JEJUNOSTOMY
FEEDING
About
the
patient
Jejunostomy
A surgical procedure in which an opening (Stoma) is created
through the abdominal wall into the jejunum (a part of the small
intestine) to allow for enteral feeding, drainage or decompression
Jejunostomy feeding
The administration of nutritional
formula directly into the jejunum
via a surgically placed tube, used
when oral or gastric feeding is
not possible or contraindicated
Types of Tube feeding
Types of tube feeding
Based on Tube placement
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Surgical Jejunostomy
Percutaneous Endoscopic Jejunostomy
Radiologically inserted Jejunostomy
Gastrojejunostomy Tube
Techniques
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Witzel jejunostomy
Needle catheter technique
Percutaneous endoscopy
Laparoscopy
Based on Feeding technique
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Intermittent administration/
Bolus feeds
- Administered intermittently using a syringe
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Continuous administration/
Drip feeds
-Administered continuously using a drip set
Intermittent administration/ Bolus feeds
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200 to 250 ml per administration Q2hly
Highly preferred for patients after surgery
Given by gravity drip
Continuous administration/ Drip feeds
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Administered at the rate of 1.5ml/minute
A feeding pump is used to regulate the flow of feed
Reduces the risk of vomiting and aspiration
INDICATIONS
Upper GI obstruction
High risk of aspiration
Esophageal
stricture/cancer
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Head and neck cancer
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GERD
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Severe dysphagia
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Gastroperesis
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Post esophagectomy
or gastrectomy
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Neurological
conditions
Prolonged inability to
tolerate gastric feeds
Pancreatic disorders
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Pancreatitis
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Gastric Outlet
Obstruction
Postoperative
nutritional support
After major abdominal
procedure
CONTRAINDICATIONS
Gastric neoplasm
■ Active gastritis
■ Severe intestinal ischemia
■ Mechanical bowel obstruction
■ Severe peritonitis
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INITIATION OF TUBE FEEDING
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Initially the patients will be on feeding tubes connected
to dependent drains.
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Start tube feeds after assessing :
○ Bowel sounds.
○ Absence of abdominal distension
○ Absence of nausea and vomiting.
○ Decrease in amount of the gastric residue.
INITIATION OF TUBE FEEDING
Initiate
■ With drinking water and 1 ORS as continuous
infusion with 20 ml/hour and the amount is
increased gradually every 2 hours.
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If the feed is tolerated, start high-calorie feeds
with low volume and then gradually increase.
FEEDS
Formula feeds are available commercially.
■ Polymeric formulas -composed of protein,
carbohydrates and fats in a high molecular weight form
■ Chemically defined or pre digested formulas contain
easier to absorb nutrients.
■ Disease specific formulas to treat various conditions.
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Dietitians give home based feeds book according to the
caloric needs and preferences of the patients.
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CARE OF FEEDS
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Check the name, hospital number of the patients and
also the expiry date before administration.
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Ensure that feed is neither too hot or too cold.
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Thaw it to the room temperature before
administering to the patients.
FEEDING TECNIQUE
DEMONSTRATION
PREPARATION OF ARTICLES
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Collect all the necessary articles in a trolley with appropriate waste
segregation covers
A tray containing
Towel
Mackintosh
Disposable 50 cc syringe
Gauze piece
Measuring cup/ Ounce glass
Feeds and water
Gloves
K-basin
Special instruction
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If the tube is blocked, flush with 30 ml of water using 50cc syringe
PREPARATION OF ARTICLES
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A tray containing
Towel
Mackintosh
Feed administration set
Gauze piece
Feeds and water
Gloves
K-basin
Sterile cork
Sterile bottle
Adhesive/micropore
Body guard-Feeding pump
Bowl filled with water
POST PROCEDURE CARE
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Ensure continuous flow of feed
Watch for obstruction
COMPLICATIONS
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Diarrhea
Nausea
Vomiting
Abdominal discomfort/distension/pain/cramping
Aspiration
Hyperglycemia
Tube blockage
Tube displacement
Dumping syndrome
Nursing care
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