Our Services – Gastric Tube Changes

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VCU Health at Baird Vascular Institute is a multi-disciplinary collaboration of interventional radiologists and vascular surgeons. By working in tandem, we can use the most advanced imaging technology to give us the fastest, clearest picture of a patient’s peripheral circulatory system and vascular problems and diseases, pointing us precisely to the right diagnosis and treatment plan and procedures.

It also allows us to provide services outside those of a traditional vascular practice. We can treat the pain of plantar fasciitis and other tendon injuries, place IV ports for long-term care or dialysis, or treat painful, sometimes debilitating, varicose veins. And as a division of VCU Health, we partner with our colleagues at VCU Health Medical Center to refer patients whose conditions require higher levels of care.

We also perform gastric tube changes here in our office – a service we haven’t written much about.

We spoke with Nancy Lang, a member of Baird Vascular Institute’s nursing team about gastric tube changes and what’s involved for the patient.

What is a gastric tube change? For patients that have a gastronomy tube (more commonly referred to as a feeding tube), about every 3 or 4 months they must come in to have the tube changed because it gets clogged or starts leaking. When the feedings become slower going in or the patient is seeing some leaking around the tube, that’s a sign that it’s time for the tube to be changed. Occasionally, a tube will get accidently pulled out and folks have to come in to get it reinserted.

Who needs this service? A feeding tube can be required for several medical conditions, some short term or others that are long term – depending on the patient’s medical needs. Some folks are undergoing radiation treatments and unable to eat solid food. Some people are unable to perform the function of swallowing. Sometimes patients are paralyzed and food doesn’t move through their system very well, so they also require a feeding tube for nutrition.

How long does it take? A gastric tube change is a very quick procedure. The patient comes in and the staff takes their vital signs, the doctor then explains the procedure, then the patient signs a consent form.  Next, the patient is taken back to a sterile procedure room, the staff cleans the area and drape the patient. The physician inserts a wire into the current tube and removes current tube. After the physician gets the tube out, that leaves the wire, and then they insert the new tube over the wire and inflate the tube. An X-ray machine is used during the procedure to guide the insertion process.

Is it painful? The process is not painful. Some people are irritated where the tube has been rubbing, so if the patient is irritated or sore, the physician will use a little numbing medication. Some patients that have had their tube for a long time don’t need to be numbed, it greatly depends on the patient and their tolerance for irritation or minor pain.

What should I know before coming in for a gastric tube change? We generally ask you to not eat for about 4 hours before procedure so that the stomach is empty before the tube is changed. After the tube is changed you can resume normal feeding and daily schedule.

Why is Baird Vascular Institute a good provider for this service? Here at Baird, we have the x-ray equipment right here in the office. Of course, the procedure can be done at the hospital, but it’s a lot more convenient for the patients to come here. We have free, convenient parking, and most of the time we are right on schedule because we’re a small facility. Here, the same nurse stays with the patient before during and after the procedure, so there’s very little waiting – and the patient gets a little more individualized care.

For more information regarding gastric tube changes or any of the other services that are offered at the VCU Baird Vascular Institute, feel free to call 804.828.2600 or visit us on the web at http://www.vcuvascular.com.

What is a DVT?

Baird IVC Filter

Many of the terms that are used when describing vascular diseases and conditions can be very confusing, especially for those seeing them or hearing them for the first time. We make every effort to explain your diagnosis and recommended treatment options as clearly and understandably as possible, but during your visits or while reading our website or doing research, you may come across new terminology.

One condition we haven’t talked at length about is DVT, or deep vein thrombosis. Deep vein thrombosis is a blood clot that usually forms in the extremities (arms or legs) and if untreated, the clot can break off, travel through your bloodstream and lead to a pulmonary embolus, or blood clot in the lung. This is a very serious and potentially life-threatening condition that may require immediate medical attention. Symptoms of DVT include swelling of the affected arm or leg, pain or tenderness, and warmth in the area. If any of these symptoms are noticed, it is crucial that you seek medical advice immediately. However, it’s also possible that a DVT can occur with no symptoms. Usually, a vascular ultrasound is used to determine if a DVT is present or not and will be ordered by your health care provider. If detected, a DVT can be treated medically with anti-coagulants (i.e. “blood-thinners”) and in some severe or urgent cases, through invasive procedures to remove or dissolve the clot.

According to the Mayo Clinic, “deep vein thrombosis can develop if you have certain medical conditions that affect how your blood clots. It can also happen if you don’t move for a long time, such as after surgery or an accident, or when you’re confined to bed.”

