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    Default Jejunostomy Tube Pictures - Stomach Atlas

    What is a jejunostomy tube (J-tube)?
    A jejunostomy tube, also called a "J-tube," is a surgically placed tube that is put directly into your child's small intestine. The tube is usually a red rubber tube that is stitched at the stoma site, which is the opening in the skin. This type of tube doesn't have a balloon or mushroom end to hold it in place, so it can come out easily.

    For many reasons, some children can't eat enough by mouth to grow. These children can get J-tube feedings that have enough calories and nutrients to help them get good nutrition and grow well.

    How is a J-tube put in place?
    A pediatric surgeon surgically places the J-tube. While your child is asleep in the operating room, the surgeon makes an incision on the belly area and makes an opening into the small intestine, called the jejunum. She then places a tube is into the opening and into the small intestine and stitches it into place.

    The surgeon will place a dressing at the opening where the tube comes out. This dressing will be removed 48 hours later and replaced with a special piece — called a HOLLISTER attachment device — to keep the tube in place and keep it positioned straight up and down so that the stoma (opening) will heal well. There will be stitches placed around the tube and into the skin at the opening to the jejunum. These won't need to be removed, but will eventually come out of the skin.
    Occasionally, the surgeon will use another kind of a tube — such as a MIC-KEY or BUTTON — as the J-tube.

    Follow-up care
    Your child's J-tube shouldn't interfere with his normal activities. He should bathe, play, swim and sleep as usual. You may find that certain clothing — such as one-piece or "bib"-type outfits — help keep the tube from catching on something and pulling out. It will also discourage your child from pulling on the tube.

    Keeping the tube in place
    It's very important to make sure your child's J-tube moves as little possible, not only to prevent it from falling out, but also to keep it from moving at the stoma site. The more the tube moves at the site, the larger the opening becomes. A larger opening, in turn, allows fluid to leak out. This fluid can cause skin irritation and breakdown, as well as a type of scar tissue called granulation tissue.

    Caring for the stoma and skin
    It isn't uncommon for J-tubes to leak at the stoma site. This leakage from the small intestine can be very harsh to the skin and can quickly cause skin irritation and breakdown. That's why it's important to look at the stoma site and surrounding skin — and clean it — once daily.

    Clean the stoma site daily with mild soap and water, but don't scrub; this can slow down healing or cause skin breakdown. Dry well.

    When the HOLLISTER device is in place, use a cotton swab to clean around the tube at the device opening. You don't need to change it every day — only when it starts falling off or is soiled, usually about every three or four days.

    You may see a type of scar tissue — called granulation tissue — forming at the stoma site. Granulation tissue, which is usually dark pink or red, has a good blood supply, so it bleeds very easily. It forms because the body wants the stoma to heal, and the tube goes through the opening and it can't heal over, so tissue grows around the tube. In some children, granulation tissue grows at a fast rate; others have no problem with it all. Granulation tissue grows faster when there's a lot of tube movement at the stoma site.

    If you see some of this tissue starting to grow, do everything you can to minimize the movement of your child's tube by taping it into place to prevent movement of tube and friction; you may be shown a taping technique to hold tube in place.

    If you see a large rim of granulation tissue around the tube, call your doctor or nurse for an appointment; they'll treat it in the office with a medicine called silver nitrate, which shrinks the tissue and turns the tissue gray/brown. The drainage after silver nitrate treatment may be brown or black. Because this drainage shouldn't get on the "good" skin around the tube, your child's doctor or nurse will put Stomahesive powder at the site to absorb it.

    Preventing clogging
    It's also important to prevent the J-tube from clogging by flushing it with 10 cc of water after each feeding and each medicine.
    If the tube does become clogged, attach a 5 cc syringe with warm water to the end of the feeding tube adapter. Try to flush the tube. If you're unable to flush, pull back on the syringe plunger. Try to flush and pull back up to five times. If you still can't flush the tube, try using warm water in a 3 cc syringe and repeat the same steps.
    Jejunostomy Tube Pictures Stomach Atlas attachment.php?s=e805f4403fd0f938cb42da00836cb4f1&attachmentid=2592&d=1443118817

