J-Tube, TPN, G-Tube and NG Tube – Feeding Tubes
Chronic patients who suffer with different health problems which affect their GI tract and who cannot eat or procure pain when they eat or do not tolerate lots of foods can be malnourished. For those patients the doctors by placing different kinds of feeding tubes save their lives. If it’s not taken care of the malnutrition can make lot of other health problems. Sometimes the patient can die when the body does not get any kind of nutrition it weakens the immune system and they are prone to get all kinds of infections and becomes hard to fight them.
The Science and Medical Technology made so much progress to keep people alive for years without eating too. The doctors either suggest that the nutritional supplements that are available in the super markets like, Breakfast Carnation in different flavor, Pediasure, Boost, etc. If the patient can tolerate that they continue that so that they won’t get any problems with the malnutrition. They check them every week to see whether they are gaining weight or not. But there are some chronic patients, Cancer patients who cannot tolerate any kind of food and they accept pain whenever they eat that’s when the doctor’s decide the placement of J-Tube and the way called Jejunostomy. The J-tube is placed in the upper portion of the small intestines called the Jejunum which is just below the stomach. The tube will be located lower and closer to the center of abdomen.
The main reason of J-tube is to bypass the stomach and directly feed into the small intestines so that it won’t bother the stomach. The patients regain a special Enteral pump through which they are supposed to be fed. Enteral treatment means a formula is given to the patient through the tube feedings. Different brands of formulas like some are not that high in fat, some are high in protein and has little bit fat too and the doctor taking all the facts of the patient into consideration writes the prescription for the right mark. The tube feedings can be short term or long term. When the patient has to go through a major surgery and lost too remarkable weight then the doctors plot the feeding tube and give the patient Enteral tube feedings until the patient gains enough weight and has all the nutritional levels are normally required. The tube feedings take a while to adjust to the bowels and the doctors choose that the patient should derive the nutrition at a certain rate which helps them to tolerate and also helps them to gain weight. The tube site should be taken care of everyday cleaning the area and changing the dressing so that the infections can be avoided. When they do the Jejunostomy they check whether it’s in the right place or not. Whenever I go to Radiology Department of Penn Hospital to get the new J-tube after the procedure they check it to seek whether it is in the right place or not.
As I am a chronic Pancreatitis patient and none of the surgeries could pick away my pain I ended up with J-tube forever. I can eat snacks but I will never be able to eat full meals like everyone. When I got the J-tube it was such a hard thing to gain used to. The body does not like the foreign bodies and it always tried to push it out and whenever the tube moved it hurt so much. No matter how much I took care of the site I ended up with so many infections and had to be treated with anti-biotic. At one time I think I was on antibiotic almost every month or alternate month for a year. They had to give good bacteria to replace it which was lost because of taking too much antibiotic. After having so many infections the pain around the tube became very severe. It wound when I toddle, when I try to sleep on to the side, sit for continuously an hour in a chair working on something the injure became unbelievable. So the radiologists told me that it has become chronic. I was very mad for a while. My life was full of pain and they keep adding new kinds to the already exists. When tube was placed it has a small balloon to block the tube from coming out from the small hole but after few months or rarely a year after the balloon gets ruptured and the tube comes out. We make appointment to replace the tube and the Radiologists at the Interventional Radiology replace it. Sometimes this balloon ruptures and the tube starts to come out that means it’s time to get a new tube. I go to Penn Hospital Radiology Department to get it changed.
I ended up in the hospitals with the infections to secure I.V antibiotic treatments by a injure specialist. Then they figured it out and said because I have Meta Port I can retract the I.V treatment at home when the nurses from Infusion Company will come and show me how to do it. I have suffered like that almost two years. My friend from Nevada said one of her neighbor’s daughter have some chronic problems so she has this J-tube too but she uses an ointment which blocks the infections. So she sent me the name of the ointment and we showed that to the wound specialist which he has not seen before so he called the pharmacist in the hospital and gave the name of the ointment. I have started using the ointment and the infections stopped all of a sudden and now the tube site is very clean and I take marvelous care of it. Of course the afflict around the tube also came down. It is still there but it gets worse when I work for hours sitting or bend too much if I get in the mood of cleaning and carried away without paying attention to the time.
