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No Pain with J-tube Placement
For those of you with surgically placed J-tubes, I have two golden nuggets of advice, compliments of some radiological procedures I underwent recently with Dr. Elvira Lang, Director Cardiovascular/Interventional Radiology, Beth Israel Deaconess Medical Center, Boston, MA. Dr. Lang recently wrote an article on access for the LifelineLetter, and spoke on this topic at the 2000 Oley conference.
Prior to meeting Dr. Lang, I had experienced two horrendous procedures to replace and/or reposition my J-tube. I had a standard J-tube which kept falling out of the tract, and spasming in my intestines often caused the tip of the J-tube to end up in places it should not have been. Each of the replacements/repositionings took over two hours without any anesthesia. You could hear my screams of pain from the procedures, two blocks away. Scar tissue in the tract will cause the procedures to be painful, and unfortunately this pain can’t be topically anaesthetized with Novocain injections.
My most recent procedure was my first with Dr. Lang. When interviewed prior to the procedure, I was assured that all would be done to minimize discomfort. I listened with great skepticism. Dr. Lang offered me a mild anesthetic intravenously to relax me and mitigate the discomfort. Next she pulled the old tube out for a short distance, sprayed it heavily with an anesthetic called Hurricane Spray (Hurricaine Spray* Topical anesthetic, Benzocaine 20%, Beutlich Pharmaceuticals, Waukegan, IL), and slowly pushed it back into the tract. The spray anesthetized the tract from the inside as the tube was pushed back in. Dr. Lang gave the Hurricane Spray a few minutes to work internally and then pulled out the old tube without so much as an, “Ouch.” She sprayed the new tube and the guide wire as well. Again, as they were inserted and positioned, I never felt a twinge. The whole procedure was over in 55 minutes without screams, drama, or trauma.
New Tube Stays in Place
The second lesson to be learned from this story is about pain prevention. Dr. Lang chose a different kind of tube for me; one with a pigtail retention which would be far less likely to fall out or need repositioning (Wills Oglesby G-tube, Cook Inc., Bloomington, IN). There is also another model with a mushroom retention to accomplish the same end. When I asked why these tubes are not universally used, Dr. Lang explained that it was because both the pigtail and mushroom tubes are called G-tubes, not J-tubes. Although they are G-tubes, they work well as J-tubes without interrupting the transport of food in the gastrointestinal tract.
If you identify with any or all of this story, you need to speak to the radiologist prior to your procedure about the pigtail, the mushroom and the Hurricane. Ineffective tube configurations and painful procedures are not necessary, as proven by a knowledgeable, compassionate physician/radiologist.
—Diane V. Owens
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Oley exhibit at A.S.P.E.N.'s Clinical Nutrition Week