I am guessing\u00a0 you are reading this page for one of two reasons. You are either looking for information because your little one has feeding issues and you are looking for more information about feeding tubes. Or you just want to learn more about James. Either way, I am glad you are here. The information on this page is not intended provide complete coverage of all the various feeding tube options and what is involved with each. This is just a brief overview of what tube options are available, and what we have learned as we went through it with James.<\/p>\n
After James was born it was discovered that he had no suck\/swallow reflex. Normal infants are able to suck the nipple on a bottle or their mother\u2019s breast and swallow the milk or formula, usually without an issue. But what about babies that are unable to do this? How do they \u201ceat\u201d or get their nutrition or take medications? This was one of our first questions when we learned that James didn\u2019t have a suck\/swallow reflex and therefore was unable to take milk or formula by mouth. This is when we learned about feeding tubes.<\/p>\n
Nasal Tubes<\/span><\/h4>\n![\"\"](\"https:\/\/capenotrequired.com\/wp-content\/uploads\/2020\/03\/NG-tube-1024x768.jpg\")
James at 3 days old with a nasal tube for feeding<\/span><\/center><\/figcaption><\/figure>\nThere are several ways to feed a baby (or someone at any age) that is unable to eat by mouth. One of the most common ways is via a feeding tube inserted into the nose, called a nasal tube. There are three kinds of nasal tubes that can be used: NG-tubes, ND-tubes, and NJ-tubes.<\/p>\n
NG-Tubes<\/span><\/h5>\nThe NG-tube (n<\/span>asog<\/span>astric) is inserted through the nose, runs down the esophagus, and into the stomach. In the picture above, James has an NG-tube in his nose.<\/p>\n{naso = nasal; gastric = stomach}.<\/p>\n
ND-Tubes<\/span><\/h5>\nAn ND-tube (n<\/span>asod<\/span>uodenal) is also inserted into the nose like an NG-tube, but instead of stopping at the stomach, it continues to the first portion of the small intestine.<\/p>\n{naso = nasal; duodenal = the first part of the small intestine}<\/p>\n
NJ-Tubes<\/span><\/h5>\nThe NJ-tube (n<\/span>asoj<\/span>ejunal) goes even further than an ND-tube and stops in the second portion of the small intestine.<\/p>\n{naso = nasal; jejunal = the second part of the small intestine}<\/p>\n
<\/p>\n
Shortly after James arrived in the NICU (neonatal intensive care unit) they inserted an NG-tube for feeding. If you remember from above, the NG-tube stops in the stomach. This feeding tube seemed to work okay for a while, but after the first couple of weeks, the NICU nurses started to notice a correlation between his feeds and a drop in his sats (oxygen saturation levels in his blood). They thought that maybe he was refluxing and decided to try a NJ-tube to bypass the stomach and reduce or eliminate his reflux. \u00a0Pop quiz: Where does the NJ-tube stop? No cheating! If you answered the second part of the small intestine, you are correct.<\/p>\n
Both ND- and NJ-tubes can be used in situations where reflux is an issue. They can also be used when a patient may inhale or aspirate stomach contents. Why is one chosen over the other? I am not really sure. It could be doctor\u2019s preference. Or it could be that since both the NG- and NJ-tubes need to be inserted with the help of an x-ray or ultrasound, it makes sense to go with the NJ-tube which goes further to the second part of the small intestine, just in case the first part of the intestine also causes a reflux or aspiration issue and having to do the procedure all over again. This is what they did for James. When he appeared to be refluxing with the NG-tube, they decided to insert an NJ-tube.<\/p>\n
It is important to note that nasal tubes are only temporary solutions. Long-term use of nasal tubes can cause sinusitis, or a breakdown of the tissue within the nasal cavity. Not to mention the fact that I think it would be rather uncomfortable. Fortunately, James doesn\u2019t seem to have a gag reflex so we\u2019re not sure how much the nasal tubes bothered him.<\/p>\n
In James\u2019 case, the NICU staff decided to use both a NG- and NJ-tube. The NG-tube was to be used for medicine only, and the NJ-tube was for food. In the picture below, James has both an NG- and NJ-tube in his nose. Both tubes are in the same nostril. I’m not sure how comfortable that is, but he didn’t seem to mind it. You might notice the sock on his right hand. This wasn’t because his had was cold. It was to keep him from accidentally grabbing the tubes and pulling them out.<\/p>\n![\"\"](\"https:\/\/capenotrequired.com\/wp-content\/uploads\/2020\/03\/NG-and-NJ-Tubes-1024x768.jpg\")
James at 20 days old with both NG- and NJ-tubes.<\/span><\/center><\/figcaption><\/figure>\nBecause these tubes are only a temporary solution, and not meant to be used long-term, we started to have discussions about putting in a G-tube.<\/p>\n
What is a G-Tube?<\/span><\/h4>\nA G-tube, or gastronomy tube, is similar in function to the NG-tube mentioned above in that they both allow food or medications to go directly into the stomach without passing through the throat. Where they differ is that while the NG-tube goes through the nose, down the esophagus, and into the stomach, the G-tube goes directly into the stomach. The G-tube is surgically placed through the abdominal wall and into the stomach.<\/p>\n
