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At least 181 records · Page 10Linked to original sources
PubMed1980

An improved technique for needle catheter jejunostomy.

A modification of the needle catheter jejunostomy technique employs a No. 11 needle and a 13-gauge catheter. Because it utilizes a larger tube, the new technique requires a subserosal saline injection and a small stab serosal incision. The large-needle catheter jejunostomy allows the administration of viscous whole liquid feedings as well as elemental diets. In addition, the larger catheter offers an opportunity to vary the constituents of the infusion solution to specific patient needs, thereby broadening the uses of jejunal catheter feeding.

Catheterization↗
PubMed1981

Immediate jejunostomy feeding. Its use after major abdominal trauma.

Jejunostomy feedings were used in the immediate postoperative period in patients with massive abdominal and retroperitoneal injuries. Patients were selected for early feeding if they had two or more major visceral injuries. Over a six-month period, 30 such patients were studied: ten had blunt trauma, 11 had gunshot wounds, and nine had stab injuries. The injuries included 11 pancreatic, ten small-bowel, six colon, and six major retroperitoneal vascular injuries. A 16-gauge intracatheter was placed in the proximal jejunum. The constant infusion of nutritional solution (Vivonex HN) was begun 18 hours postoperatively, and within 72 hours all patients were receiving 2,400 calories per day. Feedings were maintained for an average of eight days. Serum albumin and transferrin levels, total lymphocyte count, and delayed hypersensitivity were maintained or improved during jejunal feeding. Patients with pancreatic injuries received supplemental nutrition without evidence of pancreatic stimulation. Needle-catheter jejunostomy can provide early, safe nutritional support after major abdominal trauma. Further investigation is needed to determine who will benefit from this early feeding.

Abdominal Injuries↗
PubMed1987

[Controlled study comparing mechanical and manual esophago-jejunostomy following gastrectomy].

40 patients with gastric malignancies were entered into a prospective randomised study of mechanical stapling (EEA) vs. manual single layer suturing of the esophago-jejunostomy following total gastrectomy. The groups were well matched with respect to clinical features, medical risk factors and tumor stage. Following manual technique, no anastomotic leak was observed. In the group with automatic mechanical suturing one technical failure and one insufficiency was seen. This difference, however, is not statistically significant. One patient died (cardiac infarction). The analysis of operating time, morbidity and hospital stay showed no significant differences. These results indicate that by use of a precise standardized conventional suture technique the same security performing an esophago-jejunostomy can be achieved as with mechanical staplers.

Adenocarcinoma↗
PubMed1977

Short tube decompressive jejunostomy.

Experience with short tube decompressive jejunostomy in twenty-nine patients with small bowel obstruction is presented. Many advantages are gained by operative decompression of obstructed, dilated small bowel. The favorable results with its use make short tube decompressive jejunostomy a safe, acceptable method of decompressing dilated small bowel.

Adult↗
PubMed1982

Modification of the needle-catheter jejunostomy.

A new technique is described wherein a J-tipped Teflon-coated stainless steel guide wire is used to facilitate the insertion of a needle-catheter jejunostomy tube. The advantages of this technique are that the guide wire is threaded down the bowel much easier than the catheter itself and also that by using the guide wire in threading the catheter over it, the hub need not be amputated, thus reducing the need for additional material to affix or glue a hub onto the catheter after completion of the procedure. Once the technique is mastered, a needle-catheter jejunostomy can be inserted in this fashion in approximately 2 to 3 minutes, thus adding minimal morbidity in terms of operating time. Nutritional support can be started much earlier without the hazard of central venous catheter infection.

Catheterization↗
PubMed1984

Outpatient use of the feeding jejunostomy catheter.

Selected cancer patients can benefit from home use of the jejunostomy catheter. The indications for this technique include chronic inability to meet basal fluid and caloric needs and risk of intestinal obstruction. This report describes the extended use of the jejunostomy catheter in 20 women with gynecologic malignancies and discusses the benefits and risks of this technique.

Ambulatory Care↗
PubMed1985

Ascending contamination of a jejunostomy feeding reservoir.

In general bacterial contamination of enteral feeding solutions is considered to be exogenous in origin. However, during feeding through catheter jejunostomy another source of contamination seems possible. We describe a patient in whom bacterial contamination of the feeding solution given through a catheter jejunostomy occurred frequently. Microbiological evaluation of several feeding samples showed that with this particular type of catheter enterostomy contamination was dual in origin. A not aseptic manipulation of the feed prior to administration led only to slight contamination. Most of the contamination however was endogenous--ie. ascending from the gut of the patient. In contrast to some previous studies, no clinical or laboratory deterioration could be observed in relation to the contamination. The food value of the feed expressed as the glucose concentration was significantly reduced after contamination with the causative organisms.

Journal Article↗
PubMed1986

A nonelemental versus an elemental diet for early postoperative enteral feeding by needle catheter jejunostomy.

