Okay, the can for Jevity 1.5 states that you need a PEG tube of at least 12 FR. Jevity 1.2 only requires 10 FR. I don't have access to a can of VHC and it may not even say - the bottles of Ensure Plus don't. So what is the minimum French (FR) Peg tube size to jump up to VHC or similar super dense "food"
The interventional radiologist implies it makes no difference that they gave me the 12FR instead of the 14FR I wanted, but my paranoia says bigger would have been better for clotting/clogging. I don't like to push back without a basis in fact. His exact words are below broken into a explanation and a specific reply to my overhearing the tech's apology
[quote]Your gastrostomy tube is a 12 Fr Wills-Ogelsby device as shown in the diagram below (the one at the TOP of the figure). It was placed on 3/6/09 using percutaneous methods rather than surgical methods and with fluoroscopic guidance rather than endoscopic guidance. At GT, and at many institutions around the country, 12 Fr or 14 Fr �Pig tail� retention type feeding tubes are frequently chosen as the initial device for placement, especially in patients with Head and Neck Cancer. One of the main reasons for this is that they can be safely placed without the need of passing an endoscope from the mouth, through the surgical site into the stomach. The larger feeding tubes (20 Fr or larger with balloon or mushroom type retention device) are typically placed using endoscopic methods which are sometimes more difficult in patients with Head and Neck Cancer and surgery. This is because the endoscope is larger and can cause trauma at the surgical site. [/quote]
[quote]

Regarding your concern about the comment you heard during the procedure, I would like to explain... Although I prefer to place the 14 Fr Mallinckrodt device over the 12 Fr Wills-Ogelsby device, this is mainly because I trained at Mallinckrodt and am more familiar with this device. In your case, the technologist had opened a 12 Fr Wills-Ogelsby device, and, based on clinical judgment during the procedure, I made the decision to leave the 12 Fr tube in rather than prolong the procedure by exchanging for a 14 Fr device. This will not cause any problems for you and I feel that it is much safer to exchange for a larger device once the tract has matured rather than to try to exchange a newly placed tube. [/quote]

You have to love the medical professions obsession with archaic, obsolete and plain idiotic terms (i.e. AUC) measurements.

Each unit of French size = 0.33 mm** (may be equal to one freedom size)
so a FR 12 is 4 mm (FR 14=4.6mm) (all that schooling finally paid off!!)
These are quite close and the area (more relevant) of the smaller tube is 75% of the bigger one.

If you are worried about clogging, depending on the viscosity of the Jevity you can always dilute it a bit with water and you will be fine. Also viscosity depends on temperature so you may warm of the stuff a little (probably a good idea anyway).
Re clogging. That happened to me several times but only because I did not blend the vegetables enough (fiber etc) ..... with enough pressure you can clean the tube, but it is s strange sensation + you may make a major mess if it does not work!

Since you are obviously more reasonable than me and are just using it for the intended purpose you should be fine.

Please note:
The pressure drop is more severe for longer tubes. They clog more easily. My PEG was way too long and I trimmed it. (please ask your physician)

Finally:
Size matters, and so does the length of the PEG

Markus

** from the web

Where does Markus learn all this stuff he passes on to us? Man we are so blessed to have some great knowledgeable posters on this one site. JM2C's

Aside from the difference in size (I don't know the Freedom size, but my crappy PEG is actually small enough in O.D. to fit inside the I.D. of the good PEG), the crappy PEG was tapered on the end with only a tiny hole in it, the food being delivered through "gouged" holes in the side. Stuf would clog at the end, then back up past each of the hole in turn until the last was reached. Even successful cleaning would then only open one hole...

OTOH, my larger PEG is effectively just a plain tube, open at the end, although the attachment fittings at top of each kind reduced the ID quite a bit.

In addition to that, there was string running down the center that had something to do with either installing it or cleaning it, but also took up valuable space inside the tube.

I had the good PEGs installed PRIOR to the radiation and the free flap surgeries, whereas the crappy PEG was installed post-surgery, so the Doc's comments re: endoscope are valid, but better planning would have paid off, esp because that surgery was on mobile tongue, not throat.

I did some close looking at my previous crappy PEG and my current work-horse PEG. Here are some things I learned.

1. The French size apparently refers to the *outer* diameter, not the inner; My Good PEG is 20 French, 6.6mm, which computes to slightly larger than 1/4" and that's what it is on my ruler (Plus, it fits into the 17/64" hole in my drill index, one size up from 1/4") -- My Bad PEG is 12 French is 5/32", slightly less in calculation, fits that hole in drill index. The 12F is actually a loose fit into the F20.

2. The inner diameter can be affected by tubing wall thickness; my 20F PEG is 3/16" inside and the 12F is 3/32" inside -- This means the area of the F20 is *four* times that of the 12F, despite slightly thicker wall.

Both, of course, are reduced by fittings, the 20F more than the 12F, with slightly more than 7/64" (2.78mm or 8.4F).

I am having no problems feeding Nutren 2.0, which is pretty dense at 500 cal/can with pump or syringe through the 20F; I haven't tried it on gravity feed. OTOH, pumping with syringe was a chore with the 12F; no way gravity would have worked.

3. The 20F also sez "traction removable", about which Wiki sez "PEG tubes with a deflatable bumper can be removed simply by pulling the PEG tube out through the abdominal wall once the bumper has been deflated (traction removable PEG tubes or "button" PEG tubes)." The 12F has no bumper on the end, in fact it is tapered for easy placement, and seems to rely on length and some curvature to hinder unintended removal.

http://en.wikipedia.org/wiki/Percutaneous_endoscopic_gastrostomy

Thank you Pete for confirming my opinion that my 12 FR PEG is "crappy" and "bad" with serious problem potential. My ENT yesterday said she is considering having a "good" one put in of at least 20 and maybe even 24 once I start to heal. She is concerned that when I get the additional 5 CyberKnife radiation treatments on top of my already so called maximum of 72GY that I had burned into me, I may need the PEG longer than I thought. We will of course not be having that PEG procedure done at Georgetown University Hospital, home of the PEG butchers, although I may have to get CyberKnife there BUT only on an outpatient basis and with witnesses present.

The trick is to get it done by endoscope *before* the new treatments so you get around the problems described by the radiation doc. You want to be going to a Gastro Doc.

making an appointment tomorrow with a gastroenterologist

I took the info from my sizing, using Markus's .33mm, plus the quotes from GT's PEG guy, and passed them on to my CCC at UW so they can consider getting PEG done *before* surgery -- Not only results in better PEG, but in my case it did away with the need for a Naso-Gastric Tube and some in-hospital PEG blockages.

whoa...he said, "size matters" hehehehehe...

sorry...it's my Beavis and Butthead days coming out...

Charm--you seem to be doing well...you are a CHAMP!!