Pediatric Feeding Tube Research Articles

Temporary arterial shunting following a complete transection of femoral artery in a resource-limited setting

The aim of a surgeon managing vascular trauma in an extremity is to save the life, limb, and function of the patient. The use of temporary intravascular shunting has been shown to be a successful damage control strategy in patients who present with hemodynamic instability. We present the first reported case of a penetrating arterial injury of the lower limb causing a large defect that was successfully treated with temporary intravascular shunting before definitive repair in the country of Liberia. In a low-resource setting such as ours, the surgeon often opts to amputate limbs with vascular injuries that are not believed to be candidates for primary repair. Using a pediatric feeding tube with good postoperative results, we demonstrated that temporary arterial shunting in damage control situations before definitive repair was not only feasible but also cost-effective and ultimately resulted in the preservation of the patient’s limb.

Management of Sialocele Secondary to Iatrogenic Parotid Duct Injury: A Case Report

Sialocele is extra glandular subcutaneous collection of saliva. Etiology ranges from trauma or laceration to the salivary duct or the gland parenchyma itself. The injurious cause can be trauma or insult from surgeries involving the salivary gland like superficial parotidectomy. The objective of this study is to bring in light the potential of iatrogenic trauma to the Stensonrsquos duct. The paper also includes the key to diagnosis and surgical technique to correct the sialocele resulting from the ductal injury. The surgical procedure of ductal repair of two patients of Sialocele was conducted in the Department of Oral and Maxillofacial Surgery CDCRI. The treatment included distal canulation of the duct intra-orally extra-oral surgical exploration removal of the cystic lining in one patient and catheterising with a paediatric feeding tube the distal part of the duct up to the site of saliva accumulation. Post-operative monitoring done with thorough irrigation and pressure dressing. After 21 post operative days the patency of the tract for saliva drainage was marked. Removal of the feeding tube also showed intact saliva drainage on stimulation. Treatment spectrum ranges from conservative medicinal treatment anti-cholinergic drugs administration and surgical intervention. Enucleation and Catheterization is a promising treatment modality.

Evaluation of uterine cavity after myomectomy by ultrasonography and hysteroscopy

Background: Uterine fibroids are tumor of the smooth muscles and the connective tissue of the uterus. They are considered to be the most common benign tumor of the pelvis. Objective: The aim of the study was to evaluate uterine cavity after myomectomy by hysteroscopy and ultrasonography. Methods: A prospective (observational) analytical design will be used in this study. This study was including 50 patients was selected from the outpatient gynecological clinic, (Dar Al-Om Medical Center & Fares Medical Center & Al-Azhar University Hospital “Al-Hussien and Sayed Galal”). Results: We aimed to evaluate uterine cavity after myomectomy by hysteroscopy and ultrasonography. This study was including 50 patients was selected from the outpatient gynecological clinic, (Dar Al-Om Medical Center & Fares Medical Center & Al-Azhar University Hospital “Al-Hussien and Sayed Galal”). Conclusion: From our study we could conclude that hesteroscopy improves results 3-4D ultrasound imaging it’s not currently available in all units, its use has significant implications in terms of cost and training. Saline infusion on the other hand may be undertaken easily using various dedicated systems or modifications of readily available cheaper catheters such as Intra-uterine Insemination catheter or a paediatric feeding tube.

A Technique for Witzel Tunnel Catheter Drainage of the Biliary and Pancreatic Anastomosis of a Whipple Procedure

