Overview of Feeding Jejunostomy Tube
Artificial nutrition is the process of giving or supplementing daily nutritional needs to patients who can’t eat through their mouth or aren’t eating enough. This can be given through two ways – parenteral or enteral methods. Parenteral nutrition is when nutrients are given through a large vein. Enteral nutrition, on the other hand, uses the digestive system to receive nutrition. There are various ways to do this: by putting a feeding tube through the nose or mouth, or surgically inserting the tube into the stomach or the small intestine, which is known as the jejunum.
In the past, parenteral nutrition was used more often than enteral nutrition. This is because people thought that certain diseases would make it hard for the digestive system to absorb food properly. However, it’s now known that even seriously ill patients can tolerate enteral nutrition. It has even been linked to lower infection rates, reduced costs, and shorter hospital stays.
I want to talk about feeding jejunostomy specifically. This means inserting a tube into the jejunum to provide nutrition or give medications. This is different from a definitive jejunostomy, which is a type of major stomach surgery. The first successful feeding jejunostomy was placed in 1858 by a person named Bush on a patient with stomach cancer. The most commonly used method for creating a jejunostomy was developed by Witzel in 1891. In the early 1980s, a new method was developed which led to the creation of a technique for feeding jejunostomy. After 1990, improvements in laparoscopic surgical techniques, which use a small camera and tiny instruments, permitted the insertion of feeding jejunostomy. The methods of doing jejunostomy have changed a lot over the years the ‘Witzel technique’ is the one that’s most associated with feeding jejunostomy.
This information is meant to help you understand when and why feeding jejunostomies are used. It also covers the equipment, preparation, and techniques of doing this procedure as well as potential problems and how they’re managed. It’s also important to note that good communication and coordination within the medical team can improve the success of feeding jejunostomies and overall patient outcomes.
Why do People Need Feeding Jejunostomy Tube
A feeding jejunostomy is a type of surgery which creates a route for accessing food when other pathways are unavailable. This can happen when a person is unable to eat through their mouth or if a feeding tube through the nose isn’t possible. It might also be used if the person needs artificial nutrition for more than six weeks, or if they’ve had serious surgery on their stomach or intestine and are expected to have a long recovery. This kind of surgery might also be considered if food is able to pass through the small intestine (jejunum), but not the stomach.
Feeding jejunostomies are often recommended for patients who’ve had major surgeries involving the removal of parts of their esophagus, stomach, pancreas, or the first part of the small intestine known as the duodenum. After these kinds of surgeries, complications may arise that could delay the recovery time, like issues with the surgical connection between the remaining parts of the digestive tract, or possible blockage in the stomach.
People suffering from a condition known as gastroparesis, where there is a delay in food movement from the stomach to the small intestine due to weak stomach muscles, may also need a feeding jejunostomy. The same goes for individuals with a blocked path from the stomach due to an untreatable tumor, hard to treat ulcer, or a rare condition called Bouveret syndrome. Sometimes, the procedure is the only option for patients with unresectable (non-removable) tumors or scarring in the duodenum or when the duodenum cannot perform its function due to conditions like pancreatitis.
Feeding jejunostomy can be used to administer medicines to treat certain conditions like Parkinson’s disease. It has been found that delivering medicine like Levodopa and Carbidopa directly to the small intestine can help reduce symptoms more effectively compared to taking them orally.
It’s important to note that the decision to carry out a feeding jejunostomy depends on different factors. These include the overall health condition of the individual, the risk of eating or drinking going down into the lungs (aspiration), the availability of healthcare facilities and resources, as well as the experience level of the surgeons.
When a Person Should Avoid Feeding Jejunostomy Tube
A feeding jejunostomy, which is a surgical procedure where a tube is inserted into the small intestine to supply nutrition, can often be the only way to provide nourishment to a patient. It can be a life-saving method as it eliminates the need for nutrition given directly into a vein (called ‘parenteral nutrition’) and the risks associated with it. However, the procedure cannot be performed if the patient has a blockage in the bowel below where the tube would be placed.
There are also a bunch of other conditions that may make this procedure riskier, but don’t necessarily mean it cannot be done:
Local conditions include:
* An infection in the belly at the place where the tube would be inserted
* A large accumulation of fluid in the belly, known as severe ascites
* Inflammation of the lining of the belly, or peritonitis
* Prior cases of dying bowel tissue resulting from a similar procedure
Conditions affecting the entire body include:
* Extreme difficulties in the ability of the blood to clot (with specific measurable complications)
* Unstable blood pressure needing medication to maintain it
* Dependence on a respirator which prevents the patient from being moved to the operating room.
In any of these situations, doctors will weigh the risks and benefits before deciding on the procedure.
Equipment used for Feeding Jejunostomy Tube
The tools your doctor will need can change based on the methods used to insert your jejunostomy tube, a special feeding tube that goes into your small intestine (jejunum). Here’s a list of typical supplies that might be used:
- Alcohol swabs/povidone-iodine swabs that clean your skin and prevent infection.
- A surgical blade (No. 11) to make the necessary cuts in your skin.
- An anesthetic called Lidocaine. This numbs your skin so you don’t feel pain during the procedure.
- Sterile gown and gloves to keep everything clean and germ-free.
- A 14-to-18 gauge needle, a guidewire, a sheath, and the actual jejunostomy feeding tube.
- Sutures (stitches) to create a Witzel tunnel – This is just a path or tunnel under your skin that helps keep the feeding tube in the right place.
- Dressing materials like 2×2 or 4×4 gauze and adhesive tape to cover the area after the procedure.
- Basic laparoscopic equipment might also be used. This is a less invasive procedure where your doctor uses small incisions, a camera and specialized tools to insert the tube.
