Jejunostomy tube

A feeding jejunostomy tube, also called a J-tube, is a tube inserted through the abdomen and into the jejunum (the second part of the small bowel) to assist with feeding and to provide nutrition.

Indication
A feeding tube is placed for the patient who is unable to take in enough food or drink through the mouth to maintain body weight. Most people who receive a J-tube are those who have trouble digesting food or emptying their stomach, aspirate food into their lungs, or have pancreatic disease.

What happens after the procedure?
After the procedure, an antibiotic ointment is applied to the tube site, and a dressing is placed over the tube. An abdominal binder is applied to protect the tube. Then you will be taken to your hospital room.

• The nurse will give a report to the nurse on the floor taking care of you.
• A dietitian or floor nurse will discuss with you how to use your tube for feeding, how to use a feeding pump, how to take care of it at home, and what feeding solution is the best for you at that time.
• Tube feeding is started by your primary care team once you have met certain goals after surgery.

Checking, cleaning, dressing and securing the jejunostomy tube

• Checkthe skin around the tube daily.
  • Look for skin redness (greater than ½-inch around the tube).
  • Look for drainage or leaking.
  • Look for swelling or cracked skin.
  • Check for pain or discomfort around the tube.
• Cleanthe skin around the tube daily and anytime there is leakage around the tube.
  • For the first four to six weeks after a J-tube is put in, bath water should not be so deep that the tube is under water. Shower water should fall on your back only. Ask your doctor if you can bath or shower normally after four to six weeks.
  • Wash hands before and after cleaning the jejunostomy site.
  • If dressings are used around the tube, these must be removed and discarded first.
  • Use a clean wash cloth or cotton balls to wash the skin around the tube with a mild soap and water.
  • Clean the tube with soap and water at this time also.
  • Use cotton tip swabs to clean hard-to-reach places.
  • Rinse skin and dry it well.
• Dressingthe jejunostomy tube
  • J-tube sites that are healed and not draining may be left open to air.
  • For the first few days after placement and if there is any drainage, you will need to cover the area with a dressing. Your nurse will teach you how to change the dressing.
• Securethe jejunostomy tube
  • A tube that is left hanging will pull on the tract. Over time, this can injure the tract and the inside of the intestines. There are several ways you can secure the jejunostomy tube:
    • Tuck the tube gently into clothing.
    • Make a tape tab on the tube, then pin through the tape tab to the inside of clothing.
    • Use paper, micropore, or other tape that is not ‘gummy’ to tape the tube to the skin barrier or dressing.

Using the J-tube for feeding
Feedings through a J-tube are always done using a feeding pump. A visiting nurse or home care company will help arrange for your feeding pump and instructions on how to use the pump at home. They will also be available to assist you in caring for your tube at home.

Flushing the J-tube
To reduce the risk of tube clogs, always flush with lukewarm water:

• Before and after each intermittent feeding
• Before and after giving any medicine through the tube
• Every four to six hours if feeding is continuous
• Whenever feeding is interrupted
• Every day if the J-tube is not being used

Your nurse will tell you how much water to use.

Medicines through the J-tube
If you are giving medications through the J-tube, it is very important to flush the tube with 30 cc water between each medicine and after the last medicine. You do not want the medications to mix with each other or mix with the feeding in the tube. This may cause your tube to become clogged.

• Use a liquid form of the medicine if possible. If you must use solid medicines, be sure to crush them finely and mix with water. If in doubt, ask your pharmacist if your medicines can be crushed.
• Never add medicines to a tube feeding formula. Use a syringe to add the medicine directly through the feeding adapter.

Dealing with problems

• Tube accidentally falls out
  • Cover the abdominal Jejunostomy site with a clean gauze pad. Call your surgeon immediately to arrange for a new tube to be placed.
• Tube clogs
  • If the tube becomes clogged alternate between flushing with water and aspirating with the syringe. (Aspirating with the syringe means to pull back the plunger on the syringe while it is connected to the feeding tube.) Call your home care nurse or surgeon if the tube remains clogged after 4-6 attempts over an hour’s time.
• Connection problems
  • If the tip of the feeding set does not stay securely in place in the feeding tube, use a cotton tip swab moistened with water to “scrub” the inside of the feeding tube adapter. This helps to remove oils that build up. Make sure the tip of the feeding tube set is also clean.
  • Check the feeding tube adapter for wear and replace if necessary. You may also try taping the connection. Call your home care nurse if these steps do not help.

When do I need to call the doctor?
If you have a problem with your tube, refer to the chart below.

Problem	Action
Fever or chills Redness or swelling around the tube site Bleeding through or around the tube.	Call your doctor immediately for advice. Go to the Emergency Department or Urgent Care if you cannot reach your doctor.
Hard abdomen or abdominal pain	Call your doctor for advice.
The tube becomes dislodged or clogged (tube will be hard to flush) Leaking around the tube site	Call your doctor immediately. Dislodged tubes must be replaced quickly (within 1-2 hours) or the hole will close up. Clogged tubes are not usually an emergency but will be replaced as quickly as possible on the next working day.