Introduction: Stenting the pancreatic and biliary anastomoses in a Whipple procedure has been shown to lower the rate of anastomotic leak. Method: We have identified a combined biliary and pancreatic ductal external drainage catheter/stent to decompress the small bowel limb and both anastomoses. The single catheter is a combination of a red Robinson catheter and a silastic pediatric feeding tube each of appropriate size for the duct they are draining. The silastic feeding tube is inserted into the lumen of the red rubber catheter though a small tight fenestration in the elastic external segment of the red catheter and exits the red rubber catheter through a similar fenestration at the level of the hepatico-jejunostomy. The silastic feeding tube is then advanced into the pancreatic duct where it is secured to the small bowel mucosa with a fine absorbable suture to prevent dislodgement. The combined tubes then exits the small bowel “Whipple limb” though a Witzel tunnel. The small bowel is secured to the right upper quadrant abdominal wall with several interrupted 3-0 Vicryl sutures. Results: Our technique offers several advantages. It’s a more durable way of stenting the two anastomoses and prevents stent migration. It provides an opportunity to study the two anastomosis via contrast administration. The witzel tunnel and the anchoring of the jejunal limb to the lateral abdominal wall opens the door for several IR/endoscopic interventions. Conclusion: The use of a combined biliary and pancreatic ductal external drainage catheter/stent system has many theoretical advantages.

A technique for witzel tunnel catheter drainage of the biliary and pancreatic anastomosis of a Whipple procedure

Presenter: Mridul Pansari MD | Florida Atlantic University Background: Stenting of the pancreatic and biliary anastomoses of a Whipple procedure has been shown to lower the rate of anastomotic leak in several retrospective and prospective studies. We describe here a combined biliary and pancreatic ductal external drainage catheter we have used successfully in our pancreatico-duodenectomy operations. Methods: We have identified a combined biliary and pancreatic ductal external drainage catheter / stent which we construct on the operating table to decompress the small bowel limb and both anastomoses. The single catheter is a combination of a red Robinson catheter and a silastic pediatric feeding tube each of appropriate size for the duct they are draining. The silastic feeding tube is inserted into the lumen of the red rubber catheter though a small tight fenestration in the elastic external segment of the red catheter and exits the red rubber catheter through a similar fenestration at the level of the choledocho or hepatico- jejunostomy. The silastic feeding tube is then advanced well into the lumen of the pancreatic duct where it is secured to the small bowel mucosa with a fine absorbable suture to prevent dislodgement. Multiple small extra openings are cut into both tubes at their distal segments to facilitate ductal drainage. The combined tubes then exeunt the small bowel “Whipple limb” though a Witzel tunnel. The small bowel is secured to the right upper quadrant abdominal wall with several interrupted 3-0 Vicryl sutures. The tube is secured to the skin externally with a heavy nylon suture. The pediatric feeding tube is then secured to the outer part of the red rubber catheter with benzoin and three ¼ inch steri-strips. Both catheters are connected to separate external drainage bags. We perform our pancraetico- jejunostomy with a single layer of interrupted 3-0 silk suture and our bile duct anastomosis with a single layer of 4-0 or 5-0 PDS or Maxon suture. Two 10 mm Jackson Pratt drains are then placed in the right upper quadrant. Results: There are several theoretical advantages that our procedure offers. First, it diverts the pancreatic fluid and bile, decreasing it's flow through the respective anastomosis which helps in the healing of the anastomosis. Secondly, our technique is a more durable way of stenting the two anastomoses and prevent the migration of the stents. The pediatric feeding tube has three areas of resistance that prevents its migration. The fenestration in the external portion, the fenestration in the internal portion and the mucosal stitch that is placed to hold it in place. The red rubber catheter is kept in place by the Witzel tunnel itself. Third advantage is that it provides an opportunity to study the two anastomosis via contrast administration. Fourth, the witzel tunnel and the anchoring of the jejunal limb to the lateral abdominal wall opens the door for several wire based treatments in a Seldinger fashion, should a leak be identified in the post operative period. Conclusion: The use of a combined biliary and pancreatic ductal external drainage catheter / stent system has many theoretical advantages.

Behavior-Analytic Treatment Progression for a Child With Tube Dependence: Reaching Age-Typical Feeding

The current case study outlines a behavior-analytic treatment progression for a child with a pediatric feeding disorder and tube dependence. The child participated in an intensive day-treatment program for 8 weeks where she transitioned from tube feedings to oral feedings. She successfully transitioned to a less intensive, telehealth outpatient model for follow-up care where she continued to progress to age-typical feeding. Following a systematic and gradual reduction in follow-up appointments, she consumed all meals of age-appropriate foods in both home and school environments. Another important contribution of the case study is that it demonstrated the importance of follow-up services that occur in the child’s natural environment while highlighting the utility of rubrics. With rubrics, caregivers effectively and efficiently progressed toward treatment goals independently. This case study also discusses the importance of ongoing interdisciplinary collaboration and the unique contributions of each team member in employing effective interventions while ensuring client safety.