James had his G-tube surgery on October 9, 2009. This was his first surgery so we were obviously very nervous. The surgery was scheduled for 11:45 am, but he didn\u2019t go down for surgery until 1:45 pm. We were told that it would be a 2-hour surgery, but he didn\u2019t get back to the NICU until around 5:00 pm. I think Stacy and I wore a groove into the floor with all of our nervous pacing! The surgeon said the surgery went great and without any complications which was a relief.<\/p>\n
When he came back from surgery, James did not have a G-tube in place. Instead he had a percutaneous endoscopic gastronomy tube, or PEG tube<\/span> for short. A PEG tube is often used as an initial G-tube before moving to a G-tube button like a MIC-KEY or a Mini. As you can see in the picture below, a PEG tube is a one-piece tube the comes out of the stomach. Care must be taken as to not accidentally grab the PEG tube and pull on it.<\/p>\n![\"\"](\"https:\/\/capenotrequired.com\/wp-content\/uploads\/2020\/03\/PEG-Tube-768x1024.jpg\")
James with a PEG tube.<\/span><\/center><\/figcaption><\/figure>\nSorry that the pic is not the greatest, but I wanted to give you an idea of what a PEG tube looks like. The picture was taken while standing on James left side. The dark area above the PEG tube that looks like a hole is his belly button.<\/p>\n
MIC-KEYs and Minis<\/span><\/h5>\nWhen the terms MIC-KEY (pronounce mickey) and Mini buttons were first mentioned, I kinda chuckled. I thought, well, that\u2019s easy to remember\u2026like Mickey<\/span> Mouse and Minnie<\/span> Mouse. I\u2019m not sure if that was intentional or just a coincidence.<\/p>\nMIC-KEYs and Minis are called balloon buttons. Each are made by a different manufacturer. When James was ready for his button, he got a MIC-KEY. The PEG tube was removed, and the MIC-KEY was inserted into the opening in his abdominal wall that the PEG came out of. When removed from the package, the balloon on the MIC-KEY is deflated.\u00a0 Once the button is fully inserted into the abdomen, a water-filled syringe is attached to a port on the button, and water is injected into the balloon. This fills the balloon (which is inside the stomach) with water and holds the button in place so that it cannot fall out. To see a better example of what a MIC-KEY looks like, please see the manufacturer’s website here<\/a>. Also check out the Feeding Tube Awareness Foundation’s G-tube page<\/a>.<\/p>\nThe nice thing about balloon buttons is that they can be replaced at home, after you have been trained on how to do it by a healthcare professional. There are non-balloon buttons as well, but these cannot be replaced at home and must be done in a doctor\u2019s office.<\/p>\n
As you will notice in the picture below, a g-tube button sits flush against the skin and doesn\u2019t have a permanent tube sticking out of it.<\/p>\n![\"\"](\"https:\/\/capenotrequired.com\/wp-content\/uploads\/2020\/03\/G-tube-1.jpg\")
James’ G-tube without extension.<\/span><\/center><\/figcaption><\/figure>\nTo administer feeds and medications, a removable extension is used. When not in use, simply remove the extension, and insert the plug. No more tube to get caught on something or accidentally pulled out.<\/p>\n![\"\"](\"https:\/\/capenotrequired.com\/wp-content\/uploads\/2020\/03\/G-tube-768x1024.jpg\")
James with his G-tube and extension in.<\/span><\/center><\/figcaption><\/figure>\n <\/p>\n
Wait, what about his reflux?<\/span><\/h5>\nIf you’ve read through this entire post and were paying attention, you might be asking yourself about James’ reflux. When I was talking about nasal tubes, I mentioned that the nurses thought he might be refluxing when he was being fed with the NG-tube, and that was the reason they put in an NJ-tube. Remember that the NG-tube goes to the stomach and the NJ-tube goes past the stomach and into the small intestine, thereby reducing or eliminating reflux issues. So by putting a G-tube into the stomach, wouldn’t this bring back the reflux issues? There is one part that I left out above. I wasn’t sure how to fit it in above so I will mention it here.<\/p>\n
In addition to his G-tube surgery, we also opted to have a fundoplication<\/span> surgery at the same time.\u00a0 A fundoplication is a surgery to treat GERD, or gastro-esophageal reflux disease. During surgery the surgeon wraps the top of the stomach (or fundus) around the bottom of the esophagus. This reinforces the lower esophageal sphincter, making it less likely that acid will back up in the esophagus. If you are interested in seeing what this looks like, Mayo Clinic<\/a> has some nice diagrams of the procedure.<\/p>\nSummary<\/span><\/h4>\nI know I didn’t cover everything there is to know about feeding tubes, but that wasn’t the intention. I just want to provide a little bit of info what we, or should I say James, went through to overcome his feeding issues. When he was born he didn’t have the ability to suck or swallow so we had to use various types of feeding tube methods. We started with an NG-tube, added an NJ-tube for feeding, and eventually James had G-tube and fundoplication surgery.<\/p>\n
There are several ways to feed a baby (or someone at any age) that is unable to eat by mouth. One of the most common ways is via a feeding tube inserted into the nose, called a nasal tube. There are three kinds of nasal tubes that can be used: NG-tubes, ND-tubes, and NJ-tubes.<\/p>\n
