Name of the Procedure:

Replacement of Duodenostomy or Jejunostomy Tube, Percutaneous, under Fluoroscopic Guidance including Contrast Injection(s), Image Documentation and Report
Common names: Duodenostomy/Jejunostomy Tube Replacement under Fluoroscopy

Summary

This procedure involves the replacement of an existing tube in the duodenum or jejunum, using real-time X-ray imaging (fluoroscopy) to guide the placement. Contrast dye is used to enhance imaging, and the process is documented with images and a report.

Purpose

This procedure addresses issues such as tube blockage, dislodgement, or malfunction in patients who require direct access to the small intestine for feeding or drainage. The goal is to restore or maintain effective enteral nutrition or drainage.

Indications

• Blocked or clogged duodenostomy/jejunostomy tube
• Dislodged or malfunctioning tube
• Need for a replacement due to wear and tear or complications
• Patient criteria typically include those with conditions necessitating jejunal or duodenal feedings, such as severe gastroparesis, chronic pancreatitis, or significant upper gastrointestinal tract surgery.

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjustment or temporary discontinuation of certain medications (as instructed by the healthcare provider)
• Pre-procedure imaging and assessments to evaluate tube position and underlying conditions

Procedure Description

1. Preparation: The patient will lie on an examination table, and an intravenous (IV) line may be inserted for administering medications.
2. Anesthesia: Local anesthesia is usually administered at the replacement site.
3. Initial Imaging: Fluoroscopy is used to guide the process. Initial images ensure accurate identification of the tube location.
4. Contrast Injection: A contrast dye is injected to outline the digestive tract structures, aiding in precise tube placement.
5. Tube Removal and Replacement: The old tube is carefully removed, and a new tube is inserted through the same percutaneous site.
6. Verification: Additional fluoroscopic images are taken to confirm the correct placement of the new tube.
7. Documentation: The procedure is documented with images and a detailed report.

Duration

The procedure typically takes about 30-60 minutes.

Setting

It is usually performed in a hospital radiology department or an outpatient imaging center.

Personnel

• Interventional radiologist
• Radiology technicians
• Nursing staff
• Sometimes an anesthesiologist or sedation nurse

Risks and Complications

• Infection at the insertion site
• Bleeding
• Discomfort or pain during and after the procedure
• Allergic reaction to contrast dye
• Tube displacement or malfunction
• Rarely, injury to surrounding organs

Benefits

• Restores or maintains effective enteral feeding or drainage
• Minimally invasive with a short recovery period
• Immediate confirmation of correct tube placement

Recovery

• Monitoring for a short period after the procedure to ensure there are no immediate complications
• Pain management usually includes over-the-counter pain relievers
• Instructions on tube care and feeding procedures
• Follow-up appointments to ensure proper tube function and position

Alternatives

• Surgical replacement of the tube (more invasive, longer recovery)
• Continued management with the existing tube (if issues are minor and manageable) Pros and cons of alternatives should be discussed with the healthcare provider to determine the most appropriate approach.

Patient Experience

• During the procedure: mild discomfort due to anesthesia injection and manipulation of the tube. Fluoroscopy usually does not cause any discomfort.
• After the procedure: Some pain or soreness at the insertion site is common but manageable. Most patients can resume normal activities relatively quickly, with specific care instructions for the new tube.