Abstract No. 591 Pediatric enteral feeding tubes: avoiding the trap of the “routine” tube exchange?

Abstract No. 591 Pediatric enteral feeding tubes: avoiding the trap of the “routine” tube exchange?

1695 Removal of a Retained Biliary Stent in a Liver Transplant Patient Secondary to Biliary Cast Syndrome Using Digital Cholangioscopy and Electrohydraulic Lithotripsy

INTRODUCTION: We describe the use of electrohydraulic lithotripsy(EHL) in conjunction with digital cholangioscopy which was used effectively to treat a retained intraoperative biliary stent in a liver transplant patient due to biliary cast which spared the patient from surgery. CASE DESCRIPTION/METHODS: A 72-year-old male who received an orthotopic liver transplant for end stage liver failure secondary to cirrhosis due to nonalcoholic steatohepatitis and hepatocellular carcinoma which was complicated by hepatic artery thrombus that ultimately required a second liver transplant with a pediatric feeding tube placed intraoperatively as an internal stent to prevent anastomotic stricture of the bile duct. Approximately eight years later, the patient presented to an ER with altered mental status and elevated liver enzymes. A computed tomography of abdomen and later a magnetic resonance cholangiopancreatography was done which showed an intra and extrahepatic biliary ductal dilation of the common hepatic and duct debris indicative of obstruction (Figure 1a,b). Endoscopy showed an enlarged prominent major duodenal papilla with a biliary stent which was visibly occluded (Figure 2). Attempted removal of stent was unsuccessful and a new plastic biliary stent was placed beside the impacted stent to relieve the obstruction. One month later, the new plastic biliary stent was removed and digital cholangioscopy was used to visualize the the bile duct which showed the endobiliary stent was embedded in stony material that was adherent the duct walls. Cholangioscope was slowly advanced from distally to proximally along the encased stent with the use of EHL which sequentially broke up the surrounding stony material. One half of the stent was stripped and the process was repeated on the other side until the stent was free floating. The stent was then successfully removed using rat-toothed forceps (Figure 3). DISCUSSION: This case demonstrated that cholangioscopy with lithotripsy can be used to treat an impacted stent in a liver transplant patient due to biliary cast. This is an unusual case as the intraoperative stent was found to be retained and the timeline of 8 years since liver transplant till presentation of biliary cast syndrome is one of the longest reported in the literature. We demonstrated a novel technique by fragmenting the cast of the encased stent from distally to proximally in order to disimpact the stent and this technique used may be applied to other challenging cases where standard methods have failed. Watch the video: http://bit.ly/32zEMOY.