NG-Tubes<\/span><\/h5>\nThe NG-tube (n<\/span>asog<\/span>astric) is inserted through the nose, runs down the esophagus, and into the stomach. In the picture above, James has an NG-tube in his nose.<\/p>\n{naso = nasal; gastric = stomach}.<\/p>\n
ND-Tubes<\/span><\/h5>\nAn ND-tube (n<\/span>asod<\/span>uodenal) is also inserted into the nose like an NG-tube, but instead of stopping at the stomach, it continues to the first portion of the small intestine.<\/p>\n{naso = nasal; duodenal = the first part of the small intestine}<\/p>\n
NJ-Tubes<\/span><\/h5>\nThe NJ-tube (n<\/span>asoj<\/span>ejunal) goes even further than an ND-tube and stops in the second portion of the small intestine.<\/p>\n{naso = nasal; jejunal = the second part of the small intestine}<\/p>\n
<\/p>\n
Shortly after James arrived in the NICU (neonatal intensive care unit) they inserted an NG-tube for feeding. If you remember from above, the NG-tube stops in the stomach. This feeding tube seemed to work okay for a while, but after the first couple of weeks, the NICU nurses started to notice a correlation between his feeds and a drop in his sats (oxygen saturation levels in his blood). They thought that maybe he was refluxing and decided to try a NJ-tube to bypass the stomach and reduce or eliminate his reflux. \u00a0Pop quiz: Where does the NJ-tube stop? No cheating! If you answered the second part of the small intestine, you are correct.<\/p>\n
Both ND- and NJ-tubes can be used in situations where reflux is an issue. They can also be used when a patient may inhale or aspirate stomach contents. Why is one chosen over the other? I am not really sure. It could be doctor\u2019s preference. Or it could be that since both the NG- and NJ-tubes need to be inserted with the help of an x-ray or ultrasound, it makes sense to go with the NJ-tube which goes further to the second part of the small intestine, just in case the first part of the intestine also causes a reflux or aspiration issue and having to do the procedure all over again. This is what they did for James. When he appeared to be refluxing with the NG-tube, they decided to insert an NJ-tube.<\/p>\n
It is important to note that nasal tubes are only temporary solutions. Long-term use of nasal tubes can cause sinusitis, or a breakdown of the tissue within the nasal cavity. Not to mention the fact that I think it would be rather uncomfortable. Fortunately, James doesn\u2019t seem to have a gag reflex so we\u2019re not sure how much the nasal tubes bothered him.<\/p>\n
In James\u2019 case, the NICU staff decided to use both a NG- and NJ-tube. The NG-tube was to be used for medicine only, and the NJ-tube was for food. In the picture below, James has both an NG- and NJ-tube in his nose. Both tubes are in the same nostril. I’m not sure how comfortable that is, but he didn’t seem to mind it. You might notice the sock on his right hand. This wasn’t because his had was cold. It was to keep him from accidentally grabbing the tubes and pulling them out.<\/p>\n
James at 20 days old with both NG- and NJ-tubes.<\/span><\/center><\/figcaption><\/figure>\nBecause these tubes are only a temporary solution, and not meant to be used long-term, we started to have discussions about putting in a G-tube.<\/p>\n
What is a G-Tube?<\/span><\/h4>\nA G-tube, or gastronomy tube, is similar in function to the NG-tube mentioned above in that they both allow food or medications to go directly into the stomach without passing through the throat. Where they differ is that while the NG-tube goes through the nose, down the esophagus, and into the stomach, the G-tube goes directly into the stomach. The G-tube is surgically placed through the abdominal wall and into the stomach.<\/p>\n
James had his G-tube surgery on October 9, 2009. This was his first surgery so we were obviously very nervous. The surgery was scheduled for 11:45 am, but he didn\u2019t go down for surgery until 1:45 pm. We were told that it would be a 2-hour surgery, but he didn\u2019t get back to the NICU until around 5:00 pm. I think Stacy and I wore a groove into the floor with all of our nervous pacing! The surgeon said the surgery went great and without any complications which was a relief.<\/p>\n
When he came back from surgery, James did not have a G-tube in place. Instead he had a percutaneous endoscopic gastronomy tube, or PEG tube<\/span> for short. A PEG tube is often used as an initial G-tube before moving to a G-tube button like a MIC-KEY or a Mini. As you can see in the picture below, a PEG tube is a one-piece tube the comes out of the stomach. Care must be taken as to not accidentally grab the PEG tube and pull on it.<\/p>\n
James with a PEG tube.<\/span><\/center><\/figcaption><\/figure>\nSorry that the pic is not the greatest, but I wanted to give you an idea of what a PEG tube looks like. The picture was taken while standing on James left side. The dark area above the PEG tube that looks like a hole is his belly button.<\/p>\n