There are some practical steps that you can take to help avoid the likelihood that you will develop a DVT.

  • Maintain a health weight – being overweight will tend to increase your risk for developing DVTs
  • Keep moving – exercise regularly and stay active.
  • Avoid long periods of remaining still.
  • Wear compression socks or stockings that are designed to enhance blood flow.

DVT is also associated with other vascular issues such as varicose veins and peripheral vascular disease. If you have varicose veins, they may also be a sign of a blockage in deeper which is DVT.

We have the latest in technology, techniques and medications to treat vascular disease, ease your pain and help you get back into good health. Call us at (804) 828-2600 to discuss your options.

What are the risks of an IVC filter?

baird IVC filter risk

One of the services we offer our patients is IV filter placements. Inferior vena cava (IVC) filters are small metal devices placed in patients at risk of developing blood clots or deep vein thrombosis in the legs or pelvis; the clots can break off and cause pulmonary embolism, the lodging of an embolus, such as a blood clot, in the lungs. Your doctor may recommend an IVC filter for conditions such as deep vein thrombosis (DVT), pulmonary embolism, trauma immobility or recent surgery or childbirth.

Recently, IVC filters have been a topic of conversation on whether they’re safe or not. We talked to Dr. Brian Strife about IVC filters and here’s what he had to say.

“IVC filters have been placed for the last several decades, developed initially in the 1960’s,” he said. “Originally, they were designed as permanent devices, meaning the filter would be placed in the patient’s vein, and it was designed to remain in place for the life of the patient.”

In the last few years, retrievable filters were developed. They have a hook or some other component to the filter where a physician could grab it and remove it. “Over time, what we learned is that some of these filters were prone to develop problems in a very small number of them,” said Dr. Strife. “The problems included migration, or movement of the filter, fracture or breaking of the filter, and then clotting of the filter.” Those are the 3 main complications that we often hear about with inferior vena cava filters.

“When the filter itself develops a blood clot,” he continued, “it can block the main vein, the IVC, this can lead to significant pain and swelling in the lower extremities. Also, the filters themselves, being made out of metal, over time the metal can stress and fatigue. The filter can break, pieces of the filter can migrate into the patient and damage adjacent organs. Very rarely, pieces of the filter can break off and go to the heart and lungs.”

The filters, whether they are permanent or retrievable types, are meant to stay in the patient for a long time. The filters are made out of stainless steel or some kind of metal alloy that is designed to withstand years of being inside a human body. It’s a rare occurrence that the filters have any problems at all.

“Although these complications are extremely uncommon,” said Dr. Strife. “It is a source of patient anxiety and we often receive a number of phone calls from patients asking if they should have their filter removed to avoid these complications.”

“In 2010, the FDA recommended that physicians who placed these filters, and physicians who follow patients with these filters, make an attempted to consider IVC filter retrieval when the filter is no longer needed,” he continued. “Sometimes that’s a tough question to answer, because we don’t necessarily know which patients are best suited to have a filter in for the rest of their lives. When a patient calls our office and says ‘I have an inferior vena cava filter and I’d like to have it removed,’ we typically have the patient come in for a consultation, discuss why they have the filter in the first place, and try to make an informed decision on whether retrieval is appropriate for them or not. Sometimes, that’s a very easy question to answer, sometimes we need to do additional tests and consult with other physicians before making that decision.”

If you need an IVC filter, our would like to talk to us about one you currently have, call us at (804) 828-2600 to discuss your options.

Conscious Sedation

baird conscious sedation

One of the first questions that our patients ask us when they are scheduled for a procedure is, “Will I feel pain?” This is an understandable concern for someone getting ready to undergo a minimally invasive procedure, especially if it’s their first time having a medical procedure performed. Minimizing pain and discomfort is one of our primary concerns here at BVI. We want to do everything possible to ensure that our patients have a positive experience during their visit which is why we use conscious sedation during many of our procedures.

What is conscious sedation?

Conscious sedation is when a combination of medicines is administered to help you relax (a sedative) and to block pain (an anesthetic) during a medical procedure. Conscious sedation is safe and effective for people who need a minimally invasive procedure. Here at BVI, these medicines are given through an intravenous line (IV) by one of our nurses under the direct supervision of a physician. You will begin to feel drowsy and relaxed very quickly. You may fall asleep, but you will wake up easily to respond to people in the room. You may be able to respond to verbal cues. You will be monitored throughout the entire procedure by our medical team to make sure that your blood pressure, heart rate and oxygen levels stay within safe limits.

