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cocoa

NG tube risks: notification of first responder and ER doc

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Hi Dr. Callery,

Your response on a previous question has me curious. I am 8 years post-op Lap Band, done by you (waves!). You stated that an NG tube placement must be done with care. Do you recommend we carry a wallet card or wear a medical alert bracelet notifying ED teams that we have had surgery or are banded? Or would quick placement in an emergent situation be more critical?

Thank you for your time,

Denise

Me before and after, face.jpg

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Dear Cocoa,

Good to hear from you and to know that you are doing well after all of these years.

It's always a good idea to carry a wallet card that states your medical conditions, medications, medication allergies, and previous surgeries. I'd place it with your insurance card so that in the event of a real emergency, the hospital folks will be sure to see it. :)

NG tubes are riskiest for GBP patients. The tube can potentially perforate the stub of small bowel near the gastrojejunostomy. Misplacement or perforation can be avoided if the NG tube is placed under x-ray guidance (flouroscopy). Sleeve and lap band patients are much less vulnerable, but there is still increased risk in certain circumstances. If the cause of the vomiting is a lap band slip, the tissue that has slipped up through the stomach can become thinned out and weakened under certain circumstances. The tube could go right through it. Likewise, if a sleeve were twisted or "corkscrewed", the tube could be pushed through the wall of the stomach.

So if you have to go to the ER because of repetitive vomiting, discuss your stomach surgery with the ER doctor. I would be sure to speak with the physician about this, not just the nurse or assistant. Let him or her know about your concern about stomach perforation. Suggest that either he or she pass the tube or have the radiologist do it under flouroscopy.

Hope this is non-issue!

Happy New Year,

Dr. Callery

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