MIC-KEYs and Minis<\/span><\/h5>\nWhen the terms MIC-KEY (pronounce mickey) and Mini buttons were first mentioned, I kinda chuckled. I thought, well, that\u2019s easy to remember\u2026like Mickey<\/span> Mouse and Minnie<\/span> Mouse. I\u2019m not sure if that was intentional or just a coincidence.<\/p>\nMIC-KEYs and Minis are called balloon buttons. Each are made by a different manufacturer. When James was ready for his button, he got a MIC-KEY. The PEG tube was removed, and the MIC-KEY was inserted into the opening in his abdominal wall that the PEG came out of. When removed from the package, the balloon on the MIC-KEY is deflated.\u00a0 Once the button is fully inserted into the abdomen, a water-filled syringe is attached to a port on the button, and water is injected into the balloon. This fills the balloon (which is inside the stomach) with water and holds the button in place so that it cannot fall out. To see a better example of what a MIC-KEY looks like, please see the manufacturer’s website here<\/a>. Also check out the Feeding Tube Awareness Foundation’s G-tube page<\/a>.<\/p>\nThe nice thing about balloon buttons is that they can be replaced at home, after you have been trained on how to do it by a healthcare professional. There are non-balloon buttons as well, but these cannot be replaced at home and must be done in a doctor\u2019s office.<\/p>\n
As you will notice in the picture below, a g-tube button sits flush against the skin and doesn\u2019t have a permanent tube sticking out of it.<\/p>\n
James’ G-tube without extension.<\/span><\/center><\/figcaption><\/figure>\nTo administer feeds and medications, a removable extension is used. When not in use, simply remove the extension, and insert the plug. No more tube to get caught on something or accidentally pulled out.<\/p>\n
James with his G-tube and extension in.<\/span><\/center><\/figcaption><\/figure>\n <\/p>\n
Wait, what about his reflux?<\/span><\/h5>\nIf you’ve read through this entire post and were paying attention, you might be asking yourself about James’ reflux. When I was talking about nasal tubes, I mentioned that the nurses thought he might be refluxing when he was being fed with the NG-tube, and that was the reason they put in an NJ-tube. Remember that the NG-tube goes to the stomach and the NJ-tube goes past the stomach and into the small intestine, thereby reducing or eliminating reflux issues. So by putting a G-tube into the stomach, wouldn’t this bring back the reflux issues? There is one part that I left out above. I wasn’t sure how to fit it in above so I will mention it here.<\/p>\n
In addition to his G-tube surgery, we also opted to have a fundoplication<\/span> surgery at the same time.\u00a0 A fundoplication is a surgery to treat GERD, or gastro-esophageal reflux disease. During surgery the surgeon wraps the top of the stomach (or fundus) around the bottom of the esophagus. This reinforces the lower esophageal sphincter, making it less likely that acid will back up in the esophagus. If you are interested in seeing what this looks like, Mayo Clinic<\/a> has some nice diagrams of the procedure.<\/p>\nSummary<\/span><\/h4>\nI know I didn’t cover everything there is to know about feeding tubes, but that wasn’t the intention. I just want to provide a little bit of info what we, or should I say James, went through to overcome his feeding issues. When he was born he didn’t have the ability to suck or swallow so we had to use various types of feeding tube methods. We started with an NG-tube, added an NJ-tube for feeding, and eventually James had G-tube and fundoplication surgery.<\/p>\n
{naso = nasal; gastric = stomach}.<\/p>\n
ND-Tubes<\/span><\/h5>\nAn ND-tube (n<\/span>asod<\/span>uodenal) is also inserted into the nose like an NG-tube, but instead of stopping at the stomach, it continues to the first portion of the small intestine.<\/p>\n{naso = nasal; duodenal = the first part of the small intestine}<\/p>\n
NJ-Tubes<\/span><\/h5>\nThe NJ-tube (n<\/span>asoj<\/span>ejunal) goes even further than an ND-tube and stops in the second portion of the small intestine.<\/p>\n{naso = nasal; jejunal = the second part of the small intestine}<\/p>\n
<\/p>\n
Shortly after James arrived in the NICU (neonatal intensive care unit) they inserted an NG-tube for feeding. If you remember from above, the NG-tube stops in the stomach. This feeding tube seemed to work okay for a while, but after the first couple of weeks, the NICU nurses started to notice a correlation between his feeds and a drop in his sats (oxygen saturation levels in his blood). They thought that maybe he was refluxing and decided to try a NJ-tube to bypass the stomach and reduce or eliminate his reflux. \u00a0Pop quiz: Where does the NJ-tube stop? No cheating! If you answered the second part of the small intestine, you are correct.<\/p>\n
Both ND- and NJ-tubes can be used in situations where reflux is an issue. They can also be used when a patient may inhale or aspirate stomach contents. Why is one chosen over the other? I am not really sure. It could be doctor\u2019s preference. Or it could be that since both the NG- and NJ-tubes need to be inserted with the help of an x-ray or ultrasound, it makes sense to go with the NJ-tube which goes further to the second part of the small intestine, just in case the first part of the intestine also causes a reflux or aspiration issue and having to do the procedure all over again. This is what they did for James. When he appeared to be refluxing with the NG-tube, they decided to insert an NJ-tube.<\/p>\n
It is important to note that nasal tubes are only temporary solutions. Long-term use of nasal tubes can cause sinusitis, or a breakdown of the tissue within the nasal cavity. Not to mention the fact that I think it would be rather uncomfortable. Fortunately, James doesn\u2019t seem to have a gag reflex so we\u2019re not sure how much the nasal tubes bothered him.<\/p>\n
