From the Guidelines
For colon preparation via NJ tube, administer polyethylene glycol (PEG) solution as the preferred bowel lavage solution, as recommended by the most recent guidelines 1. When using a NJ tube for colon preparation, it is essential to ensure the tube is properly positioned and patent before starting the preparation.
- The solution should be delivered via gravity or using a feeding pump, and the patient should be monitored for signs of discomfort, abdominal distension, or nausea during administration.
- If needed, metoclopramide can be given 30 minutes before starting the preparation to improve gastric emptying, as suggested by previous studies 1.
- The PEG solution is particularly suitable for NJ administration as it doesn't cause significant fluid or electrolyte imbalances.
- For patients with renal impairment or heart failure, reduce the volume and slow the rate of administration while monitoring fluid status closely. Key considerations for NJ tube placement include:
- Using a stylet-filled tube (stiffened) and a corkscrew motion on the tube to facilitate blind bedside placement 1.
- Placing the patient in the right lateral decubitus position and tracking the tube into proper position in the small bowel by auscultation 1.
- Using endoscopic or image-guided placement techniques if blind bedside placement is unsuccessful 1. It is crucial to follow best practices for prevention of further transmission of infections when administering colon preparation via NJ tube, as outlined in the guidelines 1.
From the Research
Colon Preparation Protocol via NJ Tube
- There are no studies that directly address the use of a nasojejunal (NJ) tube for colon preparation protocol.
- However, studies have compared the efficacy and tolerability of different bowel preparation solutions, such as polyethylene glycol and mannitol 2, and polyethylene glycol with bisacodyl versus sennosides in children 3.
- Another study compared oral sodium phosphate solution with polyethylene glycol with bisacodyl, finding that the sodium phosphate solution was better tolerated and more effective 4.
- A study on the use of a polyethylene glycol based bisacodyl suppository for bowel care in myopathy patients found that it reduced bowel care time by about half compared to a conventional bisacodyl suppository 5.
- The use of an NJ tube has been studied in the context of enteral nutrition in critically ill patients, with an improved endoscopically guided NJ tube placement technique showing a 100% success rate and significant improvement in serum albumin levels after 7 days of enteral nutrition therapy 6.