    How do I prevent the feeding tube from becoming clogged?
    Proper tube flushing is the best way to avoid clogging the tube. Flush the tube with water every 4-6 hours during continuous feeding, before and after every intermittent or bolus feeding, or at least every 8 hours if the tube is not being used.
    The feeding tube should also be flushed before and after administration of medications and after checking for stomach residuals. Medications should be given in liquid form. If a medication is only available in tablets or capsules, make sure it can be crushed and mixed with water. Medication should not be mixed with formula. Never crush enteric-coated medication. Before and after giving medication, the port should be flushed with water.
    When flushing a tube, use water and a 30cc-60cc catheter tip syringe. Do not use smaller sizes as this can increase pressure on the tube and potentially rupture the tube. The amount of water used to flush the tube will depend on the individual's needs, clinical condition and type of tube, but the average volume ranges from 10-50 ml for adults, and 3-10 ml for children. Do not use excessive force to flush the tube as this can perforate the tube and can cause injury to the gastrointestinal tract.

    How should medications be given?
    Medications should be given in liquid form. Thick medication can plug the feeding port.
    If a medication is only available in tablets or capsules, make sure it can be crushed and mixed with water.
    Medication should not be mixed with formula as they may harden together and cause the tube to become occluded.
    Never crush enteric-coated medication.
    Before and between each medication the port or tubing should be flushed with water.

    What if the feeding administration set becomes disconnected?
    If the feeding administration set becomes disconnected from the MIC-KEY* extension set tubing, stop the pump and estimate the amount of formula lost. Thoroughly wipe the tube connections with soap and water or alcohol. Clean inside the MIC-KEY* extension set feeding port with a cotton-tipped applicator and alcohol. Irrigate the tube with warm water. Dry the connections and firmly reconnect the tubes with a quarter turn. Resume feeding.

    How should the end user/patient be positioned during feeding?
    Correct feeding position is essential to avoid aspiration of stomach contents through the esophagus and potentially into the lungs. The end user/patient should be placed in an upright position or at least at a 30-degree angle during, and one hour after feeding.

    My child's gastrostomy-jejunostomy tube
    A gastrostomy-jejunostomy tube -- commonly abbreviated as "G-J tube" -- is placed into your child's stomach and small intestine. This tube is used to vent your child's stomach for air or drainage, and / or to give your child an alternate way for feeding. You will use the J-tube to feed your child.

    The word "gastrostomy" comes from two Latin root words for "stomach" (gastr) and "new opening" (stomy). "Jejunostomy" is made up of the words for "jejunum" (or the second part of the small intestine) and "new opening."

    The tube stays in your child's stomach because there is a balloon or a plastic bumper at the end of the tube inside the stomach. There is a plastic disc around the tube outside of the child's body. This keeps the tube from sliding in and out of the opening. This plastic disc should not slide around on the tube. The tube should be able to move in and out of the child's stomach just slightly. The plastic disc should be snug against the skin, (the space between the bottom of the disc and the stomach should be about the depth of a dime) but it should not cause pressure.

    There is a small tube (the J-tube) that will go into the jejunum. There is a balloon that will sit inside the stomach that will hold the tube in place. On the end of each tube are three ports: gastric, jejunal and balloon. These are all clearly labeled and your doctor or nurse will give you further instructions for their use.

    Overview
    Although surgeons and gastroenterologists have traditionally provided enteral access services, interventional radiologists can safely, effectively, and successfully perform these procedures as well. Experience with percutaneous radiologically guided gastrostomy and gastrojejunostomy access is extensive, and experience with direct percutaneous jejunostomy access is growing. This article reviews issues and highlights areas of controversy important to radiologists providing these services

    Overview
    Although surgeons and gastroenterologists have traditionally provided enteral access services, interventional radiologists can safely, effectively, and successfully perform these procedures as well. Experience with percutaneous radiologically guided gastrostomy and gastrojejunostomy access is extensive, and experience with direct percutaneous jejunostomy access is growing. This article reviews issues and highlights areas of controversy important to radiologists providing these services

    References:
    http://emedicine.medscape.com/article/1821257-overview
    G-J Tube Care | Gastrostomy-Jejunostomy Tube | Instructions Tips

    Halyard Digestive Health | MIC_Jejunostomy_Feeding_Tube
    http://www.chop.edu/treatments/jejun...s#.VgQ9VWAaOGs







    Last edited by Medical Photos; 09-24-2015 at 06:20 PM.

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