The goal is to make sure everything is done safely and with minimal discomfort to you.
Preparing for Feeding Jejunostomy Tube
Before starting any surgery, including an appendectomy, doctors need the patient’s permission. This process, known as informed consent, outlines the steps of the surgery, the kind of anesthesia (medication used to reduce pain) to be used, and any potential complications that might occur. Understanding these elements can help patients make well-informed decisions about their health.
Doctors also recommend that patients should not eat or drink anything (a state called nil per os or NPO) for at least six hours before surgery. This reduces the chances of vomiting and choking when under anesthesia.
Antibiotics are given before the surgery as a precautionary measure to help prevent any potential infections. This is in line with the guidelines set by healthcare institutions. These guidelines ensure patient safety and best practices in medicine.
On the patient’s bedside, a reliable suction device should be present. This tool is used to remove fluids from the mouth and throat during surgery. Having it on hand helps ensure that the patient can breathe easily and stay safe during the procedure.
Lastly, the patient will be given intravenous (IV) sedation, which means medications will be delivered into a vein to help the patient relax and reduce any discomfort during the procedure. This is administered at the bedside for the patient’s comfort and convenience.
How is Feeding Jejunostomy Tube performed
Jejunostomy, or the procedure to place a feeding tube directly into your small intestine (or jejunum) can be performed by a doctor using a variety of methods. These include traditional surgery, non-invasive laparoscopic surgery, needle catheter insertion, or through a technique commonly known as percutaneous insertion which involves making a tiny hole in your skin to insert the tube inside.
In the open surgical method, the doctor will make a small incision and bring a piece of your small intestine out through the wound. A special stitch, known as a purse-string suture, is applied to the outer edge of the intestine. A small cut is then made on this spot where the tube will be inserted. After placing the tube, the doctor will secure the stitch to keep the tube in place. A specific technique, known as the Witzel technique, is utilized to keep the tube from leaking by sealing it inside a tunnel-like formation.
Laparoscopic procedure is a lesser invasive technique. Here, the doctor inserts a tiny camera into your abdomen which allows them to see your internal organs on a video screen. The small intestine is then pulled to the abdominal wall using sutures, and a tiny tube is inserted through one of the small incisions made in the abdomen. The tube is then secured in position and the small incisions are closed.
Needle catheter technique is often preferred during a major gastrointestinal surgery. The doctor creates a small pathway within your small intestine wall using a needle. Then, they place the catheter (a thin, flexible tube) through this pathway and secure it with a stitch. The intestine is then stitched to the lining of the abdominal cavity. The benefit of this method is that feeding can begin soon after surgery, usually within 6 to 12 hours.
The percutaneous technique involves the use of an endoscope, a long tube with a light and camera attached, which is passed into your small intestine. A special tool called a trocar is used to make a small hole through your abdominal wall into the intestine, and a tiny wire is inserted. This wire guides a tube up into the small intestine, after which the tube is secured. This method is similar to the gastric tube placement, only located in the small intestines, hence the reference as ‘pull-PEG’.
Possible Complications of Feeding Jejunostomy Tube
There isn’t any clear information suggesting that one type of jejunostomy tube (a tube inserted into the small intestine for feeding) is less likely to cause complications than another. However, all types can cause some issues. Examples of these complications can be broken down into four distinct categories: mechanical, infectious, gastrointestinal, and metabolic.
Mechanical complications can include an obstruction in the intestines, often due to the feeding tube’s balloon over-inflating. This can be both diagnosed and treated by deflating the balloon. Other mechanical issues might be due to the feeding tube methods. For example, certain issues are connected with the transverse Witzel technique, the needle catheterization, or a laparoscopic jejunostomy. Some of these problems might include damage to the inner lining of the stomach by the tube, withdrawal or blockage of the catheter, and complications related to the increased pressure inside the belly during laparoscopic surgery.
With regard to infectious complications, pneumonia from aspiration (when food or liquid enters the lungs instead of the stomach) and feed contamination are two common issues. Aspiration may occur if the feeding tube is not correctly placed. If a tube is placed too proximally (closer to the stomach), it could result in reflux. Some studies have also shown that continuous feeding through a tube can cause pneumonia in critically ill patients.
Gastrointestinal problems can include feeling nauseous, vomiting, diarrhea, a bloated abdomen, and stomach cramps. The type of food being used in the feeding tube plays a significant role in the severity of these complications.
Finally, metabolic complications. Things like low potassium levels (hypokalemia), high blood sugar (hyperglycemia), and imbalances in the body’s acid-base balance are often reported. These could occur due to incorrect placement of the feeding tube, inadequate feeds, or failure to correct resulting biochemical issues. Because the food bypasses the stomach and the upper portion of the small intestine (duodenum), there could be vitamin B12 and iron deficiencies. Additionally, if tube feeding is initiated after a period of starvation, it can lead to “refeeding syndrome” which is characterized by low levels of potassium, phosphate, and magnesium in the body. This syndrome happens because the body starts producing insulin when feeding is initiated and can show in critical patients as unstable blood pressure, respiratory failure, and other non-specific signs.
What Else Should I Know About Feeding Jejunostomy Tube?
A feeding jejunostomy is a medical technique used for providing nutrition directly to the body when there’s a reason not to use a tube in the stomach. This procedure can also be part of larger surgeries, like removing parts of the esophagus or stomach. There are various ways to perform a feeding jejunostomy, but those that are less invasive are usually preferred.
Some complications can arise from this process, either due to the type of nutrition being given or mechanical issues with the procedure itself. However, it’s generally a straightforward surgery that general surgeons can safely carry out.