1317 Case of an Unusual Complication of a Biliary Stent

INTRODUCTION: Biliary stent complications are not rare but we present a very rare complication of biliary stent. CASE DESCRIPTION/METHODS: 64 year old male with hypertension, diabetes mellitus, coronary artery disease, chronic thrombocytopenia, and orthotopic liver transplant six months prior to presentation for alcoholic cirrhosis was transferred to our center from an outside hospital. He was admitted with fever, nausea, and shortness of breath for 4 days. On arrival, his heart rate was 105/min, and blood pressure 141/88 mm Hg, oral temperature 36.8°C. Physical exam was unremarkable. Total and direct bilirubin were newly elevated to 2.7 and 2.0 mg/dL respectively from 1 and 0.5 mg/dL 10 days ago. WBC was 6.4 × 103/mcL. Gram negative rods were detected in cultures drawn at outside hospital. Due to these findings abdominal ultrasound was done which showed a well positioned pediatric feeding tube inside the bile duct placed at time of transplant to maintain anastomotic patency. There was lack of pneumobilia and progressive extrahepatic biliary ductal dilation. Due to a concern for cholangitis from blocked biliary tube an ERCP was recommended. During ERCP, feeding tube was visualized at ampulla and removed. Biliary cannulation was achieved with wire and sphincterotomy performed. A 1.5 cm anastomotic stricture was seen with ductal dilation proximal and distal to it. A 7 French and 9 cm plastic biliary stent was placed across the stricture. Patient improved symptomatically and bilirubin trended down over next 3 days. On fourth day, he developed sudden onset diffuse abdominal pain which was exacerbated by minimal movement. No rebound tenderness or rigidity was noted. He was tachycardic to 112 beats/min. Due to this a stat CT of abdomen/pelvis was done without contrast. Biliary stent was seen to be extending through the contralateral wall of the duodenum, terminating into peritoneal fat with increase in intra-abdominal free fluid. No free air was seen. He was immediately taken to OR for an omental patch repair of the duodenum and peritoneal washout revealed bilious fluid in the peritoneum. Pt had a slow recovery and was discharged to skilled nursing facility fourteen days after the surgery. DISCUSSION: We present a rare but important early complication of biliary stent placement that needs to be recognized promptly to reduce morbidity and mortality. There are very few cases described in literature and most stent related perforation occured between 5 days and 2 weeks post placement.

Laparoscopic pancreaticojejunostomy with transpancreatic “blumgart” and running “hopkins” sutures and external pancreatic duct stent (PDS)

Background: Laparoscopic pancreaticoduodenectomy (LPD) has been increasingly used in patients at high risk of pancreatic leak due to soft glands and small ducts. Varying open techniques can mitigate the risk of this complication, but translation to laparoscopy can be challenging. We describe a laparoscopic pancreaticojejunostomy with transpancreatic ‘Blumgart’ sutures, anterior and posterior running internal layers and placement of an externalized pancreatic duct stent (PDS) utilizing a Seldinger technique. Methods: A totally LPD was performed with percutaneous introduction of a 8 Fr pediatric feeding tube, via Seldinger technique and standard 11 Fr introducer sheath into the jejunal limb. Sutures were tied together to create double armed sutures (DAS) of adequate length. Two 3-0 Vicryl DAS were used for the transpancreatic stiches, followed by a posterior running 3-0 V-Loc row. The external PDS was placed in the duct and secured with 5-0 Polydioxanone DAS. A second anterior running row was performed and the anastomosis was completed after the final anterior stiches were placed through the intestine and tied down. The PDS exit site was secured similarly to a feeding tube with a 3-0 Vicryl purse string suture and two Witzel stitches. Results: 70 y/o woman with pT2N2 pancreatic acinar cell cancer underwent uncomplicated totally LPD with external stent placement. Patient tolerated the procedure well and was discharged home on POD 5. The externalized PDS was removed at 6 weeks post op. She is now 3 months out from surgery and has not had any complications. She is currently undergoing adjuvant chemotherapy. Conclusion: LPD is an established procedure for the treatment of pancreatic head lesions. Patients at high risk of pancreatic leak - soft glands, small ducts, and/or high BMI - may benefit from adapting open techniques that have been shown to decrease complications such as pancreatic fistulas. This laparoscopic method for placing an external PDS may further mitigate potential complications.

How to perform laparoscopic duct-to-mucosa pancreatojejunostomy in high-risk score patients

