[Oceanaura]

Hi everyone, I am an LPN who works in a group home with 8 developmentally delayed adults. Everyone who lives in the home has either a GT, JT, GT AND JT, or a G/JT. We have a guy here who is 11 months s/p JT placement. He has GERD, gastroparesis, gall stones, hiatal hernia, scoliosis, kyphosis, seizure d/o. He gets all meds and a continuos feed through the JT. He is NPO.
Recently, he has had two bouts of vomiting bile. (Within 6 weeks of each other) Both times he was dx with an illeus, but then aspirated on the emesis. We took him to the GI doc today who said to apply sx to his JT with the Gomco sx pump for two hours, TID. I can find NO info on this....is this a common practice? We were always taught to never do this.
We do have exp. with the Gomco, as one of my other pts. has it applied to his GT two hrs a day. Please help. Thanks!

[janfrn]

I think that would be a very bad idea. The purpose of a jejunostomy feeding tube is to put the feeds past the pyloric sphincter to prevent reflux and aspiration. Applying suction to this area will damage the mucosa and not decompress the stomach, which is where the offending substance is accumulating. The motility of the duodenum or jejunum drastically limits the volume of fluid that would be present and all you'd be doing is sucking the mucosa up against the tube. I routinely perform blind placement of nasojejunal feeding tubes in the ICU where I work, and one of the tests we do for proper placement prior to radiography is called the "snap test". This test is done with a 20 mL syringe; the plunger on the syringe is drawn back and if it snaps back to the starting position the tube is probably in the right place. The plunger is sucked back into the syringe by the vacuum present in the jejunum. I have never, ever been able to aspirate feed or residual fluid from one of these tubes. I could undertand applying intermittent suction to a gastrostomy tube, since the tip of it would be in the stomach where fluid sits for some time before moving along, but not a jejunostomy... Maybe the physician didn't catch that person has a JT and not a GT. Having said that, what does your facility policy say?

[Oceanaura]

The physician is absolutely aware the pt has a JT.....we are scratching our heads as well. Our facility has no policy regarding JTs being used in this manner. We are an agency consiting of several group homes housing developmentally delayed adults of all functioning levels. We are the only home in the agency with 24hr nursing, so we get the pts who would prob. have been sent to a nursing home d/t fragile medical conditions and need for nursing. This house raises the bar on what the agency handles medically. In fact, the outcome of this situation may, in fact, dictate any policy that may need to be written. Thanks for your response!

[janfrn]

I took your question to a friend who is the manager of the endoscopy unit of a major hospital. She initially said, "Oh no, we'd never do that. I can't think of a reason why that would be considered, or what it's intended to do." Then she started listing things she could think of that 'might' be reasons for wanting to do it. In the end she'd basically reversed herself and the upshot is that for problems like your client's, putting the GJ to intermittent suction for two hours TID might help. There are risks of course, because the jejunum is a small lumen channel with very little defence against injury such as might be caused by the tube being sucked up against the mucosa. One thing she did mention was ensuring that your clients, who are on multiple medications for their underlying condition, are adequately hydrated. Meaning significant free water in their tubefeeds. Not boluses of water, though because that'll injure the mucosa too. So there you are, an answer that really isn't an answer.