Patient Information Leaflet

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Patient Guide to Chyme Reinfusion Therapy

This leaflet answers questions you may have about chyme reinfusion therapy. It explains the process of having a tube inserted into your fistula or stoma and how chyme reinfusion therapy works. This leaflet outlines the benefits and risks of chyme reinfusion therapy. If you have any questions or concerns after reading this leaflet, please speak to your healthcare team.

 

What is Chyme Reinfusion Therapy?

Chyme (kaɪm) is the medical term for the brown/green/yellow fluid that comes from your fistula or stoma. It is the watery or pulpy liquid  you see in your ostomy appliance. Chyme is made up of all the food and fluids that you eat and drink, plus the digestive juices that your body adds to help breakdown food. Chyme keeps you hydrated, nourished, and your body functioning.

You have a fistula or stoma somewhere along your small intestine. This means chyme leaves your body earlier than expected and does not pass through the rest of your intestines where some of it would normally be absorbed. This puts you at higher risk of becoming dehydrated and malnourished.

Chyme reinfusion therapy is a treatment method for patients like you with fistulas and stomas. Chyme reinfusion therapy involves returning chyme from your ostomy appliance back into the rest of your intestines through the hole of your fistula or stoma. Returning chyme to your body gives the rest of your intestine the chance to absorb the valuable nutrients to keep you hydrated and nourished.

 

How Chyme Reinfusion Therapy Helps

Research shows that chyme reinfusion therapy has benefits for maintaining your gut health, keeps you hydrated and well-nourished, and better prepares your intestines for fistula or stoma reversal.

Performing chyme reinfusion therapy can:

  • Keep the remaining part of your intestine working and rehabilitated. Without chyme reinfusion therapy, it will start to shrink due to lack of use. Reinfusing chyme keeps your intestine healthy so that it will begin working immediately after your reversal surgery.
  • Rehabilitate your large intestine with healthy bacteria (microbiome) to help your body breakdown and absorb chyme.
  • Maintain the health of your entire digestive tract, keeping you hydrated. Chyme reinfusion therapy may reduce the need for intravenous (IV)fluids. Chyme contains electrolytes, such as salt, which will help keep your system balanced and reduces kidney damage.
  • Help you to have regular bowel movements again.
  • Reduce the amount of time you might spend in the hospital.
  • If you need IV nutritional support, reinfusing chyme encourages your liver to keep working, making digestive enzymes needed to breakdown food, reducing long-term liver damage.

Chyme Reinfusion Therapy Risks

You may experience some lower tummy discomfort. Because fluid and nutrients are entering the body again, your lower intestine is stretching open. Discomfort from bloating may last for 5-7 days. Pain can be minimised by reinfusing chyme slowly and using pain relief medication.

Chyme reinfusion therapy could cause an infection called Clostridium difficile (C. diff). This may occur in patients who have had a fistula or stoma for more than three months, where bacteria has been lying dormant for some time in their intestine. The infection is usually resolved with a short course of antibiotics. There is a very low risk of a C. Diff infection, and would happen without chyme reinfusion therapy when you are reversed.

Can I Decline?

It is your choice whether to use chyme reinfusion therapy or not. If you choose chyme reinfusion therapy, you will need to provide consent to your healthcare team to start this treatment. Choosing not to provide consent will not affect your overall treatment, and you will continue to receive expert care from your healthcare team. If you choose not to reinfuse chyme, then there are other treatment options available to you involving IV medications to keep you nourished and prepare you for reversal of your fistula or stoma.

Performing Chyme Reinfusion Therapy

Chyme reinfusion therapy can be done two ways: manually or with a medical device called The Insides® System.

If performing manual chyme reinfusion, a nurse will insert a tube into the downstream hole of your stoma. The chyme is taken out of your ostomy appliance, strained, and drawn up into a syringe. It is then syringed down a tube multiple times a day. The frequency at which the nurse needs to perform this depends on how much chyme you pass into your ostomy appliance and how often you would normally empty it.

Alternatively, chyme reinfusion therapy can be done using The Insides® System (explained below).

What is The Insides® System?

The Insides® System is a medical device that helps you perform chyme reinfusion therapy by yourself. The device is made up of three parts:

  • The Insides® Tube (Tube) is placed in your fistula or stoma’s downstream intestine by a healthcare professional and sits inside your ostomy appliance. The Tube is changed every month by your healthcare professional; otherwise, it remains in the stoma throughout refeeding. Although you will be aware of the Tube, it will not be uncomfortable.
  • The Insides® Pump (Pump) is a device that slides onto the end of the Tube and is replaced every 2-3 days when changing your ostomy appliance. The Pump sits submerged in the chyme in yourostomy appliance.
  • The Insides® Driver (Driver) is a handheld device that you use throughout the day to actively pump chyme from your ostomy appliance into the lower intestine through your fistula or stoma.

Using The Insides® System

The following information will guide you on what you to expect while using The Insides® System.

The First Week

It takes approximately one hour to set up The Insides® System and teach you how to use it. This can be done in a hospital, at home, or in a health clinic.

You will only use the device once or twice a day in the first week to minimise lower tummy discomfort, allowing your intestine to rehabilitate slowly. Your intestine has shrunk while it has been out of use. Putting your chyme down it again is like waking it back up. The first week is the hardest week due to this rehabilitation and it can be uncomfortable until you have had your first few bowel movements. You will discard all remaining chyme in your ostomy appliance into the toilet.

In addition to this, you will also be learning how to change your ostomy appliance with the tube in place. Your stoma nurse is there to support and help you modify how you change your ostomy appliance. Learning to chew your food more and avoiding overly fiberous food will also be a learning process. Please be reassured it does get easier after the first week!

Weeks Two and Three

You will likely have your first bowel movement by the end of your first week. By now, your body should be used to pumping chyme, and your lower tummy discomfort should be disappearing.

You should now be able to pump more often throughout the day. Pumping more often means you will have more bowel movements. Slowly increase the number of times you pump each day based on your comfort level. If you have questions about how much you should pump, speak with your healthcare team.

The Fourth Week

Your healthcare team should be visiting at the end of this week to change your Tube and see how you are doing. You should be feeling comfortable with the device, pumping more often throughout the day, and having regular bowel movements. Based on your progress, your surgeon and healthcare team will be able to tell you how long you will have The Insides® System for.

 

Preparing for Chyme Reinfusion Therapy

Your healthcare team will help with your care by providing The Insides® System for your treatment; they have been trained in how to use The Insides® System. Your healthcare team can provide you with the information needed to use The Insides® System safely and effectively.

To prepare for chyme reinfusion therapy using The Insides® System, you will need:

  • A positive attitude and commitment to your health.
  • To make some small modifications to your diet so that The Insides® Pump will work properly.
  • To chew your food well and drink plenty of water.

Notes

Use this area to jot thoughts or questions for your healthcare team.  

           

 

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