Feeding Jejunostomy Tube

Excerpt

Artificial nutrition refers to the provision or supplementation of daily metabolic nutrition requirements in patients with contraindications to feeding through the mouth or those with inadequate oral intake. Artificial nutrition is provided through parental or enteral access. Parenteral nutrition is provided through a large vein in the central venous system. Enteral nutrition makes use of the gastrointestinal (GI) tract to provide nutrition. Enteral access can be obtained by passing a feeding tube through the nose (nasogastric and nasojejunal) and mouth (orogastric) at the bedside. It can also be achieved by surgical implantation of a feeding tube into the gut, such as a feeding gastrostomy (stomach) or a feeding jejunostomy (jejunum). Historically, enteral nutrition has not been as well emphasized as parenteral nutrition because of the belief that many disease states will prevent the gut from normal absorptive function. However, it is clear that enteral nutrition is well tolerated even in severe disease states in critically ill patients. Moreover, enteral nutrition has been associated with reduced infectious complications, lower costs, and reduced length of hospital stay.

Feeding jejunostomy refers to a surgically inserted tube, preferably in the proximal jejunum, to provide enteral nutrition or administer medications. This differs from a definitive jejunostomy, commonly done as part of gastric resection by a Roux-en-Y technique. Bush was the first person to successfully place a feeding jejunostomy in 1858, performed on a patient with inoperable gastric cancer. Subsequently, Witzel, in 1891, developed the most commonly used technique for jejunostomy creation. A needle catheter technique was described by Delany et al. in 1973. The invention of the percutaneous endoscopic gastrostomy technique in the early 1980s paved the way for the development of the technique for feeding jejunostomy. After 1990, advances in laparoscopic surgical techniques permitted the insertion of feeding jejunostomy techniques. However, techniques of jejunostomies have been modified over the years; the ‘Witzel technique’ is synonymous with feeding jejunostomy.

This chapter is aimed at presenting indications and contraindications of feeding jejunotomies. Furthermore, it describes the equipment, preparation, and techniques of positioning and potential complications with their management. The role of the interprofessional team strategies for improving care coordination and communication to advance feeding jejunostomies and improve outcomes is also addressed.