Caring for Your J-tube
What is a Jejunostomy?
A jejunostomy is a procedure that creates a small opening through the outer abdomen into the small intestine (jejunum). A thin tube placed through this hole is called a J-tube. It allows fluids and feedings to be given into the small intestine.
Cleaning the J-tube Site
The J-tube needs to be cleaned daily to prevent infection. For the first 3 days after the tube is placed, clean the skin around the tube with normal saline (see below) and then let air dry. After 3 days, you may simply shower and let the water run over the skin where the tube enters your body. If you can’t shower, keep cleaning with saline or water and swabs using the these steps.
1. Gather all supplies needed: 4x4 split gauze and tape, cotton swabs, and normal saline
2. Wash hands well with soap and water for 30 seconds.
3. Open the sterile 4x4 split gauze and sterile Q-tips®.
4. Remove the old dressing. Place the old dressing in a plastic bag and throw away.
5. Check the skin around the site for signs of infection. These may include
- The site is more tender and painful.
- Increased redness or swelling.
- Drainage that is green in color or foul smelling.
- Sutures (stitches) at the J-tube site that have come loose.
6. Clean the site with the sterile Q tips and normal saline. Dry.
7. Place the sterile split 4x4 gauze dressing on the skin under the tube.
8. Secure the tube by taping it on your stomach. This helps prevent the tube from being pulled out.
What to Feed
Formula Name: ____________________________________________________
Name of Manufacturer: ______________________________________________
Name of Equivalent Products __________________________________________
Total amount of formula per day ______________________________________
Total amount of water per day: _______________________________________
Additional
Vitamins/Minerals/Supplements: ______________________________________
Once opened, cans of unused formula should be covered, dated, and refrigerated. If it is not used in 48 hours, throw it away.
When to Feed
Give _____________ cans/ml at ____________ ml ____________ times per day.
Flush the tube with ___________ ml of water promptly after each feeding is complete.
When to Delay Feeding:
If you feel full, have nausea, or cannot flush your tube freely, try again in one hour. If this does not help, call your doctor.
Supplies:
- Tube feeding formula
- 60 ml catheter tip syringe
- Water for flushing before and after feedings
- Pump stand or IV pole
- Feeding pump with feeding bag
| What to Do | Why |
| 1. Wash hands with soap and warm water for 30 seconds | Helps remove germs and prevent infection. |
|
2. Flush the tube with 15-30ml tap water. |
Flushing before feeding helps you check to be sure the tube is open |
| 3. Give the new feeding at room temperature | Cold feedings can cause intestinal cramps. |
| 4. Fill feeding bag with supplement | |
| 5. Remove air from tubing, clamp the tubing and pour food into feeding bag. Open clamp and let food fill tubing. When it reaches end of tubing, reclamp. | Prevents extra air from entering the intestine with feeding. |
| 6. Connect the tubing to the J-tube and pump. | |
| 7. Start the pump and check the rate. | |
| 8. Do not lie flat during the feeding or for one hour after. Use a couple of pillows to keep your head up at least 30 degrees. | Helps to keep feedings from being inhaled into your lungs. |
| 9. When feeding is done, flush the tube with 15-30ml of tap water, as soon as feeding is complete. | Prevents clogged tubes |
| 10. Clean your supplies by rinsing the syringe and bag with cool water. Then swish with warm water and a small amount of liquid dishwashing soap. Rinse well. Hang to dry. Replace the feeding bag every 3 days and the syringe once a week. |
|
Giving Medicines
Only liquid medicine can be placed through your J-tube. Flush the tube with 30 ml of water before and after giving the medicine.
- Crush all medicines in pill-form and mix with 30-50mLs of warm water. Your pharmacist should tell you which ones can be crushed and which ones cannot. All crushed medicines may be mixed with any liquid medicines. Check with the pharmacist before mixing any medicines.
- Use the plunger syringe and draw back at least 30 mL of water. This is the “flushing stage,” remember that you must flush the J-tube before and after giving any medicines.
- Remove red cap from three-way stop cock and insert plunger syringe into opening.
- Turn “off” knob on the three-way stop cock towards the blue attachment piece.
- Inject the water into the J-Tube and then turn the “off” knob towards the patient.
- Turn knob back to the starting position. Remove plunger syringe.
- Draw back the mixture of crushed medicines, liquid medicines (if applicable), and water solution into the plunger syringe. Make sure it is mixed well with the water prior to injection.
- Attach the plunger syringe into the opening again.
- Turn “off” knob towards the blue attachment piece and inject the medicine solution into the J-tube.
- Turn the “off” knob back towards the patient and remove the plunger syringe. If there is more medicine to give than the plunger syringe can hold you may repeat steps 7-10 as needed.