In James\u2019 case, the NICU staff decided to use both a NG- and NJ-tube. The NG-tube was to be used for medicine only, and the NJ-tube was for food. In the picture below, James has both an NG- and NJ-tube in his nose. Both tubes are in the same nostril. I’m not sure how comfortable that is, but he didn’t seem to mind it. You might notice the sock on his right hand. This wasn’t because his had was cold. It was to keep him from accidentally grabbing the tubes and pulling them out.<\/p>\n
James at 20 days old with both NG- and NJ-tubes.<\/span><\/center><\/figcaption><\/figure>\nBecause these tubes are only a temporary solution, and not meant to be used long-term, we started to have discussions about putting in a G-tube.<\/p>\n
What is a G-Tube?<\/span><\/h4>\nA G-tube, or gastronomy tube, is similar in function to the NG-tube mentioned above in that they both allow food or medications to go directly into the stomach without passing through the throat. Where they differ is that while the NG-tube goes through the nose, down the esophagus, and into the stomach, the G-tube goes directly into the stomach. The G-tube is surgically placed through the abdominal wall and into the stomach.<\/p>\n
James had his G-tube surgery on October 9, 2009. This was his first surgery so we were obviously very nervous. The surgery was scheduled for 11:45 am, but he didn\u2019t go down for surgery until 1:45 pm. We were told that it would be a 2-hour surgery, but he didn\u2019t get back to the NICU until around 5:00 pm. I think Stacy and I wore a groove into the floor with all of our nervous pacing! The surgeon said the surgery went great and without any complications which was a relief.<\/p>\n
When he came back from surgery, James did not have a G-tube in place. Instead he had a percutaneous endoscopic gastronomy tube, or PEG tube<\/span> for short. A PEG tube is often used as an initial G-tube before moving to a G-tube button like a MIC-KEY or a Mini. As you can see in the picture below, a PEG tube is a one-piece tube the comes out of the stomach. Care must be taken as to not accidentally grab the PEG tube and pull on it.<\/p>\n
James with a PEG tube.<\/span><\/center><\/figcaption><\/figure>\nSorry that the pic is not the greatest, but I wanted to give you an idea of what a PEG tube looks like. The picture was taken while standing on James left side. The dark area above the PEG tube that looks like a hole is his belly button.<\/p>\n
MIC-KEYs and Minis<\/span><\/h5>\nWhen the terms MIC-KEY (pronounce mickey) and Mini buttons were first mentioned, I kinda chuckled. I thought, well, that\u2019s easy to remember\u2026like Mickey<\/span> Mouse and Minnie<\/span> Mouse. I\u2019m not sure if that was intentional or just a coincidence.<\/p>\nMIC-KEYs and Minis are called balloon buttons. Each are made by a different manufacturer. When James was ready for his button, he got a MIC-KEY. The PEG tube was removed, and the MIC-KEY was inserted into the opening in his abdominal wall that the PEG came out of. When removed from the package, the balloon on the MIC-KEY is deflated.\u00a0 Once the button is fully inserted into the abdomen, a water-filled syringe is attached to a port on the button, and water is injected into the balloon. This fills the balloon (which is inside the stomach) with water and holds the button in place so that it cannot fall out. To see a better example of what a MIC-KEY looks like, please see the manufacturer’s website here<\/a>. Also check out the Feeding Tube Awareness Foundation’s G-tube page<\/a>.<\/p>\nThe nice thing about balloon buttons is that they can be replaced at home, after you have been trained on how to do it by a healthcare professional. There are non-balloon buttons as well, but these cannot be replaced at home and must be done in a doctor\u2019s office.<\/p>\n
As you will notice in the picture below, a g-tube button sits flush against the skin and doesn\u2019t have a permanent tube sticking out of it.<\/p>\n
James’ G-tube without extension.<\/span><\/center><\/figcaption><\/figure>\nTo administer feeds and medications, a removable extension is used. When not in use, simply remove the extension, and insert the plug. No more tube to get caught on something or accidentally pulled out.<\/p>\n
James with his G-tube and extension in.<\/span><\/center><\/figcaption><\/figure>\n <\/p>\n
Wait, what about his reflux?<\/span><\/h5>\nIf you’ve read through this entire post and were paying attention, you might be asking yourself about James’ reflux. When I was talking about nasal tubes, I mentioned that the nurses thought he might be refluxing when he was being fed with the NG-tube, and that was the reason they put in an NJ-tube. Remember that the NG-tube goes to the stomach and the NJ-tube goes past the stomach and into the small intestine, thereby reducing or eliminating reflux issues. So by putting a G-tube into the stomach, wouldn’t this bring back the reflux issues? There is one part that I left out above. I wasn’t sure how to fit it in above so I will mention it here.<\/p>\n