Background: According to prospective validated study score for pancreatic fistula, the main risk factors are gland texture, pathology, duct diameter and blood loss. While major blood loss usually is not an issue in laparoscopic surgery, we present our technique to safely perform pancreatojejunostomy in patients with soft gland and extremely small pancreatic ducts. Methods: This video presents laparoscopic duct-to-mucosa pancreato-jejunostomy in different scenarios. Small and extremely small pancreatic ducts, odd position of the pancreatic duct (position from posterior edge <3 mm) in patients with soft texture of pancreas are shown. Results: In most cases there is a difficulty in finding the main duct. The duct located near to the posterior edge needs pancreatic stump posterior face dissection in order to allow duct-to-mucosa anastomosis without compromise external layer. Internal stents are used for extremely small ducts (1 mm). Sometimes even pediatric feeding tubes are not small enough to be introduced and venous catheter may be used. Interrupted sutures are usually necessary. Forty-seven patients with high-risk score submitted to laparoscopic duct-to-mucosa pancreatojejunostomy after pancreatoduodenectomy or central pancreatectomy were studied. Pancreatic fistula occurred in 15 patients (35%) but only two patients with grades B and C. Conclusion: Laparoscopic duct-to-mucosa pancreatojejunostomy is feasible and safe even in patients with high-risk score for developing postoperative pancreatic fistula.

How to perform laparoscopic duct-to-mucosa pancreatojejunostomy in high-risk score patients

Background: According to prospective validated study score for pancreatic fistula, the main risk factors are gland texture, pathology, duct diameter and blood loss. While major blood loss usually is not an issue in laparoscopic surgery, we present our technique to safely perform pancreatojejunostomy in patients with soft gland and extremely small pancreatic ducts. Methods: This video presents laparoscopic duct-to-mucosa pancreato-jejunostomy in different scenarios. Small and extremely small pancreatic ducts, odd position of the pancreatic duct (position from posterior edge <3 mm) in patients with soft texture of pancreas are shown. Results: In most cases there is a difficulty in finding the main duct. The duct located near to the posterior edge needs pancreatic stump posterior face dissection in order to allow duct-to-mucosa anastomosis without compromise external layer. Internal stents are used for extremely small ducts (1 mm). Sometimes even pediatric feeding tubes are not small enough to be introduced and venous catheter may be used. Interrupted sutures are usually necessary. Forty-seven patients with high-risk score submitted to laparoscopic duct-to-mucosa pancreatojejunostomy after pancreatoduodenectomy or central pancreatectomy were studied. Pancreatic fistula occurred in 15 patients (35%) but only two patients with grades B and C. Conclusion: Laparoscopic duct-to-mucosa pancreatojejunostomy is feasible and safe even in patients with high-risk score for developing postoperative pancreatic fistula.

Novel Biliary Reconstruction Techniques During Liver Transplantation.

Biliary complications remain a significant problem following liver transplantation. Several surgical options can be used to deal with a significant size mismatch between the donor and recipient bile ducts during the biliary anastomosis. We compared biliary transposition to recipient biliary ductoplasty in cadaveric liver transplant. A total of 33 reconstructions were performed from January 1, 2005 to December 31, 2013. In the biliary transposition group (n=23), 5 reconstructions were performed using an internal stent (5 or 8 French pediatric feeding tube), and 18 were performed without. Of the 10 biliary ductoplasties, 2 were performed with a stent. All patients were managed with standard immunosuppression and ursodiol. Follow-up ranged from 2 months to 5 years. No patients in the biliary transposition group required reoperation; 1 patient had an internal stent removed for recurrent unexplained leukocytosis, and 2 patients required endoscopic retrograde cholangiography and stent placement for evidence of stricture. Three anastomotic leaks occurred in the biliary ductoplasty group, and 2 patients in the biliary ductoplasty group required reoperation for biliary complications. Our results indicate that biliary reconstruction can be performed with either biliary transposition or biliary ductoplasty. These techniques are particularly useful when a significant mismatch in diameter exists between the donor and recipient bile ducts.

Frazier Metallic Suction Tube: An Adjunct in Irrigation of Deep Fascial Spaces.

Once incision and drainage of fascial space abscess is performed, irrigation of deep spaces with saline and antibiotic solution should be done daily for effective elimination or reduction of infection. Various advocated aids for irrigation into deeper areas are: small pediatric nasogastric feeding tubes, French catheter, polyethylene irrigation tubes and scalp vein infusion set. All these aids have major inherent disadvantages like, they tend to kink inside the deep spaces limiting the reach of irrigating solution into deeper spaces, are not readily available in dental departments and have to be discarded after every use. Overcoming these disadvantages, a simple yet an effective method is proposed here-use of a Frazier suction tube.

