Is it safe to gravity bolus tubefeeds through a GJ tube? (J port only)

I have been on HEN about a year now after a brain tumor left me unable to swallow. I also have gastroparesis for which I'm supposed to take Reglan every 6 hours but I don't take it at all anymore because I don't like the side effects. I have a GJ tube in place but all I ever use is the J port. I was on a Kangaroo Joey pump which I hated. I'm supposed to be on it 17 hours a day. I choose not to be hooked to a machine so I do my feeds with a 60cc syringe without the plunger (gravity only) The nutritionist says this is a no-no but it's been working for me. After losing 180 pounds I have finally figured out how to maintain my weight. My question is this: have any of you fed this way through the J tube and have you had any complications from it? Also, do you have some ideas for keeping the tube still so there isn't such a problem with leaking and granulation tissue? I'm hoping to start VitalStim therapy soon with the goal of getting this awful thing removed. In the meantime I'd like to make the most of it.Any advice appreciated...

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Some suggestions for adaptive devices, specialty clothing/tube holders, and how to deal with granulation tissue are posted on the Tube Feeding Tips page on the Oley website at http://www.oley.org/tubetalks.html.

I haven't heard of anyone bolus feeding into a J-tube. My impression is that the jejunum (intestine) doesn't tolerate a large of load of food at once. Have you asked your physician about it? (A physician would have more training to answer this question than a dietitian.)

Roslyn Dahl
Oley Staff Member
dahlr@mail.amc.edu
(800) 776-OLEY

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I have so many issues going on I always forget to ask something.I have even made a list of things to ask and I always forget to ask him that one.So no, I haven't yet asked,although that's the obvious thing to do. It's kind of strange though..I could barely tolerate the feeds through the pump but have gradually worked myself to a 13 oz bolus with a 2 oz flush.I do this on average 5 times a day,using a base of Ensure Plus mixed with some other non-carbonated beverage. Gone are the cramps and bloating and my weight is stabilized so I guess I figure this method is ok. I will ask my doctor about this but I'm still curious if I'm the only one who's tried it.

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The reason why you are not supposed to do bolus feeds through a j-tube is because it can cause diarrhea and you may not fully absorb all of the feeds.

Mimi

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In my experience, slower i sbetter. If it's cuz you hate the kangaroo pump (I also am not a fan of kangaroos), you could try to get an enteralite infinity pump. I have one and it's awesome. It holds charge for days, is half the size of a kangaroo, etc. But its pretty expensive, I imagine, so you may want to see if your insurance will cover it. But I wouldn't recommend bolusing feeds through a gj. I have a GJ too and bolusing makes me sick, and bolusing too fast can cause it to reflux in your stomach. If this happens to me I puke. Good luck!

Kaitlyn (www.caringbridge.org/visit/kaitlynl)

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Thanks for the info and advice. So far I tolerate it like it's nothing. I guess my main problem is I resent being hooked to a machine 17 hours a day. I can't seem to justify that in my mind.(After all I'm the same person who went ama and refused radiation after having a benign brain tumor removed 13 months ago.) If there was a way to use a pump for a much shorter time I'd be more open to it I guess. I only hope my stubbornness doesn't come back to bite me in the butt. Maybe those VitalStim treatments will be the magic bullet I've been looking for and I can finally get this tube removed. I really want a hamburger :)

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I was told not to bolus into the j. It's to much for the intestines to handle. Trevor gets sick if I bolus his meds, everything goes thru his pump. The pump is his best friend right now, he feeds 22 hrs. a day. Do you have the backpack for your pump? We use the zevex infinity pump. Its small and comes with a great little backpack.
Karen
www.caringbridge.org/visit/trevorlasure

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I no longer even have the pump. When I was using it I was barely ambulatory. I remember it as being very bulky (no it didn't have a backpack,which I guess could be pretty handy) and it seemed to never hold a charge. If you use one of these backpack models, how much tubing is there to snag on things? How much of a "normal" life can you lead? (IE cooking,laundry ETC) Also,where does the bag hang from? Thanks :)

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Trevor is a very active, when he feels good, little boy. He rides his bike, rip sticks etc w/ it on. In the house he likes the pole better, he likes to ride it on the tile. The backpack fits the pump, the 1200 and 500 cc bag. I use the 500 cc bag in the back pack, it works better for us. There is velcro in the backpack that keeps the extra tubing secure. When he has the pack on the only thing that shows is a small amount of tubing from both the vent and feeding bags. This web site has some good pix of the pump.
Karen
www.caringbridge.org/visit/trevorlasure

http://www.zevex.com/enteral/pumps/

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my father has had a j tube since december and he feeds at 150 ml per hour and splits his feeding to three times a day, he does two cans of jevity 1.2 in the morning for breakfast, two cans at lunch and two cans for dinner. His nutritionist said he could increase it up to 250 ml per hour as long as his body could handle it. But for now he has stuck with 150 ml per hour and hes ok with the feeding. My father is in a different situation though because he has to be very careful that he doesnt reflux his food so he takes motilium a half hour before each feeding. I think if bolus feeding works for you go for it, you have your hands full with your kids and really cant be tied down to a pump. My father is 72 and doesnt have much to do and I can see how it has really started to depress him being stuck to the pump this is why we separated his feedings to three times a day

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I feel for anyone stuck on a pump honestly. I've been on life support before even...it's just something about being hooked to a machine I guess.So far this way works and so I'll keep right on going.The only problems I've had yet have been with dislodging the tube (OOPS) and now leaking and hyperplastic tissue. I'm still hopeful I'll learn to swallow again and can go back to eating normal even if it does mean Reglan every 6 hours for the gastroparesis. That makes me wonder too though.. I've heard disturbing things about long term Reglan use. Anyone have a problem with it or know a good alternative? Thanks

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I started having problems with jerking movements in my limbs while I was on the Reglan long-term. I also had other metabolic problems - the doctors thought I had a pheochromocytoma based on some lab work I had that was abnormal all due to the Reglan. It's not a great drug to be on long-term. It never helped my motility or my nausea.

Mimi

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