In addition to his G-tube surgery, we also opted to have a fundoplication<\/span> surgery at the same time.\u00a0 A fundoplication is a surgery to treat GERD, or gastro-esophageal reflux disease. During surgery the surgeon wraps the top of the stomach (or fundus) around the bottom of the esophagus. This reinforces the lower esophageal sphincter, making it less likely that acid will back up in the esophagus. If you are interested in seeing what this looks like, Mayo Clinic<\/a> has some nice diagrams of the procedure.<\/p>\nSummary<\/span><\/h4>\nI know I didn’t cover everything there is to know about feeding tubes, but that wasn’t the intention. I just want to provide a little bit of info what we, or should I say James, went through to overcome his feeding issues. When he was born he didn’t have the ability to suck or swallow so we had to use various types of feeding tube methods. We started with an NG-tube, added an NJ-tube for feeding, and eventually James had G-tube and fundoplication surgery.<\/p>\n
{naso = nasal; duodenal = the first part of the small intestine}<\/p>\n
NJ-Tubes<\/span><\/h5>\nThe NJ-tube (n<\/span>asoj<\/span>ejunal) goes even further than an ND-tube and stops in the second portion of the small intestine.<\/p>\n{naso = nasal; jejunal = the second part of the small intestine}<\/p>\n
<\/p>\n
Shortly after James arrived in the NICU (neonatal intensive care unit) they inserted an NG-tube for feeding. If you remember from above, the NG-tube stops in the stomach. This feeding tube seemed to work okay for a while, but after the first couple of weeks, the NICU nurses started to notice a correlation between his feeds and a drop in his sats (oxygen saturation levels in his blood). They thought that maybe he was refluxing and decided to try a NJ-tube to bypass the stomach and reduce or eliminate his reflux. \u00a0Pop quiz: Where does the NJ-tube stop? No cheating! If you answered the second part of the small intestine, you are correct.<\/p>\n
Both ND- and NJ-tubes can be used in situations where reflux is an issue. They can also be used when a patient may inhale or aspirate stomach contents. Why is one chosen over the other? I am not really sure. It could be doctor\u2019s preference. Or it could be that since both the NG- and NJ-tubes need to be inserted with the help of an x-ray or ultrasound, it makes sense to go with the NJ-tube which goes further to the second part of the small intestine, just in case the first part of the intestine also causes a reflux or aspiration issue and having to do the procedure all over again. This is what they did for James. When he appeared to be refluxing with the NG-tube, they decided to insert an NJ-tube.<\/p>\n
It is important to note that nasal tubes are only temporary solutions. Long-term use of nasal tubes can cause sinusitis, or a breakdown of the tissue within the nasal cavity. Not to mention the fact that I think it would be rather uncomfortable. Fortunately, James doesn\u2019t seem to have a gag reflex so we\u2019re not sure how much the nasal tubes bothered him.<\/p>\n
In James\u2019 case, the NICU staff decided to use both a NG- and NJ-tube. The NG-tube was to be used for medicine only, and the NJ-tube was for food. In the picture below, James has both an NG- and NJ-tube in his nose. Both tubes are in the same nostril. I’m not sure how comfortable that is, but he didn’t seem to mind it. You might notice the sock on his right hand. This wasn’t because his had was cold. It was to keep him from accidentally grabbing the tubes and pulling them out.<\/p>\n
James at 20 days old with both NG- and NJ-tubes.<\/span><\/center><\/figcaption><\/figure>\nBecause these tubes are only a temporary solution, and not meant to be used long-term, we started to have discussions about putting in a G-tube.<\/p>\n
What is a G-Tube?<\/span><\/h4>\nA G-tube, or gastronomy tube, is similar in function to the NG-tube mentioned above in that they both allow food or medications to go directly into the stomach without passing through the throat. Where they differ is that while the NG-tube goes through the nose, down the esophagus, and into the stomach, the G-tube goes directly into the stomach. The G-tube is surgically placed through the abdominal wall and into the stomach.<\/p>\n
James had his G-tube surgery on October 9, 2009. This was his first surgery so we were obviously very nervous. The surgery was scheduled for 11:45 am, but he didn\u2019t go down for surgery until 1:45 pm. We were told that it would be a 2-hour surgery, but he didn\u2019t get back to the NICU until around 5:00 pm. I think Stacy and I wore a groove into the floor with all of our nervous pacing! The surgeon said the surgery went great and without any complications which was a relief.<\/p>\n
When he came back from surgery, James did not have a G-tube in place. Instead he had a percutaneous endoscopic gastronomy tube, or PEG tube<\/span> for short. A PEG tube is often used as an initial G-tube before moving to a G-tube button like a MIC-KEY or a Mini. As you can see in the picture below, a PEG tube is a one-piece tube the comes out of the stomach. Care must be taken as to not accidentally grab the PEG tube and pull on it.<\/p>\n
James with a PEG tube.<\/span><\/center><\/figcaption><\/figure>\nSorry that the pic is not the greatest, but I wanted to give you an idea of what a PEG tube looks like. The picture was taken while standing on James left side. The dark area above the PEG tube that looks like a hole is his belly button.<\/p>\n
