Tube or needle catheter jejunostomy for enteral alimentation, intraoperative, any method (List separately in addition to primary procedure)
CPT4 code
Name of the Procedure:
Tube or needle catheter jejunostomy for enteral alimentation, intraoperative, any method
Common name: Jejunostomy
Summary
A jejunostomy is a surgical procedure where a tube or needle catheter is inserted into the jejunum (part of the small intestine) to provide enteral nutrition directly. This is typically done during another surgical operation.
Purpose
Medical Condition or Problem Addressed:
Patients who cannot eat by mouth, have obstructions, or need bypass of the upper gastrointestinal tract.
Goals or Expected Outcomes:
To ensure nutritional support, bypass gastrointestinal obstructions, or provide a means for postoperative feeding.
Indications
Specific Symptoms or Conditions:
- Severe swallowing difficulties (dysphagia)
- Gastrointestinal obstructions
- Certain cancers
- Postoperative nutrition support
Patient Criteria or Factors:
- Inability to ingest food orally
- Need for long-term enteral nutrition
- Patients undergoing major gastrointestinal surgery
Preparation
Pre-Procedure Instructions:
- Fasting for at least 8 hours prior
- Adjustments to medications as advised by the healthcare provider
Diagnostic Tests or Assessments:
- Blood tests
- Imaging studies like X-rays or CT scans
- Nutritional assessments
Procedure Description
Step-by-Step Explanation:
- The patient is placed under general anesthesia.
- A small incision is made in the abdomen.
- A tube or needle catheter is inserted into the jejunum.
- The tube is secured in place and connected to the exterior for feeding.
- The incision is closed and secured with sutures or staples.
Tools and Equipment:
- Surgical instruments
- Jejunostomy tube or needle catheter
- Anesthesia delivery systems
Anesthesia or Sedation Details:
- General anesthesia is commonly used for patient comfort and immobility.
Duration
The procedure typically takes about 1 to 2 hours, depending on complexity.
Setting
This procedure is performed in a hospital operating room.
Personnel
- Surgeons
- Anesthesiologists
- Surgical nurses
- Operating room technicians
Risks and Complications
Common Risks:
- Infection at the incision site
- Bleeding
Rare Risks:
- Injury to surrounding organs
- Tube dislodgement or blockage
- Peritonitis (inflammation of the abdominal lining)
Complications Management:
- Monitoring for signs of infection or complications
- Immediate medical intervention if complications are suspected
Benefits
Expected Benefits:
- Direct nutritional support
- Improved recovery and nutritional status
- Bypass of obstructed or dysfunctional gastrointestinal sections
Realization of Benefits:
- Benefits are usually seen immediately post-surgery once feeding begins.
Recovery
Post-Procedure Care:
- Monitoring in a hospital setting
- Instructions on tube care and feeding protocols
- Pain management
Expected Recovery Time:
- Initial recovery within a few days
- Full recovery in a couple of weeks
Restrictions and Follow-up:
- Limited physical activity during initial recovery
- Regular follow-up to monitor tube function and nutritional status
Alternatives
Other Treatment Options:
- Nasogastric (NG) tube feeding
- Percutaneous endoscopic gastrostomy (PEG)
- Total parenteral nutrition (TPN)
Pros and Cons of Alternatives:
- NG tubes are less invasive but not suitable for long-term use.
- PEGs are less invasive but may not bypass all upper GI tract issues.
- TPN avoids the GI tract but carries risks of infection and metabolic complications.
Patient Experience
During the Procedure:
- The patient will be under general anesthesia and will not feel the procedure.
After the Procedure:
- Mild to moderate pain at the incision site managed by prescribed pain medications.
- Initial discomfort adjusting to the jejunostomy tube.
Pain Management and Comfort Measures:
- Use of pain relief medications
- Instructions on positioning to reduce discomfort and proper tube care to avoid irritation