- Draw back 30mL of water into the plunger syringe to flush the J-tube again.
- Reattach plunger syringe into the opening.
- Turn “off” knob towards the blue attachment piece and then inject the water.
- Turn the “off” knob back to its original position or towards the patient if nothing else is to be given, or towards the “red cap” opening if tube feedings are running.
- Replace the red cap back onto the three-way stop cock opening.
Congratulations! You are done!
Common Problems
1. Blocked tube
2. Excessive leakage around the tube
3. Redness around the tube
4. Bleeding around tube
5. Stitches come loose or tube falls out
6. Tube is punctured or torn
7. Noticing blood
8. Vomiting
9. Diarrhea
10. Dehydration
11. Constipation
1. Blocked tube
- Gently flush the tube using 15 ml of warm water. You may need to flush and pull out the water many times until the tube will flush. Prevent blockage by always flushing tube with 30 ml water after feedings, before and after medicines. If you cannot unclog your tube, call your doctor.
2. Excessive leakage around the tube
- Call your nurse or doctor.
3. Redness around the tube
- Keep the skin around the tube clean and dry. (Some redness is normal, but moisture can irritate the skin and lead to an infection.)
- Clean the skin around the site more often using plain water.
- Keep irritated areas open to air if possible.
- Ask a nurse about other ways to fasten the tube in place.
- Call the nurse or doctor if you see signs of infection (redness, swelling, rash, greenish drainage).
4. Bleeding around the tube
- If you notice more than a few drops of blood, call your doctor or nurse.
- Keep the tube taped or secured tightly to your skin to prevent accidental pulls that might cause injury.
5. Stitches come loose or tube falls out
- If the tube falls out partly, or all the way, do not try to push it back into the opening. If you can, secure the tube with tape.
- Call your doctor right away or go to the closest Emergency Room. You will need to have the tube changed or replaced.
6. Tube is punctured or torn
- Clamp the catheter (or seal with tape), close to your skin. Call your doctor right away or go to the closest Emergency Room.
7. Bleeding
- If you cough up blood, see 50 cent-size blood clots coming from the J- tube, or see blood in your stool, call your doctor.
8. Vomiting
- Because vomiting causes the loss of body fluids, salts, and nutrients in the body, call your doctor or nurse if it doesn't stop.
- Do the feeding in an upright position with the head of the bed raised 45 degrees.
- Try smaller feedings more often. Make sure total amount for the day is the same. The type of the formula may need to be changed.
- Infection may cause vomiting. Be sure equipment is cleaned well and rinsed between feedings. Wash your hands after contact with persons who are ill. This helps prevent the spread of infection.
- Other causes of vomiting might include food intolerance, side effects of medicine, too much formula at one time.
9. Diarrhea
- Diarrhea means frequent, loose, watery stools. Looser stools may be normal with certain types of formula. A few loose stools in a 24-hour period are not a problem.
- There are many causes of diarrhea when on tube feeding. To avoid some of these problems:
1. Do not hang feedings for longer than 8 hours.
2. Give the tube feeding more slowly.
3. If the diarrhea does not stop after 2 or 3 days, call your doctor.
10. Dehydration
Vomiting, diarrhea, a fever and sweating cause the body to lose fluid. You may no longer get thirsty so you must be very careful to note the signs of dehydration. If you have any of the following, call your doctor to find out how much and what kind of extra fluid to give at these times.
- Decreased urine or darker colored urine
- Crying with no tears
- Dry skin that has no recoil when squeezed
- Fatigue or irritability
- Weight loss
- Dizziness
- Dry mouth and lips
- Sunken eyes
- Headache
11. Constipation
- Constipation may be due to not enough fluids, lack of fiber in the diet or a side effect of medicine.
- This is common in the elderly or those who are less active.
- If you have chronic constipation, call your nurse or doctor, they may have you give extra water or change your formula. (Always check with your doctor before giving extra water.)
Common Questions and Answers
Is there anything special I should know about traveling?
Remember to take all the supplies needed for feeding: pump, pole, syringe, formula, tubing, bottled water, tape, etc. Opened formula can be stored in a cooler in the summer to prevent spoilage. A small canvas bag that is always filled with supplies needed for travel may be helpful.
Can I sleep on my stomach?
Yes. After the tube site has healed, most people are quite comfortable on their stomachs. You should not sleep on your stomach during a feeding.
You will receive supplies from the inpatient unit for discharge. Your Home Health agency will provide you with a pump and pole. You will need to contact the Home Health agency for more supplies when you are at home.
Phone Numbers
Please call if you have concerns or questions.
|
Who |
Phone Number |
| Doctor | |
| Local Doctor | |
| Nurse | |
| Dietician | |
| Vendor |
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 10/15/2010
Copyright © 05/26/2009 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #6102
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