Gastronomy Jejunostomy Tube Exchange: Case Study

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Gastronomy Jejunostomy Tube Exchange

On July 6th, 2015, a 76-year-old female was admitted to the hospital. She was admitted with fever, weakness, and abdominal pain with recurrent episodes of nausea and vomiting. The patient has a complicated previous medical history of bilateral mastectomy, gastric adenocarcinoma, central line placement, partial gastrectomy, hepatomegaly, atelectasis, spleen enlargement, diverticula, cholestasis, gastronomy tube placement, and hepatotoxicity. A CT scan was performed upon her arrival to the hospital which found evidence of fluid overload and a coiled gastronomy tube in the left lower quadrant which was thought to be causing obstruction. She was scheduled to have her gastrostomy tube tested with a small bowel …show more content…

During the small bowel series, the radiologist was not able to determine the exact area of obstruction. The study was terminated after two hours and the patient was returned to her room. Following the small bowel series, the patient complained of abdominal pain and cramping. The patient’s tube was leaking bowel from the side of the tube and onto her abdomen. It was also noted that her parenteral nutrition was not adequate (LWR radiology, 2015). Due to the patient’s pain and lack of adequate nutrition, her gastronomy tube was scheduled to be exchanged with a gastronomy Jejunostomy tube. This procedure is completed under fluoroscopy using a sterile field. In addition to the sterile tray and equipment, other materials used were: x-ray tube, Bucky, x-ray table, digital cassette, lead markers, lead shielding, patient chart, fluoroscopy tube, fluoroscopy monitors, …show more content…

The tube passes through the stomach and goes to the second part of the small intestine, the jejunum. The tube allows the patient to be fed and helps to ensure adequate nutrition is obtained. Gastronomy jejunostomy tubes are made of different sections. Directly on the opening into the abdomen is a round plastic disk, which sits against the skin to help secure the tube in place. On top of the plastic disc are three access ports. The first port is marked G tube, which goes directly to the stomach. The second port is marked J tube, which goes directly to the jejunum. The third port is marked balloon port, which goes directly to the balloon. The balloon sits inside of the stomach and helps hold the tube in place when it is inflated (Duszak, 2014). A patient is a good candidate for a GJ tube when the gastrointestinal tract is intact (Simons, 2013). Gastronomy jejunostomy tubes are most commonly placed for nutritional support. However, there are many reasons a patient may need to have a GJ tube including a inability to take food in by mouth, dysphagia, loss of appetite, cancers of the stomach and esophagus, strokes, and neurological conditions (Simons, 2013). The tube can be placed by a surgeon, radiologist, or gastroenterologist. Before the procedure, the patient is instructed to fast for at least eight hours. To insert the tube, the patient is sedated and the catheter is

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