I had a patient today who is s/p j tube placement 2 days ago. He has been getting tube feedings at 40 ml/hr.
When I came in to work today. His stomach was distended and full of air. Doctor ordered dulcolax suppository and two hours after that, no result, just a few gas passing. Surgeon who placed j tube said to put in NG tube to decompress his stomach but patient refused because of multiple mass he has in his esophagus. I was a little hesitant too to insert the tube since his INR is 4.0. Anyway, the surgeon then ordered j tube to low intermittent suction. Has anyone heard of this?
Jun 25, '09
Bad idea. The tip of the tube is well past the pylorus and although there may be some air in there, the intraluminal space is really only a potential space. There would be no benefit to applying suction to a J-tube and the likelihood of injury to the bowel is quite high. When I do blind placement of NJ tubes one of the methods for assessing placement is to aspirate the tube and if the syringe snaps back (due to the vacuum in the bowel lumen) the tube is probably where it needs to be. Then I order an x-ray to confirm... Your guy might benefit more from a rectal tube!