Tubes & Lines-What is what?

Tubes

These are the most common forms of tubes used for both tube feeding and draining. If you hear the word enteral, you are talking about these types of devices that are used for enteral feeding. Enteral feeding is feeding by bypassing the throat, or stomach. This can be necessary if a patient cannot tolerate eating by mouth, or if their stomach doesn’t work the way it is supposed to. They still absorb nutrients through their gut.

These tubes can also be used for decompression and draining. When someone is unable to move anything through their digestive system, even stomach acids and other fluid produced in the gut can cause issues, so some people have to let those out of these types of tubes.

Tubes like these are capable of getting an infection in their stoma, since it is essentially an open wound that is never able to heal. But while it is important to keep these very clean, they are not kept sterile like that of a central line. These go into dirty organs (stomach and small intestine).

G-TubesG-Tube

These tubes are typically used as feeding tubes (I say typically, because I use mine to drain rather than to feed) they come in several different sizes that are normally measured in the French scale (with the smaller the number being the smaller the circumference of the tube). The tube is placed either surgically, endoscopically, or through interventional radiology. Each department do the procedure a little bit differently, and usually the team picked to place the tube is dependent on the patient’s anatomy and/or diagnosis situation. But each placement ends up looking very similar. They have a stoma (the hole in the abdomen) and a tube that has either a balloon (that gets filled with a syringe of water from the outside of the tube once placed inside the abdomen as a deflated balloon) or a silicone bumper on the end that goes on the inside of the abdominal wall to hold it in place.
It also has a bumper that is movable on the outside of the abdomen. You use this bumper to make the tube fit the person using it. Be careful not to make it too tight though! That can cause a lot of pain and/or granulation tissue. But so can having it too loose. In my experience, having a tube flopping around is just as likely to cause granulation tissue as one that is too tight.
The other end of the tube has ports that serve different functions. On a balloon ended tube, one of the ports on the opposite end is where you push saline to fill the balloon that is inside the abdomen. There is also a port that goes directly into the stomach. And sometimes there is a third port that is smaller than the other feed port that is good to use for small medicine syringes.

 J-TubesJ-Tube

Essentially the same as a G-Tube, but they go into a section of the small intestine called the jejunum. These are also traditionally used to feed (although, mine was initially placed for draining, and I currently use it only for medicines). They differ from the G-Tube because they have a bit more of an internal tail on them. While the G-Tube stops at the balloon on the inside, the J-Tube continues on a bit longer past the internal balloon.

 

G-J TubesG-J Tube

A combo of both of the tubes I just described. But while each of those tubes requires a separate stoma, an G-J Tube only requires one. So it goes into a stoma in the stomach as a G-Tube, and then there is a smaller tube inside of the G-Tube that continues down into the jejunum. These can act in all sorts of ways I’m sure. The most common I’ve heard of it the G portion is used for draining (of stomach acid, etc.) and the J portion is used for feeding. I’ve personally never had one of these types of tubes before.

Low-Profile G, J, and GJ ButtonsLow Profile G-Button

These tubes are wonderful because they are much more discrete under clothing, and unless they are connected to something, don’t have as much potential of being tugged as regular tubes do. In my personal experience, they only work for tube feeding, and don’t work very well as a draining solution. Mostly due to the fact that they are pretty small, and the adapters that lock onto into them are Feed Extensionalso very small. The first photo shown is a balloon G-Button. The second and third small photos, that look very similar, are the extension sets. The top one is for when you are connected to a feedingBolus Extension with a pump, it is the one with the 90* angled “key.” This “key” part is what locks into the little hole on top of the button. This set is nice because it lays closer to the body, rather than it protruding straight out of the button. The other, straight extension set is used for bolus feeds, and when I “tried” to drain   through a button, this is the set I attempted to use.

*Side note* All of the tubes you see listed above are Haylard products. This is my personal favorite brand of tubes. They are soft and malleable. They do not protrude straight out, and are able to bend to be closer to your abdomen without putting strain on your stoma.
I have heard good things about AMT products as well (they even have glow in the dark buttons! How neat is that!) But I have never personally used their products.
I have however been stuck with a Kangaroo brand G-Tube before, and hated every moment of it. And I have a friend who had a Boston Scientific G-J placed, and it fell apart way too quickly to consider it a functioning tube option.
If you don’t like your tube, may it not be comfortable, it fall apart very easily (ehm, I’m looking at you Kangaroo) or whatever the problem may be, please do not hesitate to talk to your doctor about your concerns. There are plenty more options to look at. And I’m more than happy to discuss this with you further and helping to research more options with you.

NG TubesNG Tube used for suction

Nasogastric tubes. That’s right, they go in through the nose, down the throat, and into the stomach. They are usually placed while the patient is wide awake, and although this procedure is considered moderately uncomfortable, I personally found it to be extremely painful. There are both feeding NG tubes, and NG tubes used to suction things out of the stomach. Feeding NG tubes are typically more flexible and softer than ones used to drain. Draining NG tubes must be somewhat rigid, because they are usually connected to a suction, and if it weren’t rigid, the tube would just flop around in your stomach rather than sucking things out. The tube is typically taped to the face, either the nose or the cheek. And it really just looks like a hose with a cap on the end of it.

IMG_7910

This is a photo of me in 2013 with an NG tube (for suction) placed. You can see that my trick of helping it be a little bit more comfortable is stuffing some Kleenex into my nostril around the tube. My main problem with these tubes is the feeling of air going around the tube when I breathe, also the snot is pretty uncontrollable with me. So I like to have that barrier to make it a little less annoying. Some people say it works for them, others just say I look silly! Oh well!I also am not a fan of having my NG tubes taped to the top of my nose. I cannot even begin to understand why people do that. But I like to have it taped to my cheek as it is pictured.

