Feeding Tube Awareness Week: Various Kinds of Tubes

 

Today for Feeding Tube Awareness Week, I will explain several kinds of tubes, including Thomas's which is--no surprise--the most rare kind.

(And note Thomas's new sloth tee-shirt: "Ultimate sloth mode: I can eat while I sleep"!)

An NG tube goes down the nose to the stomach. It is used for more temporary purposes, usually not longer than three months. With training, parents can put an NG tube in and out.

A G tube is the most common type and is installed surgically and gives direct access to the stomach. There is a "button" on the skin which one opens in order to attach an extension tube. Most kids with feeding tubes receive a bolus feed, meaning they eat a meal just like the rest of us. The fluid-food/formula can be pushed in within just a few minutes, just like we can eat a meal within just a few minutes because our stomachs expand and hold food. However, all tubes can be used for continuous feeding (many, many hours at a slow rate, even given around the clock). When not in use, one removes the extension tube, closes up the button, and nothing is seen outside the clothing. Buttons need to be changed out every three months and with training, parents replace G tubes themselves.

Borrowing quite a few of these words from our surgeon who explained it to me . . . some patients have foregut motility problems that require a G-J tube to bypass the stomach and duodenum. Changing out a G-J tube every three months is a much more complicated process requiring radiologist, surgeon, or GI doctor comfortable with replacement guided by flouroscopy. Most G-J tubes are one connected device, but rarely they are a separate G-tube and J tube. In our surgeon's busy thirty-year career, he has had about 20 patients with a separate G and J tube. I'd call that rare.

But now let's talk really rare, which means Thomas! Thomas has only a J-tube, and the J stands for the jejeunum. His tube goes directly into his jejeunum, which is one of the three sections of the small intestine, located between the duodenum and the ileum. I had no idea that this was rare, but I did notice how odd it was that every time I went to a clinic appointment (any clinic, any specialty) and the nurse or doctor unfamiliar with Thomas went through his history, they would either refer to his "G tube," requiring me to correct them, or would ask outright "You mean a G-J tube, right?" There is always this confused look on their faces. On our last trip to the Emergency Department, when Thomas's J-tube button accidentally got pulled out of his intestines (ouch), the Resident walked in and, going through history, said, "You mean a G-J tube, right?" I clarified as always, "No, it's just a J tube." She asked, "But what about his anatomy would indicate that he has only a J tube?" This young doctor clearly had not read his chart before walking in, or read it in an astonishingly cursory fashion, so I explained, "Because he had a total gastrectomy. He has no stomach." Upon finally questioning my surgeon fifteen months after Thomas received his J tube, he explained that if a separate G-J tube is "rare" at only 20 in his whole career, having a J tube alone is VERY RARE. For writing this post, I did some hunting around and could not even find an article about having solely a J tube, although I do know that Thomas's fellow "seahorses" (total gastrectomy patients, virtually all adults) obviously have only a J tube.

I thank God for the redundancy within the GI tract so that there are many places and ways in which to feed a person, and I thank God for giving exceptionally creative minds to whichever scientists over the years invented the various types of feeding tubes.