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Experience with a new gastrostomy-jejunal feeding tube.

Many patients in need of long-term feeding by tube enterostomy have neurologic or mechanical deficits that increase their risk for aspiration. To reduce this risk, a combined gastrostomy-jejunal tube has been developed. This tube permits gastric decompression while the formula is being delivered into the jejunum. The use of this tube has been evaluated in 45 patients. There were three (7%) major complications and two (4%) postoperative deaths. The deaths did not appear to be directly related to the insertion of the tube. There was no clinical evidence of aspiration. This tube can be used to deliver postoperative and long-term enteral nutrition with minimal rates of morbidity and mortality.

Cerebrovascular Disorders↗

Nutritional support: formulas and delivery of enteral feeding. II. Delivery systems.

As interest in enteral feeding formulas and techniques grows, the hardware (tubes, bags, pumps) is becoming increasingly sophisticated. Newer materials have eliminated earlier problems with feeding tubes, and different lengths and lumen sizes have made access to the gastrointestinal tract more efficient. Patients can be fed via nasoenteric access or directly via gastrostomy or jejunostomy. Enteral nutrition can be administered safely if a protocol for feeding patients and monitoring them regularly is followed. If done carefully, transitional feedings can also be carried out effectively.

Enteral Nutrition↗

Evaluation of the bleeding patient.

The recent development and widespread use of flexible fiberoptic endoscopy and visceral arteriography have revolutionized the evaluation of patients presenting with gastrointestinal hemorrhage. The bleeding lesion can now be precisely identified within a few minutes to hours of a patient's arrival, allowing specific treatment to begin much earlier than was previously possible. The logical sequence of diagnostic studies is different for three different groups of patients with gastrointestinal bleeding. Those whose bleeding is active or recent require rapid evaluation, while those with chronic bleeding may be evaluated first by the more traditional and less hazardous barium radiologic studies. This revolutionary improvement in diagnostic accuracy should improve the survival of patients with gastrointestinal hemorrhage.

Acute Disease↗