J-tubes questions

I'd like to learn as much as I can about J-tubes as I am thinking I could need one down the line. I am really confused about all the different types. Could someone explain them? Also I understand that there are different types of tubes by the way they are secured. Can someone explain that too. Finally, if your small bowel is slow, how do they determine if you could tolerate a J tube and how do they determine the delivery rate? Oh, and one last question, does the tube hurt or irritate the small bowel? Any info anyone can give would be appreciated. thanks!

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J tubes are nice for people who cannot use their stomach. Your professional will help you decide if you need a j tube. Usually, the MD's will try a nasal/jejunostomy to be sure the patient can tolerate feeds before putting in a permanent j tube. If you are unable to tolerate feeds thru the j tube, you may have increasing abdominal distention, pain, nausea, vomiting etc.

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I have a J tube. My first one was put in by my surgeon and it was stitched so it wouldn't fall out. It was the stitch that hurt the most. My GI doctor then put in a PEJ tube, during an endoscopy I very rarely have pain. When they first put it in it hurt, but hey they cut a hole in me so I guess it would. I have had the PEJ for over three years without a problem. It has to be replaced once a year.

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I have had a j/g tube since Dec. 2009. I can only address the type of device I have and obviously I am not a physician. I have one main tube that gets inserted and once it is in place, they slide two smaller tubes into the larger tube, position one of the tubes in my stomach (gastric) and one goes to my small intestine (jejunal). Once all tubes are correctly positioned, they add water to a small balloon (all still inside of you - not external) and fill it to the point that it keeps the line anchored and prevents it from coming out. My stomach is almost totally paralyzed so our goal was to get nutrition into me through the j-tube. by-passing the stomach completely. So when I hang a bag of formula, it goes into my small intestines. I use the g-tube to drain or release built-up gas in my stomach. For me, having both the g and j tubes is preferable. The j-tube especially because I can put my medication in it and will get relief much sooner than putting something in my stomach and waiting for hours/days for the medication to dissolve....if it ever does. You need to be very careful about the medicine you crush and dilute in water and put in the J-tube. Always check with your physician or pharmacist before doing anything like that. Some medications are "slow release" and if you crush it and mix with water, you could potentially give yourself a major over-dose. It will take you several months to get used to the tubes and the formula. I've gone through 4 different types of formula until I found one I could tolerate. Yes, you can have some pain at the site of insertion. I've had a lot of problems with that but through trial and error have found how to minimize that problem. I put hydrocortisone cream (Walgreen's brand - it is cheaper) on the area. The skin irritation cleared up within one day. I have had 5 different j/g tubes placed for various reason but the usual cause is the balloon can burst or deflate and your line will just drop out. Don't panic (I did the first time!!!). In medical terms it is not disasterous but you do want to get another tube put in as soon as possible (that day or the next day). That "tunnel" they make to put the tube in closes up very quickly if there is no tube to keep it open. It's more painful to have another line inserted because they have to push the tube in harder to reopen the tunnel. If your line suddenly comes away from you body significantly more than before and you can easily move it in and out (not all the way out) you should (with sterile hands) push the line back in as far as you can and tape it in place. That will keep the "tunnel" open until you can get a new one put it. But do NOT use the tube. If the tube falls completely out, do NOT put it back in. It won't be sterile. Most important of all make sure a good Interventional Radiologist puts the tube in under flouroscopic xrays. That is essential to make sure the IR knows that he/she has the tube correctly placed If you have a good relationship with the IR stay with him/her. They know you, your case and your medical history. The IR group I use (at a hospital) know me very well (I have "weird anatomic anomalies"). If I have problems with my tubes they tell me to just come in and they will find a way to schedule me in.. I've been told to routinely change tubes every 4 months or so but have also been told to just keep it in if its working and I'm having no problems with it. I know this was long, hope it was useful. Good luck!

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Hey thanks so much for all the replies. Obviously I need to learn a lot. So what is the difference between a PEJ tube and regular old J tube? It sounds like the the PEJ tube hurt a lot less? Are all J tubes stitched in? Also do they all have the balloon inside or are there other types? Also is the norm to change tubes every 4 months? or is it more often every year or does it depend on the type of Jtube you have? Sorry for all the questions, just want to be prepared.

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I think a pej tube is a gastric peg tube with a jejunal extension (so a g and a j tube). I have a Pej but i cannot tolerate much through the J part as i have bowel problems also. I use the g tube to withdraw some fluids off my stomach and i use my j tube for medications as i suffer too much pain trying to feed through it so i get fed intraveniously. My pej was put in endoscoply, but mine isn't held in with a balloon i believe there is a plastic stopper on the inside. If the tube is put in surgically then it is stitched in but if not then no stitches are used. I have not been told that my tube has to be changed every so often, i assume it only needs changing if there is a problem. As i live in the UK i do not know if things are done differently here.

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I have had my tubes, separate J and G ones in for about eight months now. The J tube feeds, the G tube is used to vent out stomach contents so you don't have to puke as much and relieve the bloat some.