In a prospective randomised study the use of an elemental versus a nonelemental diet for early postoperative enteral feeding by needle catheter jejunostomy was investigated. After extensive gastrointestinal surgery, 25 patients received an elemental and 24 patients a nonelemental diet. The incidence of diarrhoea, the effects of the feeding and the costs were evaluated. The occurrence of diarrhoea was observed more frequently in the elemental diet group (14 25 ) compared to the nonelemental diet group (7 24 ), although this difference was statistically not significant (p > 0.05). No difference was found between the two groups in postoperative restoration of total protein and serum albumin levels and the extent of the postoperative weight loss. The costs showed a clear difference: the nonelemental diet was three times cheaper than the elemental diet. For early postoperative enteral feeding by needle catheter jejunostomy we therefore recommend the use of a nonelemental diet.

Journal Article↗
PubMed1997

Copper deficiency with pancytopenia due to enteral nutrition through jejunostomy.

Copper deficiency is a rare complication of enteral nutrition. Haematologic abnormalities such as neutropenia and anaemia, but not pancytopenia, have been described associated to copper deficiency. We report the case of a patient requiring long term enteral nutrition through jejunostomy who developed copper deficiency and pancytopenia. In 1991, a 47-year-old woman was admitted with severe gastroesophageal mucositis after an attempted suicide with caustic intake. Enteral nutrition with a commercial, polymeric, fiber-containing formula was started. Twenty-eight months later, the patient developed anemia and neutropenia that did not respond to combined iron and parenteral vitamin B(12) supplementation. In 1996 the patient showed pancytopenia and low serum levels of copper and ceruloplasmin. Pancytopenia improved after copper supplementation. Possible mechanism causing copper deficiency and pancytopenia are discussed. We conclude that assessment of copper status is advisable in patients receiving long-term enteral nutrition by jejunostomy.

Journal Article↗
PubMed1986

Small bowel ischemia: a consequence of feeding jejunostomy?

Continuous jejunal feeding through needle catheter jejunostomy is generally well tolerated with minimal morbidity. Small bowel ischemia or infarction has not been reported in association with jejunal feedings. We describe five patients, each of whom had grossly normal small bowel at the time of insertion of needle catheter jejunostomy. All had episodes of hypotension during continuous jejunal feedings, and subsequently had abdominal distention. Upon abdominal exploration, two patients were found to have infarction of the jejunum and three had infarction of the entire small bowel. No evidence of major vascular occlusion or mechanical obstruction was found. Patients at high risk for hypoperfusion may not tolerate jejunal feedings during such episodes. It appears possible that feeding may increase the susceptibility of the gut to hypoperfusion.

Accidents, Traffic↗
PubMed1976

Endoscopic pancreatography in evaluating results of pancreatico-jejunostomy.

It has been difficult, employing clinical methods, to establish whether pancreatico-enteric drainage shunts for chronic pancreatitis have remained patent and how the operation has affected the inflammatory changes and ductal pathological morphology. In an attempt objectively to evaluate postoperative results, 13 patients with two different types of pancreatico-jejunostomies were examined with endoscopic pancreatography. Progress of the inflammatory changes was noted to a varying degree in the majority of cases. In four patients subjected to longitudinal split of the pancreatic duct, shunt patency was evidenced. In the remaining nine patients with caudal pancreatico-jejunostomy, no contrast medium could be made to pass the shunts in six cases, whereas passage was clearly demonstrated in one and uncertain in two. All the patients reported clinical improvement after operation.

Acute Disease↗
PubMed1986

Gastric hemorrhage complicating percutaneous transgastric jejunostomy.

The first occurrence at the authors' institution of serious gastrointestinal tract hemorrhage complicating percutaneous transgastric jejunostomy and its management by a modified technique are reported. The 0.7% frequency of this complication (one in 130 procedures) compares favorably with the frequency of hemorrhage reported for surgical gastrostomy (0.9%-1.4%). Percutaneous transgastric jejunostomy represents no greater risk of hemorrhage than does surgical gastrostomy and should continue to be an alternative to the latter procedure.

Aged↗
PubMed2003

Adverse effects from inappropriate medication administration via a jejunostomy feeding tube.

Numerous complications can arise when administering medications to patients receiving continuous enteral feeding. We report a case of a patient who could not be fed by mouth and was receiving continuous jejunal enteral feeding who had an adverse event associated with inappropriate administration of a medication via his jejunostomy tube. He had taken an extended-release niacin product before hospitalization for type IIb hyperlipidemia. The patient was inappropriately given a single dose of 750 mg of niacin as the short-acting tablets that were crushed and administered via the jejunostomy tube. He experienced severe cutaneous flushing, a feeling of warmth, itching, nausea, and emesis. He was noted to have "prickly heat" to the forehead, according to the nursing notes. A discussion of problems and guidelines for medication administration in adult patients receiving continuous tube feeding is provided.

Journal Article↗
PubMedDate not supplied

Immediate postoperative feeding following massive abdominal trauma--the catheter jejunostomy.