Purse‐string suture without pancreatic parenchymal stitches in pancreaticojejunostomy during laparoscopic pancreaticoduodenectomy

AimLaparoscopic pancreaticoduodenectomy is a controversial procedure because of the technical difficulty of the procedure. Complications are associated with reconstructive surgeries, in particular with pancreaticoenterostomy. In this study, we aimed to develop a method for pancreaticojejunostomy during laparoscopic pancreaticoduodenectomy.Patients and MethodsFive patients received laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. The main pancreatic duct was identified after transection and cannulated with a 5‐Fr paediatric feeding tube. Two stay sutures of nonabsorbable 4–0 monofilament were applied in the both side of the pancreas. A hole was opened in the jejunum near the cross section of the pancreatic stump on the antimesenteric side. The surrounding layers of the jejunal hole were purse‐string sutured using a nonabsorbable 3–0 suture, and the surgeons ensured that the jejunal muscular layers enveloped the pancreatic stump.ResultsWe performed a purse‐string suture without pancreatic parenchymal stitches in a pancreaticojejunostomy during a laparoscopic pancreaticoduodenectomy in five patients. The patients began to drink water at 5–7 days postoperation. The patients began to eat a soft diet at 13–15 days postoperation. We also administered total parenteral nutrition after surgery. The average blood loss was 850 mL and the average operative time was 532 min. The postoperative hospital stays were 21, 25, 20, 25, and 19 days. Two patients exhibited delayed gastric emptying. No PFe was observed in short‐term follow‐up up to 6 months postoperation.ConclusionWe successfully performed purse‐string suturing without pancreatic parenchymal stitches during the pancreaticojejunostomy. The short‐term follow‐up exhibited no pancreatic fistulae. This anastomosis technique can be performed safely and easily.

Post-sialendoscopy ductoplasty by salivary duct stent placements.

With damage to a duct or papilla after sialendoscopy, a stent may be necessary to prevent re-stenosis and for maintaining the salivary duct open after complete sialendoscopy. However factors affecting outcomes and complications after stent placement remain unclear. This study aimed to report preliminary experiences in salivary duct stent placement after sialendoscopy. Data from 35 procedures in 33 patients who received sialendoscopy with salivary duct stent placements at Mackay Memorial Hospital between October 2013 and June 2014 were recorded and compared for clinical data, as well as procedural techniques, findings, and outcomes. In the 35 stent placement procedures, the hypospadias silastic stent tubes were used in 27 and the Fr. 5 pediatric feeding tubes were used in the remaining eight. When the hypospadias silastic stent tubes were used for stenting, the stent obstruction and irritation rates were higher compared to those who used the Fr. 5 pediatric feeding tube (100 vs. 0 % and 67 vs. 33 %, respectively). None of the stents secured by a 5-0 nylon suture were complicated by dislocation but when the stents were secured by 6-0 nylon sutures, the dislocation rate went as high as 47.4 %. The duration needed for salivary duct stent placement might be potentially shortened to only 2 weeks. If a salivary duct stent is intended to be placed for a certain period before its scheduled removal, a suture strength equivalent or stronger than the 5-0 nylon suture should be considered for stent fixation.

A Retrospective Study on the Safety and Efficacy of a Ketogenic Feeding Tube Diet in the Treatment of Obesity

