J-Tube Flushing and water every day

My 36 year old stepson just had a J-tube surgically placed and he is vomiting a lot of bile. His esophagus doesn't work and he also has gastroparesis and cannot eat or drink anything by mouth.

We were told to give him 1.5 liters of water a day - 300 cc five times a day to keep him hydrated. When we give him the water, he appears to promptly vomit a lot watery bile. I am wondering if he is getting too much water at one time or if we need to do it very slowly. Can anyone help? Thank you!

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Try pushing small amounts VERY slowly through out the day. If he can't tolerate a small amt pushed thru slowly with a syringe, I reccomend putting water in a bag and hooking it up to his pump and have it run at a slow rate. Hope this helps!

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Thank you for the quick reply Becca. He is on the pump all day. Would you recommend putting water in it at night maybe? Or adding water to the formula?

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You could try both and see how it works. If he has problems tolerating his formula it may actually help to add water to it to thin it out some. I would definitely reccomend running water at a slow rate at night if he has been vomiting a lot. Dehydration just makes nausea worse.

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I add water to my formula and use about 50 cc a few times a day to flush....I don't think I'd be able to stand up straight if I had 300 cc at one time.

What rate is he pumping at?

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Thanks again Becca. We will definitely try water at night or both. When he was in the hospital with an IV hooked up for hydration, he didn't vomit once or have trouble. It started when we upped his feeding from 40 (at hospital) to 80 and started giving a lot of water at once.

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Hi jylum. He is pumping at 80. Prior to that he was pumping at 85 with a gj tube and consistently vomited quite a bit about every 3 days. That started in February. He only had about 2 good weeks where he was feeling better but he still vomited often. We didn't get any real guidance on the feeding and it seems no one know that much about feeding through a j-tube. The GI doctor said we weren't giving him enough and to give him 1.5 liters a day.

Do you give water in the middle of feeding or before and after. We were told before and after and once in the middle. We will definitely slow this down and put water in the formula. Thanks for the help.

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How many ml of formula do they want him to take in? If he is pumping at 40-80ml/hr and you are putting in 300 ml in less then 5 minutes, several times a day....sounds traumatic to the small intestine!

I pump 70 ml an hour and it takes me 18 hrs to get in 1300ml.

Have you talked to his dietician about the problem? If you don't have one, ask your PCP or GI doc to refer you to one.

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They want him to get 1000 ml a day (4 cans of formula). We have a dietician and nurse through a home health service but I don't believe there's a lot of expertise with a J-tube. The dietician recommended 85 ml an hour (which he did prior to getting his new j tube) for 12 hours per day. When we called about vomiting, the only suggestion was to vent his stomach and if he still threw up, we were to pump his stomach. Even the GI doctor we saw yesterday simply said we had to live with the vomiting bile and phlegm. No one has suggested adjusting the rate of the formula and he also told up to up the water. My stepson has myotonic muscular dystrophy which affects the smooth muscles. These horrible problems started last December. It is highly likely that the mobility of his intestines has been affected also. Unfortunately, this is a rare type of dystrophy he has had since birth. He doesn't feel heartburn, have stomach aches, feel pain inside which makes it hard to know what he is feeling.

This is the best advice we have ever been given and can't tell you how much we appreciate it. We are slowing it way down and he'll have to live with being on the pump longer to really see what he can tolerate. I guess it will be trial and error to see what makes him feel better and stops the vomiting.

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I mix my formula with water 50/50 to make it stay in me easier. I flush the J tube off and on throughout the day with 60 ml of water.

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I'm not an expert on j-tubes but I did take care of my father who had one when he had esophageal cancer and could not swallow anything either. Its a pain but you have to give the water slower and in smaller increments more often and mixing it with the formula is a very good idea. Sorry couldn't be more help good luck!

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I had such a hard time tolerating water down my J-tube, the doc put a PICC line in so I could receive my hydration through my veins. After a ton of blood infections and poor vein access, the PICC line had to be removed. An ER doc suggested putting Normal Saline down my J-tube instead of tap water. This advice was a life saver! I find that the saline is much gentler on the intestines. I used to only be able to tolerate 60cc of tap water at a time, when I use the saline I can tolerate up to 200cc at one time. I now have the pharmacy send me 1L bags of Normal Saline 0.9%, the same bags used with IV's/PICC. I cut a slit into the bag and pour it into a water bottle.

I hope this helps,
Shannon

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Thanks ShannonCanada for replying. That is definitely something we will try. Do we need a prescription to get these bags? Best to you.

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I don't know how it works in the US, but here in Canada my doc wrote a prescription. I get the saline bi-weekly from my homecare company at no cost. I would suggest asking your doctor. :) Let me know if I can be of any more help.

blessings,
Shannon

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