Mine hurt, hurt like hell. I've replaced the J tube 4 times now and am on a button now. I have to be on the thing 24/7 but skip days now and again when it hurts too much. My sites have never healed down right, just keep sprouting granuloma tissue that won't heal no matter how many times they burn it off. I'm told this is an extremely rare thing to have as much pain as I do with mine.

I have a lot of inflamation, my stomach is kinda distended from it. It's a life saver though, you don't have to force yourself to try and eat and then experience the eating pain and then the puking.

Overall, yea, glad I had them installed. Just wish they didn't still hurt like day 1.

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Well thank you all for the very very good explainations. I can see I still have a lot to learn, but this has given me a start to understanding. Uberhiker I am really sorry that you are in pain from your tube. Have you consulted anyone else about the healing? I will keep you in my prayers, and I am hoping that things will get better for you.

Again, thanks to everyone for your help.

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I planned on asking my GI about maybe I'm alergic to the tubes, the silicone or something. Missed my appointment though, too much ice on the roads here and couldn't make it in.

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uberhiker - that's a good thought about possibly being allergic. Maybe you could do a post on this site asking if anyone else has had the same problem - maybe they might have some solutions. You are in my prayers.

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Just a quick messge to those people who have indicated they have external stitches to anchor the tube and keep it from coming out. Every Interventional Radiologist I've been to have told me they strongly recommend that I NOT have stitches put in. If I did, they would want to take them out within a week. Their reasoning (and it makes sense) IS that those stitches don't allow your tube (the external part) to move in any direction and that eventually leads to even more pain, inflammation, and possible infection at the stitch site. I'm not a physician so be sure to add that to your list of questions for the doctor. One other tip, write down any questions you have before you go to your next appointment with the doctor who will be ordering a g-tube or j/g-tube as many posts on this site that you can. You will find more issues than you would have without the information on this site. I definitely wish I had access before I got my tubes put in. Best of luck!

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I have a J-Tube due to gastroparesis. I also have bowel dysmotility (slow bowels). I had difficulty with the J-tube when I first got it due to the slow bowels. I was closely monitered in the hospital for a month after my tube placement and was kept on IV nausea meds and TPN. The Drs. slowly increased my rate of feedings until they got it to a rate that I could tolerate, and get enough calories in to maintain my nutrition labs. Different people run at different rates depending on what they can handle. I was told when I went home that I could slowly continue to increase the feeding rates if my bowels would tolerate it. Unfortunatlly they wouldn't, so I run at 55mL/hr, 24/7, unless I am in the shower or need to fast for a test.
There are many different kinds of J-Tube. Your Dr. should be able to help you find the kind of tube that would be best for you. There are 3 types I know of. One is a simple foley tube that isn't really anchored in in any way. I have never had one of these so I don't have much info about them. Another option is a surgical placed J-Tube. This is what my first tube was. This kind of tube is placed by a surgeon and rarely needs to be changed. Mine had a mess end, and the lining of the small intestine was supposed to grow into the mesh and anchor the tube in place. When the tube is first placed there are stitches around the out side of the tube to keep it in place until it heals. After the tube site heals the stitches can be removed. This kind of tube rarely falls out, and only needs to be changed if the tube quits functioning. I had my tube in for a year before I had it changed. I only had mine changed because my body treated it as a foreign object and in never anchored in like it was supposed too.
The third kind of tube I am familiar with is the tube I currently have. When my surgical tube was removed it was replaced with a GI placed tube using the same tract that the surgical tube had been in. My Drs actually put a replacement balloon G-Tube into my Jejum. It's a little confusing to Drs. that don't know me, but I love it! This tube is replaced every three months. It is an easy procedure because of the kind of tube they use. It is anchored in by a balloon in my Jejum. To replace it a syringe is used to remove the fluids from the balloon, the tube is pulled out, a new one is slid in, and the balloon is re-blown up. There is no x-ray or novicane required for the change of this tube. It is about a 5 min. procedure, and actually we could do it at home if I weren't such a chicken.
Everyones experience with how a J-Tube feels is different and dependent on your body, and where your Dr. places it in your abd. I think everyone would agree that it is uncomfortable and odd feeling for a while when you first get it. It is a foreign object that you physically and mentally have to adjust to. Once you have had it for a while, you will become used to it. Personally I do not have any major pain caused by the tube anymore. There are certain movements that make it more sore, and if it gets hit is hurts, but it is not untolerable pain, and it goes away when I quit doing whatever is hurting it. And the pain is not internal pain, but surface (skin) pain. If you get an infection, etc. it will hurt worse, but your Dr. will help you take care of that.
My J-tube saved my life. I have days where it frusterates me, but without it, I wouldn't be here today. It's a life change, but it can be done.

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I had my j tube surgically placed and it is not held in my stitches...just tape. The stitches were removed about 3 weeks after surgery.

I don't have a g tube and haven't found my feedings to make me nauseous...though eating/drinking by mouth still does. Interventional radiology didn't want me to get a g/j tube because they found that were too many long term problems with the use and a lot less problems with a surgically placed j tube.

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