Gastrointest Radiol 15:64-65 (1990)
Gastrointestinal
Radiology
9 Springer-VerlagNewYorkInc.1990
Enterostomy Catheter Exchange Using New Polymer-Coated Guide Wire: Technical Note David M. Markowitz and Donald F. Denny, Jr. Department of Diagnostic Radiology, Yale-New Haven Hospital, New Haven, Connecticut, USA
Abstract. The exchange of enterostomy feeding catheters may be facilitated by the use of a recently developed hydrophilic polymer guide wire. This has been found especially useful in the insertion of catheters constructed of polyurethane or silastictype materials. Key words: Enterostomy tube, technique.
The placement of jejunostomy feeding tubes is a common management technique for providing long-term enteral alimentation for patients in whom oral feeding is contraindicated or not tolerated. Due to the long period of time that these tubes remain indwelling, the radiologist is not infrequently asked to replace occluded, kinked, or misdirected catheters. To allow for some displacement of the catheter that naturally occurs during the patient's daily activities, the intraintestinal portion of the tube should measure at least 40 cm. While most surgical jejunostomies are created distal to the ligament of Treitz, jejunal feeding tubes inserted through gastrostomies must be positioned distal to this anatomic landmark in order to minimize gastric reflux and possible aspiration of the enteral feeding. A variety of materials have been used for the construction of enterostomy catheters. Many are made of siliconized rubber (silastic) or polyurethane compounds. These are soft, flexible, biologically inert substances that cause minimal discomAddress reprint requests to." David M. Markowitz, M.D., Diag-
nostic Imaging, Yale-New Haven Hospital, 333 Cedar Street, New Haven, CT 06510, USA
fort and are resistant to breakdown in the harsh chemical environment of the succus entericus. Unfortunately, the flexibility and high coefficient of friction of these catheter materials frequently results in an accordion-like foreshortening of the tube when friction is encountered during attempts at insertion over a standard coiled-spring guide wire [1-3]. This may occur even when the skin entrance site is dilated to the appropriate French size and the catheter is coated with a water-soluble or silicone lubricant. The Glidewire, a hydrophilic polymer-coated solid plastic and alloy guide wire (manufactured by Terumo, Tokyo) has a flexible, atraumatic tip, good torque control, and high lubricity that has been found useful in selective visceral angiography [4]. This smooth and very slippery surface allows for a near frictionless insertion of silastic-like catheters. These same properties allow the wire to more easily traverse kinked or occluded segments of catheter. Holding the guide wire with a wet gauze eliminates slippage between wire and glove, improving control. Several forms of this guide wire are available. For the purpose described here, we use the 150-cm, angled tip, 0.038-inch (0.97 mm) type and have found that this guide wire facilitates enterostomy catheter exchanges. The angled tip is preferred since this better allows the guide wire to bend and pass over the valvulae conniventes in a J-shaped configuration. The good torque control of the wire permits turning the tip away from catheter side holes during insertion of the wire into the indwelling catheter prior to exchange. The cost of the Glidewire approximates that o f the standard coiled-spring wires.
D.M. Markowitz and D.F. Denny, Jr. : Enterostomy Catheter Exchange
References 1. McLean G, Ring E, Freiman D : Applications and techniques of gastrointestinal intubation. Cardiovas Intervent Radiol 5:108-116, 1982 2. Berman HL, Bakak CW, Katz SG: Modification of the cope drainage catheter to facilitate placement. A JR 146:169-170, 1986
65
3. McLean G, Meranze S, Burke D: Enteric alimentation: a radiologic approach. Radiology 160:555-556, 1986 4. Takayasu K, Muramatsu Y, Moriyama N, et al: Plasticcoated guide wire for hepatic arteriography. Radiology 166: 545-546, 1988
Received: April 10, 1989; accepted: May 12, 1989
Gastrointestinal
Radiology
9 Springer-VerlagNewYorkInc.1990
Enterostomy Catheter Exchange Using New Polymer-Coated Guide Wire: Technical Note David M. Markowitz and Donald F. Denny, Jr. Department of Diagnostic Radiology, Yale-New Haven Hospital, New Haven, Connecticut, USA
Abstract. The exchange of enterostomy feeding catheters may be facilitated by the use of a recently developed hydrophilic polymer guide wire. This has been found especially useful in the insertion of catheters constructed of polyurethane or silastictype materials. Key words: Enterostomy tube, technique.
The placement of jejunostomy feeding tubes is a common management technique for providing long-term enteral alimentation for patients in whom oral feeding is contraindicated or not tolerated. Due to the long period of time that these tubes remain indwelling, the radiologist is not infrequently asked to replace occluded, kinked, or misdirected catheters. To allow for some displacement of the catheter that naturally occurs during the patient's daily activities, the intraintestinal portion of the tube should measure at least 40 cm. While most surgical jejunostomies are created distal to the ligament of Treitz, jejunal feeding tubes inserted through gastrostomies must be positioned distal to this anatomic landmark in order to minimize gastric reflux and possible aspiration of the enteral feeding. A variety of materials have been used for the construction of enterostomy catheters. Many are made of siliconized rubber (silastic) or polyurethane compounds. These are soft, flexible, biologically inert substances that cause minimal discomAddress reprint requests to." David M. Markowitz, M.D., Diag-
nostic Imaging, Yale-New Haven Hospital, 333 Cedar Street, New Haven, CT 06510, USA
fort and are resistant to breakdown in the harsh chemical environment of the succus entericus. Unfortunately, the flexibility and high coefficient of friction of these catheter materials frequently results in an accordion-like foreshortening of the tube when friction is encountered during attempts at insertion over a standard coiled-spring guide wire [1-3]. This may occur even when the skin entrance site is dilated to the appropriate French size and the catheter is coated with a water-soluble or silicone lubricant. The Glidewire, a hydrophilic polymer-coated solid plastic and alloy guide wire (manufactured by Terumo, Tokyo) has a flexible, atraumatic tip, good torque control, and high lubricity that has been found useful in selective visceral angiography [4]. This smooth and very slippery surface allows for a near frictionless insertion of silastic-like catheters. These same properties allow the wire to more easily traverse kinked or occluded segments of catheter. Holding the guide wire with a wet gauze eliminates slippage between wire and glove, improving control. Several forms of this guide wire are available. For the purpose described here, we use the 150-cm, angled tip, 0.038-inch (0.97 mm) type and have found that this guide wire facilitates enterostomy catheter exchanges. The angled tip is preferred since this better allows the guide wire to bend and pass over the valvulae conniventes in a J-shaped configuration. The good torque control of the wire permits turning the tip away from catheter side holes during insertion of the wire into the indwelling catheter prior to exchange. The cost of the Glidewire approximates that o f the standard coiled-spring wires.
D.M. Markowitz and D.F. Denny, Jr. : Enterostomy Catheter Exchange
References 1. McLean G, Ring E, Freiman D : Applications and techniques of gastrointestinal intubation. Cardiovas Intervent Radiol 5:108-116, 1982 2. Berman HL, Bakak CW, Katz SG: Modification of the cope drainage catheter to facilitate placement. A JR 146:169-170, 1986
65
3. McLean G, Meranze S, Burke D: Enteric alimentation: a radiologic approach. Radiology 160:555-556, 1986 4. Takayasu K, Muramatsu Y, Moriyama N, et al: Plasticcoated guide wire for hepatic arteriography. Radiology 166: 545-546, 1988
Received: April 10, 1989; accepted: May 12, 1989