Background: According to the US Department of Health and Human Services, 35.7% of adults and 17% of children in the USA are currently obese. With no American state having an obesity prevalence of = 30%, surgical interventions such as gastric restrictive or diversion bariatric operations are becoming increasingly necessary. Non-surgical therapies like very low calorie diets (VLCD) and low calorie diets (LCD) are limited in potency of nutritional ketosis because carbohydrate-free formulas are not palatable to the patient. The current study therefore sought to evaluate a physician-supervised, outpatient, 10- day ketogenic feeding tube diet as an option for overweight or obese patients using a carbohydrate-free mixture of protein, fats and micronutrients. Methods: This is a retrospective clinic chart review (n=218) of patients who underwent a medically supervised weight loss program using a feeding tube to induce and maintain a state of nutritional ketosis. After medical evaluation, a pediatric feeding tube was inserted through the nose under local anesthesia and a carbohydrate-free ketogenic mixture delivering approximately 600 to 800 kcal/day was administered continuously. Over a 24-month period, 218 patients were treated, and 177 were identified as having verifiable initial and final weights, serial blood chemistries, urinary ketone levels, and fat free mass (FFM) as measured by DEXA. Results: The mean age of patients was 44.7 years (range 20-70 years), 83.1% were female, 65% were Caucasian. The mean BMI was 31.8 kg/m² (SD=5.0); the mean duration of treatment was 8.7 days (range 2-13 days). There was a significant increase in urinary ketones (p<0.001). There was a significant reduction in total body weight of 4.9 kg (SD=2.0, p<0.001) and BMI of 1.95 kg/m² (SD=0.68, p<0.001). The procedure was tolerated well with little or no discomfort by 72.9%; 15.8% removed the feeding tube early due to discomfort or personal reasons; 3.4% did not tolerate the treatment and 6.8% had their feeding tube reinserted during the treatment. There were no serious complications. Conclusion: The ketogenic feeding tube diet induced nutritional ketosis and led to a clinically significant weight loss in the 10-day program. This approach may play a role in the treatment of obesity to initiate weight loss in lifestyle or medication programs, to break through weight loss plateaus, or for preoperative weight loss prior to bariatric surgery. It may also be a useful medical strategy for patients who do not qualify for or refuse bariatric surgery, but are significantly overweight and in need of medical intervention after failing lifestyle modifications. (No Trial Registration required)

Pediatric Feeding Tube Implantation During Orthotopic Liver Transplantation: An Anaylsis Of Effectiveness In Preventing Biliary Complications

Pediatric Feeding Tube Implantation During Orthotopic Liver Transplantation: An Anaylsis Of Effectiveness In Preventing Biliary Complications

Cannulating a narrow pancreatic duct as part of a pancreaticoenteric anastomosis.

When performing pancreaticoenteric anastomoses, the pancreatic duct is commonly cannulated with a paediatric nasogastric feeding tube. This transanastomotic stent is directed distally into the bowel to divert the flow of pancreatic enzymes away from the anastomosis. In a soft pancreas, the pancreatic duct can be too narrow to admit the smallest size (4Fr) feeding tube. More narrow lumen tubes like intravenous cannulas are too short to protect the anastomosis. A 22G cannula inserts snugly into the distal feeding tube (Fig 1A), which when trimmed creates a tapered tube (Fig 1B) that is easily inserted but still long enough to protect the anastomosis. Figure 1 The 22G cannula is inserted into a 4Fr feeding tube (A). The cannula is then divided at the level of the injection port, leaving the tapered end (B).

Everything the nurse practitioner should know about pediatric feeding tubes

To provide an overview of the current feeding tubes in use in the pediatric population including feeding tube complications, and specific guidance for patients at the initiation, throughout the use of, and at the discontinuation of tube feeding. A review of the literature was performed using multiple databases including PubMed, CINAHL, Ovid Medline, and Cochrane Library. Key words used included pediatric gastrostomy (G) tubes, nasogastric (NG) tubes, gastrojejunostomy (GJ) tubes, enteral access, and nurse practitioner (NP). Any child who cannot obtain nutrition orally is a candidate for enteral feeding tube access. Tube feeding is the recommended care guideline for children that are undernourished or unable to safely take-in oral nutrition. Tube feeding has been known to improve health-related quality of life. There are a number of different forms of feeding tubes that can be used in children, including NG, orogastric, G, and GJ tubes. Children are being sent home regularly with enteral feeding tube access and NPs will encounter these patients in everyday practice. It is important that NPs know the risks and benefits of tube feeding as well as the types of tubes currently in use and their indications, advantages, disadvantages, and complications.