The medicine will wear off quickly and recovery after the procedure is generally very fast. After conscious sedation, you may feel drowsy and not remember much about your procedure including any associated pain. Afterwards, you will feel sleepy and may have a headache or feel sick to your stomach. During recovery, your finger will be clipped to a special device (pulse oximeter) to check the oxygen levels in your blood and your blood pressure and heart rate will be monitored. You should be able to go home 1 to 2 hours after your procedure.

Is conscious sedation the same as general anesthesia?

No. General anesthesia (also known as deep sedation) is when you are administered drugs that put you in a totally unconscious state. Under general anesthesia, you have no awareness of the procedure or your surroundings at all. General anesthesia is usually reserved for more complex and lengthy procedures or when your provider deems in necessary. General anesthesia also comes with higher associated risks. Only licensed anesthesiologists or nurse anesthetists are able to administer general anesthesia. Recovery times are usually longer than conscious sedation and may present more unpleasant side-effects. BVI does NOT use general anesthesia.

Before the Procedure

Be sure to tell us if you are or could be pregnant. We also want to know what medicines you are taking, even drugs, supplements, or herbs you bought without a prescription. A day or two before the procedure, one of our nurses will contact you to go over pre-procedural instructions. This generally includes:

  • Not eating or drinking six hours prior to the procedure
  • Be sure to have someone accompany you to the procedure. You will not be in any shape to drive home
  • Discussion of any lab work that will be required prior to your procedure
  • Arrive at the time instructed

You will be given an instruction packet with more detailed information prior to your procedure. And as always, if you have any questions you can give us a call at (804) 828-2600 to talk with one of our providers. Conscious sedation is a safe and effective way to minimize pain and anxiety for our patients.

4 questions you may have about ports

VCU Health Baird Port

Many conditions, such as cancer treatment, long-term IV medication or kidney dialysis, require frequent or constant access to your veins. Repeated needle sticks in the same area can be hard on you and hard on your veins. That’s why we specialize in placing vein access ports, so that doctors don’t have to stick you with a needle or restart an IV line every time you need treatment. That makes care easier — and your life easier.

For long term IV access, placing a semi-permanent catheter such as a “port-a-cath,” chemotherapy port or IV access port into a large vein in the upper arm or neck can make treatment easier for patients undergoing treatments that require frequent or constant vein access such as:

  • Chemotherapy or anti-cancer drug infusions
  • Hemodialysis
  • Long-term intravenous antibiotic treatment
  • Long-term intravenous feeding
  • Repeated drawing of blood samples

Unlike most other types of catheters, a port-a-cath is implanted completely underneath the skin. This type of port allows you to bathe and swim without the risk of infection. Port-a-caths can remain in place for months or even years.

If you’ve been told you need a port, you may have questions – here are 4 questions people want to know.

Is having a port painful? Having a device implanted under your skin can seem frightening to many people as is concern for ongoing pain. As with any medical procedure, you can expect some pain after the insertion, but ongoing pain is minimal, and relative to each individual patient’s level of pain tolerance. We talked to Dr. Shep Morano about ports. “You’ll notice that you can see and maybe even feel the reservoir of port area under the skin,” said Dr. Morano, “you can also sometimes feel and see part of the catheter as it runs over the clavicle and into the vein into the base of the neck.” For most people, he continued, “They don’t even notice the port after a while, it just becomes part of their body and it doesn’t bother them or even notice it that much.”

What is a cancer port pillow? A cancer port small pillow with a strap is sometimes used to cover seat belts, purse handles, cross body bags, or other straps that may rub against the port. They can be handmade or found at several online retailers.

Can my port get infected? Just like any other medical device, certain precautions must be taken to care for your port. We wrote a blog post a while back on port care, but the best thing to remember is follow the instructions from your physician and care team, and be sure to contact us if anything seems out of the ordinary.

What is a cancer port tattoo? When we went to research questions related to ports, a cancer port tattoo was something that was frequently searched online. Like many life experiences, some people commemorate their cancer journey through body art like tattoos. A cancer port tattoo is simply a tattoo that uses artwork to cover or minimize the appearance of the scar where the port was placed. Whether or not to have one is a deeply personal choice, but many cancer survivors view their tattoo as a badge of strength, or a symbol of renewal and hope.

If you need a port, or have questions, call us at (804) 828-2600 to discuss your options.

Could I be at risk for PAD?