Early postoperative feeding with an elemental diet has been successful in elective gastrointestinal surgery. This study was undertaken to evaluate whether elemental feedings were feasible through a catheter jejunostomy in patients suffering massive abdominal and retroperitoneal injuries. Eight patients had a combination of hepatic, upper gastrointestinal, and pancreatic injuries. A 16-gauge intercath was placed in the proximal jejunum, and the constant infusion of elemental diet begun at 12 to 18 hr postoperatively. Within 2 days the patients were receiving 2200 to 2400 cal/day and were maintained at this level for 5 to 22 days (average 11 days) before oral intake could be resumed. Body weight, lean muscle mass, and serum albumin were maintained during this period. Transferrin levels and total lymphocyte count improved during the elemental feedings. All patients eventually recovered completely. There were no gastrointestinal complications associated with the early feeding. Catheter jejunostomy can provide early nutritional support in patients with massive abdominal injuries.

Abdominal Injuries↗
PubMedDate not supplied

Early postoperative nutritional support using the serosal tunnel jejunostomy.

A silicone rubber serosal tunnel jejunostomy for postoperative nutritional therapy was placed in 38 patients who had major operations. A dilute, chemically defined diet was begun within 48 hours of surgery and an attempt made to advance it slowly to full strength by the fifth day. No catheter-related complications occurred. Intravenous fluid therapy was shortened to less than three days in 11 (29%) patients. Only 17 (45%) patients tolerated full-strength feedings within the protocol time. Three (8%) patients depended on their tube feedings for over 30 days and the need for parenteral nutrition was avoided. Of six septic patients, four had complete intolerance of the diet; two of these developed massive gastric hypersecretion. Serum albumin was a statistically significant indicator of whether a patient could tolerate tube feedings. No patient with an albumin less than 3 g/dl tolerated full-strength feedings and the pded. Of six septic patients, four had complete intolerance of the diet; two of these developed massive gastric hypersecretion. Serum albumin was a statistically significant indicator of whether a patient could tolerate tube feedings. No patient with an albumin less than 3 g/dl tolerated full-strength feedings and the patients with albumin greater than 4 g/dl had no problems. Postoperative feeding utilizing the serosal tunnel jejunostomy is technically safe, but feeding difficulties can be anticipated in those patients who are septic or severely malnourished; these are the patients whose nutritional needs are the greatest. The greatest benefits accrue to those patients who are in need of long-term nutritional support. We recommend routine placement of these catheters in major operations.

Enteral Nutrition↗
PubMedDate not supplied

Self-administered bolus jejunostomy feeding and gastric fluid reinfusion in patients with gastric atony.

Twelve patients with profound gastric atony were taught to administer their own tube jejunostomy bolus feedings and, when necessary, to manage their gastric secretions by connecting their gastrostomy and jejunostomy tubes. These techniques allowed 11 of 12 patients to obtain reasonable nutrient intake and eight of the 12 to successfully reinfuse retained gastric secretions; alleviating the need for intravenous fluid replacement and expediting hospital discharge. Seven patients were able to resume some oral intake at home after resolution of their gastric atony. In the sufficiently motivated patient with gastric atony from multiple causes, these techniques provide alternatives to indefinite hospitalization with cumbersome and expensive intravenous hyperalimentation or constant infusion enteral alimentation.

Adult↗
PubMed1986

Low-fat versus medium-fat enteral diets. Effects on bile salt excretion in jejunostomy patients.

Nine jejunostomy patients were given three low-residue enteral diets in random order through a nasogastric tube. Total bile salt excretion in the jejunostomy contents was 13-17% lower (p less than 0.05) on low-fat diets than on a medium-fat diet. Cholate excretion was 14-20% lower, but chenodeoxycholate excretion showed no difference on the low-fat diets. The study supports the idea of a lower excretion of bile salts to the colon as an explanation of reduced diarrhoea when a low-fat diet is prescribed to patients after ileal resection.

Adult↗
PubMed1975

Pancreatico-jejunostomy in chronic pancreatitis. An appraisal of 29 cases.

Pancreatico-jejunostomy end to side after resection of the pancreatic tail, or side to side following longitudinal cleaving of the pancreatic duct, was performed in 29 patients suffering from chronic relapsing or acute recurring pancreatitis. A follow-up study with observation time ranging from 6 months to 10 years is presented. The patients were allotted to three groups according to the severity and extent of the inflammatory involvement at operation. The diagnostic findings obtained at the preoperative evaluation correlated well to these groupings. In some patients, however, the inflammatory process was mainly confined to the ductal system, as revealed by pancreatography, while in others the changes were most marked in the parenchyma, as found at histologic examination. 21 caudal pancreatico-jejunostomies and 8 longitudinal anastomoses were performed. Overall results were excellent in 20 patients, good in 6, fair in 3, and poor in none. The rate of postoperative complications was low; no mortality, one spontaneously healed anastomosis insufficiency, subphrenic abscess developed in 2 instances and postoperative diabetes in 5. Only one patient had a recurrent attack of acute pancreatitis postoperatively. Re-anastomosis was successfully performed.

Acute Disease↗