J tube feeds

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caligas

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how long do you delay for elective case like a port placement? Note: J tube not G tube.

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I think most people would say 6 hours regardless of where the tube is.

The last I looked at the data, you have about the same risk of "aspiration" but a reduced risk of "pneumonia" with jejunal feeds vs gastric feeds in critically ill people, but not sure how clinically relevant either of those research defined endpoints are for OR anesthesia.

My takeaway was that if they have a J, that may make them safer from the volume of feeds in the stomach, but they probably had some gastric emptying issue regardless which has not been addressed and some acidic stomach juices waiting to pounce.

With that said, I think you have leeway to argue either which way, risk/benefits for a critically ill patient, etc, as the guidelines are vague.
 
Post-pyloric = empty stomach = go.

Your reasoning makes sense to me, but I've mostly seen J-tubes treated just the same as G-tubes.

But then, I once knew someone who would cancel a case for over chewing gum within the previous 8 hours, because he felt that the swallowed flavor was sufficiently stimulating to the GI tract to cause increased gastric secretions. Same guy would have absolutely held a J tube feed for 8 hours, same reasoning.
 
8 Hours. Just because its post-pyloric doesnt mean the Pyloric is working .. Not taking a chance with that nonsense for a completely elective case.
 
8 Hours. Just because its post-pyloric doesnt mean the Pyloric is working .. Not taking a chance with that nonsense for a completely elective case.

Good point. Also, just because the tube is supposed to be in the jejunum, that doesn't mean that it's distal end is actually where it belongs, or that the anatomy is all hooked up like it is in the diagram. I've seen some pretty anomalous anatomy and peculiar migrations of tubes, particularly in folks who have enough pathology going on to require long term enteral access.
 
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Post-pyloric = empty stomach = go.
The data do not support this assertion. The small handful of studies that have addressed this (using dyed tube feeds or some other tagged food particle and tracking aspirations) have not shown a difference between gastric and post-pyloric feeds.
 
The data do not support this assertion. The small handful of studies that have addressed this (using dyed tube feeds or some other tagged food particle and tracking aspirations) have not shown a difference between gastric and post-pyloric feeds.
Interesting

After some brief Googling for various locations' NPO policy, it seems there's pretty wide variation in the number of hours they require J tube feeds to be held.

I only found one that doesn't hold them at all, this place.
 
The data do not support this assertion. The small handful of studies that have addressed this (using dyed tube feeds or some other tagged food particle and tracking aspirations) have not shown a difference between gastric and post-pyloric feeds.

Jejunostomy tube feedings should not be stopped in the perioperative patient.
http://www.ncbi.nlm.nih.gov/pubmed/10574485

My question to anyone who stops feeds for 8 hours would be- would you give tube feeds to patients in the ICU who have decreased/absent airway reflexes, such as stroke victims, comatose, or sedated patients? If you would, and then you hold them while under anesthesia, why? What do you see as a difference?
 
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