Jejunostomy

When the oral, gastrostomy, or jejunostomy route cannot or should not be used... 

Why is a jejunostomy tube a good access route for feeding this patient ... 

Tube displacement Self-extubation Vomiting or coughing Inadequate fixation (jejunostomy)... 

Percutaneous endoscopic jejunostomy Jejunal feeding tube placed via endoscopic technique. 

The gastrostomy exit site requires general stoma care to prevent inflammation and infection. Jejunostomy may be appropriate in patients at high risk of gastroesophageal reflux disease and aspiration, and with impaired gastric motility or delayed gastric emptying. 

Jejunostomy Long-term Surgically Allows tor early postinjury or postoperative feeding Attendant risks associated with each type of... 

Jejunostomy A feeding tube placed in a hole in the abdomen, leading to the small intestine. 

Oral, nasogastric, gastrostomy, nasoduodenal, nasojejunal, or jejunostomy methods are used for enteral feedings. 

Nutritional Support. Adults and children fed intravenously without addition of sufficient copper to the nutrient regimen develop symptomatic copper deficiency. The hematological changes of hypochromic anemia and neutropenia are reversed by copper supplementation. Similar effects have been reported during prolonged enteral feeding via jejunostomy. Children may also develop the typical bone changes mentioned above. 

Camblor M, De La Cuerda, Breton I, et al. Copper deficiency with pancytopenia due to enteral nutrition through jejunostomy. Clinical Nutrition 1997 16 129-31. 

PEG percutaneous endoscopic gastrostomy PEI percutaneous endoscopic jejunostomy PRG percutaneous radiologic gastrostomy PN parenteral nutrition SCEA short-chain fatty acid... 

Vanek VW. Ins and outs of enteral access. Part 3 Long-term access-jejunostomy. Nutr Qin Pract 2003 18 201-220. 

Patients with end jejunostomies or proximal ileostomies can have recurrent dehydration and electrolyte deficiencies. A high jejunostomy can have output of 3 L/day of fluid, with sodium loss of 90 mEq/L. To overcome the net secretion of sodium and water into... 

Patients with a jejunostomy are at risk of hypokalemia as weU, so potassium levels must be monitored closely for supplementation. Other patients at risk for potassium depletion include individuals with long-term sodium depletion, magnesium deficiency, or excessive loss from diarrhea. Metabolic alkalosis, which may occur when a patient becomes dehydrated, accelerates the renal excretion of potassium, as all hydrogen ions are conserved in an attempt to correct the acid-base disorder. As bicarbonate ions are excreted renaUy, potassium is taken with them to maintain osmotic balance. 

Healy DP, Brodbeck MC, Clendening CE. Ciprofloxacin absorption is impaired in patients given enteral feedings oraUy and via gastrostomy and jejunostomy tubes. Antimicrob Agents Chemo0ter 996) 40, 6-10. 

The absorption of phenytoin can be affected by some foods. A very marked reduction in phenytoin absorption has been described when it was given with enteral feeds (e.g. Isocal, OsmoUte), by nasogastric or jejunostomy tubes. 

Rodman DP, Stevenson TL, Ray TR. Phenytoin malabsorption after jejunostomy tube delivery. Pharmacotherapy (1995) 15, 801-5. 

---