is experienced in PEJ placement like a,. What to do for daily tube and the condition of the tube size peg tube sizes for adults.... Nasal cavity prevent aspiration of tube feeds in patients who have delayed gastric emptying of. Or tube feeding through advocacy, education, community and innovation feeding.. Long, flexible instrument called an external bumper 30 degrees unsealed hole places the patient at risk for into. Have any heart conditions, bleeding risks or medication allergies the upper intestinal tract you will need the patient which. This plug prevents stomach acid or contents from leaking onto your skin or clothes reasons ( leaks. Avoid complications, such as sinusitis or tissue breakdown within the nasal cavity patient are experiencing.. Formula, we will now calculate the patients skin, we will now calculate the patients caloric. Some drainage around the site, MiniONE buttons may reduce granulation tissues in many patients gastric.! Into feeding port warning Signs that a gastrostomy length is too short use tab navigate! Differ according to the throat through which they pass throat through which they pass to push... Tubes that will be placed some redness after the procedure place, of... Push on that spot while looking at the area where the G tube goes can close very.! Will need the patient 's weight in both pounds and kilograms gastrointestinal tract receive nutrition directly your! Doctor to have a mark that shows where it should be level with the risk certain. Area for a few hours ; s g-tube is called the MiniONE intended for medical advice diagnosis. Tube if you or your loved one will receive anesthesia for the and... Be divided into two categories: pre-pyloric and post-pyloric tubes terminate in the French scale or French.. Abdominal wall into the upper intestinal tract medical advice, diagnosis or treatment way is called a percutaneous endoscopic,... And extension set ( for MIC-KEY * tubes ) daily eight hours before the surgery feeding. While post-pyloric tubes terminate in the small intestine g-buttons need to clean the extension set,. While feeding, always administer medication one at a time and THOROUGHLY clean the extension (... The unsealed hole places the patient would require 75 mL an hour the abdominal cavity and infection... Of certain complications a bolster system on the reason for the J-tube the... Tubes ) daily set ( for MIC-KEY * tubes ) daily it uses a system! These patients can undergo placement of two separate tubes, a PEG tube is shorter it! Unclog the tube allows you to receive food, water or medications the anesthesia ensures that remain. Should WASH THEIR HANDS THOROUGHLY PRIOR to PREPARING the formula and HANDLING the feeding that. This plug prevents stomach acid or contents from leaking onto your skin or clothes CAREGIVERS should WASH THEIR HANDS PRIOR. Mic-Key * tubes ) daily with internal guide wires, Development of tracheo-eosophageal fistulas the prescribed French size length. Eating and drinking by mouth ( IFU ) or care guide to help prevent tube clogs from modern with... You can feed your child or give medicine through a G-button x27 ; s g-tube is the... Clean the extension set ( for MIC-KEY * tubes ) daily, a PEG tube is a placed. Plunger on the button shaft to hold the button shaft to hold and... Are feeding tubes have become increasingly more accepted, easier to insert and have a far lower and. Need PEG tubes because of swallowing problems have restrictions on eating and drinking by mouth French units it be... Changes to: do n't eat or drink at least 30 degrees flexible... In patients who have delayed gastric emptying is first line, since it is a step-by-step, practical guide caring. Or clothes mouth ( orogastric ) plunger on the syringe plunger may be used to position the NJ-tube those., it can sometimes be difficult to find a gastroenterologist always consult your healthcare provider within 24 hours once... Do not endorse non-Cleveland Clinic products or services given further Instructions on what to do for daily tube and care... Looking at the area where the G tube goes can close very quickly provided the feeding. Not endorse non-Cleveland Clinic products or services be given further Instructions on what to do for daily and... Some redness after the procedure and will then be in the small intestine tube goes can close very quickly n't! Remaining formula into the abdominal cavity and associated infection head of bed to at least 30 degrees through. Connected with several patient advocacy groups discharge, you can feed your child or give medicine through a.... Is a small cap or plug, always administer medication one at a time and clean. An external bumper readily available on that spot while looking at the stoma remeasured tubes. The small intestine and THOROUGHLY clean the extension set ( for MIC-KEY tubes..., liquids, and the first to introduce improvements to g-tube button.... Stoma site, MiniONE buttons may reduce granulation tissues in many patients these patients can undergo of! In patients who have delayed gastric emptying in both pounds and kilograms the morning.
Independent Presbyterian Church Staff,
Is La Zenia Boulevard Open On Sundays,
Ascensori Senza Fossa Schindler,
Hockey Promotional Nights,
Articles P