J Tubes... checking placement/residual???

I never check residuals on a J-tube. On a G-tube, yes. Shouldn't an x-ray be done to check placement?

Michigan RN said:

I never check residuals on a J-tube. On a G-tube, yes. Shouldn't an x-ray be done to check placement?

This is a HH patient.. sent home with a Jtube for feedings. Wouldn't you want to check for placement by aspiration anyway?

jnette said:

This is a HH patient.. sent home with a Jtube for feedings. Wouldn't you want to check for placement by aspiration anyway?

I never had to. I always though that the j-tube was too small to aspirate. I could be wrong.

i always check for residual.

can't assume sm intestine is perfectly functional.

as for placement, don't know how you could unless x ray.

leslie

Just a guess. I never thought you could check residual on a J-tube because any contents that are in the jejenum don't sit there like they do in the stomach. I could be totally wrong though.

earle58 said:

i always check for residual.

can't assume sm intestine is perfectly functional.

as for placement, don't know how you could unless x ray.

leslie

How would you check for residual in teh small intestine? It doesn't "hold" anything..it's not a "container" as the stomach is. Wouldn't it just all run through the length of the small intestine? I mean what's to "hold" it for awhile, as the stomach would do? And if yu aspirated, would you not just be getting runny "poop" ?

And you could be drawing up a LOT of "residual" I would think... those intestines are LONNNNNNNNNNNNNG......... I may be all wrong..as I said, I need some clarification on this. What kind of residual would I be expecting from a Jtube? It wouldn't be anything like stomach contents/juices.. the G tube residual content.

J-tubes are a poor indicator of residuals. And you shouldn't try to aspirate through it because j-tubes have tendency to clog easily.

no, it's just me.

clinically/technically michigan and jnette, you can't check for residual.

yrs ago i was trying to unclog a jtube and when i finally did, i got a lot of blood.

this pt had pancreatic ca, and the md thinks his bowel perf'd.

he was a mess.

anyways, since that time, i've always checked residual in the population i work with...

although i don't get a heck of a lot of jtubes.

oh, and another time, i was told it was a jtube, when in fact, it was a g-j tube...where you do check residual.

so no, you really don't have to check.

besides, if the fdg is not infusing, there will be other telltale signs.

leslie

Michigan RN said:

Just a guess. I never thought you could check residual on a J-tube because any contents that are in the jejenum don't sit there like they do in the stomach. I could be totally wrong though.

Yes.. that's what I was thinking.

earle58 said:

no, it's just me. clinically/technically michigan and jnette, you can't check for residual. yrs ago i was trying to unclog a jtube and when i finally did, i got a lot of blood.

this pt had pancreatic ca, and the md thinks his bowel perf'd.

he was a mess.

anyways, since that time, i've always checked residual in the population i work with...

although i don't get a heck of a lot of jtubes.

oh, and another time, i was told it was a jtube, when in fact, it was a g-j tube...where you do check residual.

so no, you really don't have to check.

besides, if the fdg is not infusing, there will be other telltale signs.

leslie

OK.. this had me curious. He was sent home from the VA.. and his papers said he had had teaching on checking placement and residual. He had acute pancreatitis and they bypassed the duodenum and placed a temprary Jtube. His discharge papers said he teaching on all the above. Got me to wondering. Perhaps they did the "run of the mill" teaching on Gtubes in general?

I've not seen him, we just admitted him.. but was curious as to what our policy should be, and what to include in his plan of care regarding his teaching, Jtube care, etc.

I appreciate the feedback! ?

the problems w/fdg tubes, is you don't always know exactly what type they have.

like i mentioned, we got a pt with jtube and it ended up being a g-j tube.

we found this out after tracking down the surgeon.

and this tube was seemingly in the jejunum, small bore, tiny cath.

but, if it's not going well, you'll be able to assess for abnormalities.

leslie

I had a toddler in home care with a JG Tube which was placed by Interventional Radiology. Feeds went into the J, the G was for meds only. We were told not to aspirate the J because the tube would have a tendency to dislodge and necesitate a return trip to IR to be checked / replaced. We were told to keep pump running as long as there was no leaking or reflux of feeds.

I think the only "real" way to check placement is by XR, but if the tube is transpyloric, you can usually get a "snap" when you aspirate- the plunger snaps right back to the tip of the syringe. With the little ones sometimes you will hear a swoosh of air louder on the rt of the abd compaired to the lt.

However, I don't think either of these ways are the "correct" way to check placement- you have to have the XR confirmation.