Having J-tube helps me to get the enough nutrition for my body. Last year I had very tough year and lost too much weight even though it bypasses the stomach whenever I get the wound I can’t use the tube feedings at the normal rate. Sometimes I have to stop it until the Pancreatitis attack goes away and then start with the low rate and increase it slowly to my normal rate. As I lost too much weight my G.I doctor suggested that I should get TPN for 12 hours at night time. TPN (Total Parenteral Nutrition) can be given through a central line or Meta Port because it is very thick solution which cannot be tolerated by the usual veins used for the I.V. So the TPN treatment is given through intravenously bypassing eating and digestion. This is temporary treatment for me. The TPN formula has all the nutrition required for the daily supplement of the body. It has lipids, amino acids, salts, glucose and all the important nutrition. We have to add vitamins when preparing the formula to hook up. For the first few days I had to check my sugar levels and if they are normal then I don’t have to do it regularly. If the sugar levels go up they give insulin to the patient. Every week the nurse from the Infusion Company visits and she draws blood from the Meta Port to send it for the labs. They check everything to see the TPN is working or not and if they have to make any changes. If something is low or high the doctor who gets the blood work recount asks the nutrition nurse at the Infusion Company to make some changes. The nurse then takes out the needle; well-organized the area, accesses it with the original one, then puts the dressing and flushes the port. The Port which was accessed needs to be flushed with Seline flush before hooking up TPN formula then when the formula is done it needs to be flushed with both Seline and a Heparin. This keeps the port clean and avoids the infection. There is always a great risk of infection with the ports. The first Meta Port I had for almost more than 5 years without any problems. But when they started TPN in fall four weeks later I had very dreadful infection and luckily caught on time. Sometimes the patient can go into Sepsis shock as the infection spreads very posthaste and can be dangerous. That’s why the patients need to be very careful in taking care of the port.
Every week the nutritionist calls and finds about the weight, and whether am I having any problems with the TPN or is it working without any problems? Usually every week I gather one or two pounds. Some times when I have lot of pain I don’t gain any weight but I don’t lose whatever I gained too. So, that’s a good note and means I am on right track. When TPN starts working I feel more energetic, when I do things I do not fetch tired quickly, the paleness goes away and the skin, face look healthy and I start looking healthy and people start noticing too. I have gained fair few pounds and I have a long way to go.
TPN is mostly musty temporarily unlike the J-tube can be used for long term. TPN is venerable for the Cancer patients, GI tract malfunctioning, diseases that need total Bowel rest, Crohn’s disease, Ulcerative colitis, Bowel destruction, Pediatric GI disorders, short bowel syndrome due to surgery.
There is another kind of tube feeding which is almost like J-tube except that it is G-tube and is placed in the stomach and they are archaic for the long term Enteral nutrition. It’s placed in the abdominal wall surgically. Just like the J-tube the station around the tube should be kept clean and use gauze for the dressing. G-tube is also called a Peg tube.
NGtube is called Naso gastric tube another kind of tube feedings which is inserted through nose and passed down the pharynx through the esophagus and into the stomach. NG tube is worn for the short term. They check it whether it’s in the right place or not before each feeding. Before my second major surgery Whipple when I was in the hospital and the doctors were horrified that I was losing the weight so badly and before they send me to the surgeon again they wanted to try NG tube so that I can get some nutrition daily, slowly gain weight and get some strength before they decide what can be done. I was reluctant about it and after the doctor pursued and explained for a long time then I agreed. My Gastroenterologist tried to insert it through my nostrils but he couldn’t get it where he wanted. I was gay it didn’t work out because if they send me home with that my kids could have been so frightened. Then they decided about the J-tube and sent me to another hospital where the surgeon agreed to do Jejunostomy.
These are the different kinds of tube feedings that are used for the people who cannot eat like the normal people because of some GI problems or some other chronic conditions. When they first talked to me about the J-tube I totally gave up at that time but they did not want to give up on me. As the doctor was explaining I said, ‘why don’t you just kill me? ‘ The doctor could not talk to me and got up and left the room. I know they were trying to save me from dying due to malnutrition. Then next day my Gastroenterologist came and slowly explained everything step by step then I agreed to get it done.
I am very glad now that the doctors did not give up on me and also I’m thankful for all these wonderful medical advances which help people like me to live and see the kids graduate, going to college and enjoy watching them becoming successful and happy in whatever they are doing. I have to thank all the doctors and surgeons who gave this life to me.
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