Baird PAD risk

Vascular diseases range from diseases of the arteries, veins and lymph vessels to blood disorders that affect circulation. Among the most common types of vascular disease are peripheral vascular disease (PVD), peripheral artery disease (PAD) and coronary artery disease. The terms peripheral vascular disease and peripheral artery disease are often used interchangeably, but we discuss both here. Many of the problems we diagnose and treat involve peripheral vascular disease in one degree or another.

The most common type of peripheral vascular disease (PVD) is peripheral artery disease (PAD). Like the blood vessels of the heart (coronary arteries), your peripheral arteries (blood vessels outside the heart) also may develop atherosclerosis. Over time, the plaque buildup narrows the artery, causing increased pressure in the blood vessel. Eventually, the inside of the artery narrows so much that it restricts blood flow and less oxygen is delivered to the tissues, causing a condition called ischemia, an inadequate supply of blood that causes tissue damage.

If a fragment of this plaque from any part of the body breaks loose and clogs one of the arteries supplying the heart itself, the result is a heart attack. If a fragment breaks and blocks an artery going to the brain, a stroke will result. Narrowing of the arteries that supply the kidneys with blood can cause high blood pressure and kidney failure. Any tissue that does not have an adequate supply of blood and oxygen will, over time, become permanently damaged and die. That it is critical to diagnose and treat peripheral vascular diseases before it becomes a more serious problem.

In the early stages of PAD, symptoms include cramping and pain in the legs and buttocks, indicating poor circulation in the legs. Other common symptoms include fatigue, heaviness and discomfort during exercise or activity. These symptoms generally go away when the activity stops or you are resting. This is called “intermittent claudication.”

PAD affects about 8 million Americans. Atherosclerosis can start as early as the age of 20, and becomes more common as one gets older. By age 65, about 12 to 20 percent of the population has some degree of vascular disease. The exact cause is unknown, but several risk factors are known to accelerate the formation of fatty deposits, or plaque, in the arteries:

  • Smoking
  • Family history of vascular disease, angina, heart attacks or stroke
  • Being overweight
  • An unhealthy diet
  • Lack of exercise
  • Diabetes
  • Being male
  • High blood pressure
  • High cholesterol levels
  • Stress

Early diagnosis is critical, as people with PAD have a four to five times higher risk of having a heart attack or stroke. Unfortunately, PAD often goes undiagnosed as symptoms are often mistaken for something else.

If you want to learn more about peripheral vascular disease (PVD) and treatment options, wish to discuss symptoms or problems you may be experiencing or if your doctor has recommended that you see us for a vascular test, please contact us at (804) 828-2600 or email us.

How we can help with your overall health

Baird overall health

There are 60,000 miles of blood vessels in the body.
Pointing us toward a lot of answers.

VCU Health at Baird Vascular Institute is a multi-disciplinary collaboration of interventional radiologists and vascular surgeons. By working in tandem, we can use the most advanced imaging technology to give us the fastest, clearest picture of a patient’s peripheral circulatory system and vascular problems and diseases, pointing us precisely to the right diagnosis and treatment plan and procedures.

Because of our advanced diagnostic imaging capabilities and convenient location, many physicians refer patients to see us for outpatient evaluations and preparation for various surgical procedures that must be conducted in the hospital, as well as for follow-up examinations. Seeing us as an outpatient saves you many trips to the hospital – and leads to a shorter hospital stay.

Whether you’re referred to us by your doctor or want to talk with us directly about your concerns and needs, our physicians are always available for consultation appointments to listen, learn and talk about your condition and what we can do to help. Open and clear communication with your doctor and you is a crucial aspect of providing proper treatment and care. We work as a team.

Before your appointment, take a few steps in advance to make sure we have the best background information. During your consultation, we’ll talk through your concerns, review your medical history and make an assessment of your current situation. Once we make our diagnosis, we discuss different options to develop a treatment plan tailored to your individual needs. We make sure you understand every aspect of your care.

Our capabilities also allow us to handle the primary treatment of a number of other conditions that once often required prolonged hospitalizations. Today, our image-guided expertise makes possible primarily outpatient care of these conditions. Depending on the condition, certain procedures are handled at the hospital; in other cases, however, these conditions can now be handled completely on an outpatient basis – without a single hospital visit.

Making an appointment at the VCU Health at Baird Vascular Institute is quick and easy. We try to accommodate patients and referring physicians as efficiently as possible.

To schedule an appointment call (804) 828-2600 to speak to one of our scheduling associates, or send us an email.