MIC-KEYs and Minis<\/span><\/h5>\nWhen the terms MIC-KEY (pronounce mickey) and Mini buttons were first mentioned, I kinda chuckled. I thought, well, that\u2019s easy to remember\u2026like Mickey<\/span> Mouse and Minnie<\/span> Mouse. I\u2019m not sure if that was intentional or just a coincidence.<\/p>\nMIC-KEYs and Minis are called balloon buttons. Each are made by a different manufacturer. When James was ready for his button, he got a MIC-KEY. The PEG tube was removed, and the MIC-KEY was inserted into the opening in his abdominal wall that the PEG came out of. When removed from the package, the balloon on the MIC-KEY is deflated.\u00a0 Once the button is fully inserted into the abdomen, a water-filled syringe is attached to a port on the button, and water is injected into the balloon. This fills the balloon (which is inside the stomach) with water and holds the button in place so that it cannot fall out. To see a better example of what a MIC-KEY looks like, please see the manufacturer’s website here<\/a>. Also check out the Feeding Tube Awareness Foundation’s G-tube page<\/a>.<\/p>\nThe nice thing about balloon buttons is that they can be replaced at home, after you have been trained on how to do it by a healthcare professional. There are non-balloon buttons as well, but these cannot be replaced at home and must be done in a doctor\u2019s office.<\/p>\n
As you will notice in the picture below, a g-tube button sits flush against the skin and doesn\u2019t have a permanent tube sticking out of it.<\/p>\n
James’ G-tube without extension.<\/span><\/center><\/figcaption><\/figure>\nTo administer feeds and medications, a removable extension is used. When not in use, simply remove the extension, and insert the plug. No more tube to get caught on something or accidentally pulled out.<\/p>\n
James with his G-tube and extension in.<\/span><\/center><\/figcaption><\/figure>\n <\/p>\n
Wait, what about his reflux?<\/span><\/h5>\nIf you’ve read through this entire post and were paying attention, you might be asking yourself about James’ reflux. When I was talking about nasal tubes, I mentioned that the nurses thought he might be refluxing when he was being fed with the NG-tube, and that was the reason they put in an NJ-tube. Remember that the NG-tube goes to the stomach and the NJ-tube goes past the stomach and into the small intestine, thereby reducing or eliminating reflux issues. So by putting a G-tube into the stomach, wouldn’t this bring back the reflux issues? There is one part that I left out above. I wasn’t sure how to fit it in above so I will mention it here.<\/p>\n
In addition to his G-tube surgery, we also opted to have a fundoplication<\/span> surgery at the same time.\u00a0 A fundoplication is a surgery to treat GERD, or gastro-esophageal reflux disease. During surgery the surgeon wraps the top of the stomach (or fundus) around the bottom of the esophagus. This reinforces the lower esophageal sphincter, making it less likely that acid will back up in the esophagus. If you are interested in seeing what this looks like, Mayo Clinic<\/a> has some nice diagrams of the procedure.<\/p>\nSummary<\/span><\/h4>\nI know I didn’t cover everything there is to know about feeding tubes, but that wasn’t the intention. I just want to provide a little bit of info what we, or should I say James, went through to overcome his feeding issues. When he was born he didn’t have the ability to suck or swallow so we had to use various types of feeding tube methods. We started with an NG-tube, added an NJ-tube for feeding, and eventually James had G-tube and fundoplication surgery.<\/p>\n
{naso = nasal; jejunal = the second part of the small intestine}<\/p>\n
<\/p>\n
Shortly after James arrived in the NICU (neonatal intensive care unit) they inserted an NG-tube for feeding. If you remember from above, the NG-tube stops in the stomach. This feeding tube seemed to work okay for a while, but after the first couple of weeks, the NICU nurses started to notice a correlation between his feeds and a drop in his sats (oxygen saturation levels in his blood). They thought that maybe he was refluxing and decided to try a NJ-tube to bypass the stomach and reduce or eliminate his reflux. \u00a0Pop quiz: Where does the NJ-tube stop? No cheating! If you answered the second part of the small intestine, you are correct.<\/p>\n
Both ND- and NJ-tubes can be used in situations where reflux is an issue. They can also be used when a patient may inhale or aspirate stomach contents. Why is one chosen over the other? I am not really sure. It could be doctor\u2019s preference. Or it could be that since both the NG- and NJ-tubes need to be inserted with the help of an x-ray or ultrasound, it makes sense to go with the NJ-tube which goes further to the second part of the small intestine, just in case the first part of the intestine also causes a reflux or aspiration issue and having to do the procedure all over again. This is what they did for James. When he appeared to be refluxing with the NG-tube, they decided to insert an NJ-tube.<\/p>\n
It is important to note that nasal tubes are only temporary solutions. Long-term use of nasal tubes can cause sinusitis, or a breakdown of the tissue within the nasal cavity. Not to mention the fact that I think it would be rather uncomfortable. Fortunately, James doesn\u2019t seem to have a gag reflex so we\u2019re not sure how much the nasal tubes bothered him.<\/p>\n