 

NJ TubesNJ Tube

The exact same as an NG tube, but it continues down and into the jejunum. These are typically always used as feeding tubes, and generally for short term to determine if a permanent J tube would benefit the patient.

 

 

Central Lines

Central lines are used to both give IV medicines through, and to administer parenteral nutrition though. Parenteral nutrition is used when a patient is unable to absorb nutrients, and it bypasses the digestive system all together and goes directly into a major vein.

Central lines can cause a very high risk of infection. And when I say infection, I mean blood infection. Blood infections can go from bad to worse very quickly, and must be taken very seriously. Checking body temperature and looking for signs of flu like symptoms is crucial when living with one of these types of catheters.

Central lines require weekly (if not more often) dressing changes that are done with proper sterile technique. It is not recommended for them to be submerged in water, and you must be careful when showering to make sure your dressing is covered properly and is not wet once out of the shower.

PICC LinePICC line

Most are used for short term home IV situations. Whether it be for IV nutrition, antibiotics, etc. PICC lines are the easiest of central lines to place. They are usually placed in interventional radiology or by a specialized PICC nurse at the bedside. The PICC lines are inserted using fluoroscopy, ultrasound or electromagnetic technology. The ones I’ve personally had have always been place in the inner upper arm, but I’ve heard of people getting them placed in other places. Typically not out of want, but out of necessity. They are typically made of polyurethane, so pretty flexible, but not nearly as flexible as silicone. They range from one to three lumens. Lumens are what the separate little ports are called. In the picture shown, there are two lumens. You want to have as few lumens as possible, depending on your treatment plan, to have as little risk for infection as possible. If you only really use one, do your best to advocate that you only need one lumen.
They also are not tunneled into the body (outside of some of them being stitched in) like other types of central lines are. They are held in by what is called a stat-lock, that is basically a sticker with a little spot to lock the line into. So when doing a dressing change, you must be very careful, because the catheter can literally slide around, and potentially out. Especially when it comes to changing the stat-lock. Which is not great for long term use, but would be more than ideal for short term use (no pain in getting it out).
While I say these are short term, there was a point in my life where I really really liked PICC lines. Most people would say I am crazy for this, and now, I probably would too. But during this time, I had several of these types of lines that lasted up to a year. Which isn’t really all that short term, but in comparison to other types of lines, it really is. Also, most doctors wouldn’t be okay with a patient having a PICC line for up to a year.

PortsPort

Probably the most mainstream type of central line. They are embedded under the skin, it almost looks like a little peppermint candy is under the skin if the patient doesn’t have much on their bones. Then the little hub has a catheter that stems from it that goes into the heart. But in order to use this type of line, it must be accessed with a huber needle that goes into the port, through the skin that lays over the port, then a dressing goes over the huber needle to keep the field inside sterile. In the illustration shown, you can see a demonstration of a port about to be accessed. The port is the purple part that is shown under the skin, and the yellow “Safety Infusion Set” is the huber needle about to access the port. The huber needle has a catheter that stems down, and you use the end of that catheter to flush and infuse your medications into. The little photo on the right of the illustration is what an actual port looks like.
The majority of ports are placed in Interventional Radiology, and sometimes by surgeons. The patient is generally in light conscious sedation (twilight) where they don’t remember the procedure, and don’t feel anything, but aren’t completely out under general anesthesia. But like with everything, it depends on the situation. It requires about a one inch incision for them to be able to place the port under the skin. It also requires this same process to remove the port if and when that is needed.
The number one great thing about ports is that they do not always have to be accessed, therefore they are not always open for a line infection. Meaning you and your de-accessed port can go swimming, shower, bathe, etc. all with ease. Which is really super great! Unless you have to be accessed every single day.
These are generally placed on the upper chest. But of course have been place elsewhere. When I had ports, they liked to place them on my ribs, just right below where my bra band would sit. It was great, because no one could see it (I was in middle and high school at the time) but it was really not great when wearing a bra, it caused a lot of pain.

Hickman

Hickman
Illustration showing where the Hickman goes. This Hickman is a double lumen.

These lines are the old school way of doing a long term central line, and honestly, my favorite. They are typically placed by an interventional radiology team while you are under light conscious sedation. They are a white silicone tunneled catheter that is typically place in the upper chest. They also come with one to three lumens, it is important to only have as many as absolutely necessary.
They have a unique feature that is a Dacron cuff that is placed internally that embeds itself into the patient’s tissue that helps prevent germs from crawling up the outside of the line.
Another unique thing you can do with a Hickman is using ethanol locks. They are a flush that goes into the line while it is not being used to help prevent infection entering the line.
These catheters are also proven safe to go without a dressing. Though many doctors will advise against it, the cuff has been proven to eliminate the need for a dressing after it has embedded itself after several weeks after placement. This is not something I, or anyone else I know does. I’m just not quite brave enough. But if it came to it and adhesive allergies didn’t allow me to wear an adhesive dressing, this would actually be an option.hickman
Important note: If you are getting this type of catheter, make sure it is the right product. Lots of times IR will place what is actually a Power PICC line with a cuff on it and call it a Hickman. IT IS NOT. True Hickmans are made of silicone, and PICC lines are made of polyurethane. They are not the same. If it came down to it and you needed to use ethanol locks in your line, silicone is the only material that can handle the harshness of that alcohol. Polyurethane with eventually wear down and break and crack. Be firm about this if this is the actual type of line you want.

Note* These are all my own definitions of these tubes and lines in laymen terms. If you’d like further medically explained definitions, there are multiple sources out there such as medical institutions websites.