Whiteboard Animation Video
Transcript
Scene 1: Say you need to start tube feeds for your patient. What enteral access do you choose and why? Letās dive in.Ā
Scene 2: Choosing the optimal enteral access depends on 3 key factors:Ā
- Where do you need the enteral access to terminate in the GI tract?
- How long do you think your patient will need enteral access?
- 3. Is the enteral access needed for nutrition, medications, decompression, or all of the above?
Scene 3: Letās dive into 1st factor: How do you choose where the tube terminates? Jejunal options are great for patients with gastroparesis or other gastric obstructions. For example, you can use a GJ for a patient with severe gastroparesis where we wouldnāt want to feed through the G, aka the gastric part since the stomach motility is compromised. Instead, you can feed through the J, aka the jejunum.Ā
Scene 4: Letās first clarify where all these tubes end. As the name suggests, gastric tubes end in the stomach; jejunal tubes reach the small intestine.Ā Our gastric enteral options include dobhoff tubes, nasogastric tubes (also known as NG tubes or Salem sumps), percutaneous gastric tubes (or PEG tubes), and G-tubes. PEG tubes are placed endoscopically through the esophagus and attached to the stomach from the inside. G-tubes are inserted surgically or with interventional radiology into the stomach from the skin on the outside. Our jejunal enteral options include nasojejunal tubes (or NJ tubes) and J-tubes. Lastly, G-J tubes are special and terminate in both the stomach and small intestine. They do this with their three ports – the gastric port, the jejunal port, and a port for the balloon to hold it in place.Ā
Scene 5: Now onto factor #2, how long do we need enteral access?Ā If it is less than 4 weeks, a temporary option like a Dobhoff tube, NG tube (AKA Salem Sump) or endoscopically placed nasojejunal tube would be best. Dobhoff tubes and NJ tubes are thinner and more flexible, making them more comfortable. NG tubes are thicker and more rigid. For enteral access longer than 4-6 weeks, more durable access such as a PEG tube, G-tube, J-tube, and the special G-J tube are appropriate.Ā Honestly, you might not know for sure how long your patient may need enteral access for and so often you might place temporary enteral options until you know further.
Scene 6: And last but not least, the 3rd factor to consider: what do we need enteral access for? Do you need it for nutrition, medications, decompression, or all the above? Letās take a look at our short-term access options first.Ā Remember our short-term options are the dobhoff tube and NG tube or NJ tube. Good news! All temporary access options are compatible with tube feeds. But for your patientās with a lot of medications, especially when they cant be given IV, DHT and NG tubes are best for medications because meds can get stuck in the thin NJ tube.Ā One thing to keep in mind with a dobhoff is that enteric-coated meds, extended-release formaulations or levothyroxine or levodopa cannot be easily crushed or given via dobhoff.Ā Ā In terms of decompression, NG tubes, which are larger and more rigid, are the best option for decompression. Dobhoff tubes and NJ tubes cannot be used for decompression.Ā So in summary, if you need a temporary tube for decompression, choose the NG;Ā if you just need for meds and/or nutrition, elect for dobhoff.Ā
Scene 7: How about our durable enteral access options (again this is for patients who need enteral access long-term >4 weeks)? What are our long-term enteral access options? The four options: PEG tube and G-tube, the J-tube, G-J tube. All durable access options are compatible with nutrition and medications. All of them can be used for decompression as well.Ā A special note for the G-J tube: it allows for decompression from the stomach via the G-port and feeding through the J part. Think back to our patient with severe gastroparesis – we can decompress the stomach with the G-tube, giving it rest while feeding through the J-tube.Ā
Scene 8: Letās summarize. First – location, location, location! Determine if access should terminate in the stomach, such as DHT, NG, PEG, G tube, and G-J or the jejunum, such as NJ, J-tube, and G-J, depending if they have gastroparesisĀ or gastric outlet obstruction. Next, short term access options for approximately 4 weeks or less include the Dobhoff tube, NG tube or NJ tube. Long term access options include PEG, G-tube, J-tubes, G-J tube. Lastly, what we are using our access for matters! All modalities are compatible with nutrition; of our short-term options, NG tubes are best for decompression and NJ tubes cannot be used for medications. All durable access options can be used for nutrition, medications, and decompression.Ā
Scene 9:Ā For more learning on tube feeds and enteral access, check out our āTube Feeds 5 Pearlsā podcast wherever you like to listen. And check out our website for show notes and infographics.