In James\u2019 case, the NICU staff decided to use both a NG- and NJ-tube. The NG-tube was to be used for medicine only, and the NJ-tube was for food. In the picture below, James has both an NG- and NJ-tube in his nose. Both tubes are in the same nostril. I’m not sure how comfortable that is, but he didn’t seem to mind it. You might notice the sock on his right hand. This wasn’t because his had was cold. It was to keep him from accidentally grabbing the tubes and pulling them out.<\/p>\n Because these tubes are only a temporary solution, and not meant to be used long-term, we started to have discussions about putting in a G-tube.<\/p>\n A G-tube, or gastronomy tube, is similar in function to the NG-tube mentioned above in that they both allow food or medications to go directly into the stomach without passing through the throat. Where they differ is that while the NG-tube goes through the nose, down the esophagus, and into the stomach, the G-tube goes directly into the stomach. The G-tube is surgically placed through the abdominal wall and into the stomach.<\/p>\n James had his G-tube surgery on October 9, 2009. This was his first surgery so we were obviously very nervous. The surgery was scheduled for 11:45 am, but he didn\u2019t go down for surgery until 1:45 pm. We were told that it would be a 2-hour surgery, but he didn\u2019t get back to the NICU until around 5:00 pm. I think Stacy and I wore a groove into the floor with all of our nervous pacing! The surgeon said the surgery went great and without any complications which was a relief.<\/p>\n When he came back from surgery, James did not have a G-tube in place. Instead he had a percutaneous endoscopic gastronomy tube, or PEG tube<\/span> for short. A PEG tube is often used as an initial G-tube before moving to a G-tube button like a MIC-KEY or a Mini. As you can see in the picture below, a PEG tube is a one-piece tube the comes out of the stomach. Care must be taken as to not accidentally grab the PEG tube and pull on it.<\/p>\n Sorry that the pic is not the greatest, but I wanted to give you an idea of what a PEG tube looks like. The picture was taken while standing on James left side. The dark area above the PEG tube that looks like a hole is his belly button.<\/p>\n When the terms MIC-KEY (pronounce mickey) and Mini buttons were first mentioned, I kinda chuckled. I thought, well, that\u2019s easy to remember\u2026like Mickey<\/span> Mouse and Minnie<\/span> Mouse. I\u2019m not sure if that was intentional or just a coincidence.<\/p>\n MIC-KEYs and Minis are called balloon buttons. Each are made by a different manufacturer. When James was ready for his button, he got a MIC-KEY. The PEG tube was removed, and the MIC-KEY was inserted into the opening in his abdominal wall that the PEG came out of. When removed from the package, the balloon on the MIC-KEY is deflated.\u00a0 Once the button is fully inserted into the abdomen, a water-filled syringe is attached to a port on the button, and water is injected into the balloon. This fills the balloon (which is inside the stomach) with water and holds the button in place so that it cannot fall out. To see a better example of what a MIC-KEY looks like, please see the manufacturer’s website here<\/a>. Also check out the Feeding Tube Awareness Foundation’s G-tube page<\/a>.<\/p>\n The nice thing about balloon buttons is that they can be replaced at home, after you have been trained on how to do it by a healthcare professional. There are non-balloon buttons as well, but these cannot be replaced at home and must be done in a doctor\u2019s office.<\/p>\n As you will notice in the picture below, a g-tube button sits flush against the skin and doesn\u2019t have a permanent tube sticking out of it.<\/p>\n To administer feeds and medications, a removable extension is used. When not in use, simply remove the extension, and insert the plug. No more tube to get caught on something or accidentally pulled out.<\/p>\n <\/p>\n If you’ve read through this entire post and were paying attention, you might be asking yourself about James’ reflux. When I was talking about nasal tubes, I mentioned that the nurses thought he might be refluxing when he was being fed with the NG-tube, and that was the reason they put in an NJ-tube. Remember that the NG-tube goes to the stomach and the NJ-tube goes past the stomach and into the small intestine, thereby reducing or eliminating reflux issues. So by putting a G-tube into the stomach, wouldn’t this bring back the reflux issues? There is one part that I left out above. I wasn’t sure how to fit it in above so I will mention it here.<\/p>\n In addition to his G-tube surgery, we also opted to have a fundoplication<\/span> surgery at the same time.\u00a0 A fundoplication is a surgery to treat GERD, or gastro-esophageal reflux disease. During surgery the surgeon wraps the top of the stomach (or fundus) around the bottom of the esophagus. This reinforces the lower esophageal sphincter, making it less likely that acid will back up in the esophagus. If you are interested in seeing what this looks like, Mayo Clinic<\/a> has some nice diagrams of the procedure.<\/p>\n I know I didn’t cover everything there is to know about feeding tubes, but that wasn’t the intention. I just want to provide a little bit of info what we, or should I say James, went through to overcome his feeding issues. When he was born he didn’t have the ability to suck or swallow so we had to use various types of feeding tube methods. We started with an NG-tube, added an NJ-tube for feeding, and eventually James had G-tube and fundoplication surgery.<\/p>\nWhat is a G-Tube?<\/span><\/h4>\n
MIC-KEYs and Minis<\/span><\/h5>\n
Wait, what about his reflux?<\/span><\/h5>\n
Summary<\/span><\/h4>\n