What is a jejunostomy (jej) tube?

A jejunostomy tube is a small tube inserted through the abdomen and into a part of the small bowel called the jejunum. Initially this will be held in position with stitches.

Why do I need a jejunostomy tube?

You may require this type of feeding tube if you cannot eat or drink enough to maintain your weight. It can:

• provide all nutritional needs
• supplement your diet if oral intake is insufficient.

Typical reasons include:

• difficulty digesting food
• delayed stomach emptying (gastroparesis)
• blockage in the oesophagus or stomach
• severe reflux or regurgitation.

How will I be fed?

You will be fed liquid feed into your jejunum via the jejunostomy tube and a feeding pump. Compared to the stomach, the jejunum is a narrow part of the gut and does not expand as easily. This means that the liquid feed needs to be drip fed slowly.

As the jejunum is lower down in the gut than the stomach, a jejunostomy tube bypasses the production of stomach acids, which usually protect your body against harmful bacteria. Therefore, it is important to reduce the risk of infection in this part of the gut by flushing the tube with cooled boiled water via a reusable syringe and using good handwashing techniques.

Important note:

If you experience pain on feeding, or external leakage of jejunal contents, or fresh bleeding is noted within 72 hours of a jejunostomy tube insertion, stop feeding and urgently attend your nearest Accident and Emergency department.

Important information about your jejunostomy tube

• if your jejunostomy tube has an external fixation plate, do not loosen it or remove any stitches unless advised, as these keep the tube in the correct position
• do not rotate or twist the tube, as this may dislodge it
• if the tube becomes dislodged or falls out, go to your nearest A&E department immediately, as the tract can close quickly
• if one to two stitches come loose or fall out, secure the tube with a dressing to help prevent it from falling out. During working hours, contact the Home Enteral Nutrition (HEN) team on 0300 123 7058 for advice. Out of hours, if the tube has moved or has no stitches, stop using it and attend your nearest A and E for assessment.

Daily care

Tube position

It is important to keep your jejunostomy tube in position and prevent it from moving. You can check this by measuring and recording the marking at the point where the tube exits the skin. This makes it easy to notice any changes. If the tube markings are not visible, measure from the exit site on the skin to the end of the tube cap instead.

If you notice the tube has moved, please contact the HEN team for advice.

Each day, check the site where the tube enters the skin.

If you experience any of the following symptoms, it may indicate an infection. Please contact your GP, enteral feeding company nurse, community nurse or community children’s nurse if you notice:

•  oozing or an unpleasant odour from the stoma site
•  redness
•  soreness
•  swelling or a raised area
• a temperature or feeling unwell
• excessive movement in and out of the jejunostomy site.

Cleaning your jejunostomy

• wash your hands before and after caring for your tube
• remove the dressing 24 hours after insertion. If the dressing is only securing the tube, take care not to move it — ask someone to help if needed
• gently clean the jejunostomy site, external fixation device and tube with water and a disposable cloth or gauze, then dry thoroughly to reduce the risk of soreness and infection. Once the stoma has fully healed, you may use mild soap and water, then dry well
• after 14 days, you may shower or bathe. Ensure the tube is capped beforehand and dry the area thoroughly afterwards
• once fully healed, you may swim, but you may need to cover the site with a dressing — contact the HEN team or your community nurse or CCN for advice
•  do not use creams or talcum powder around the stoma, as this may cause irritation and damage the tube
•  if the site is dry, no dressing is needed. A small amount of discharge is normal for 10 to 14 days after insertion, but if you are concerned, contact your enteral feed company nurse, community nurse or CCN for advice on a suitable dressing.

Feeding through your jejunostomy tube

You will be fed liquid feed into your jejunum via a feeding pump. Compared to the stomach, the jejunum is a narrow part of the gut and does not expand as easily. This means that the liquid feed needs to be drip fed slowly; therefore, feeding can be a lengthy daily process

Flushing your jejunostomy tube

If you are not using your jejunostomy tube for feeding, please ensure you flush the tube at least once a day with cooled boiled water to prevent the tube from blocking. Please contact your dietitian for advice on the amount required.

Method

• Wash your hands well
• Place the equipment you require on a clean surface, for example 60ml single use syringe, cooled boiled water in a jug or cup.
• Check that the position of the feeding tube is correct

Steps

1. Draw up the required amount of water into your syringe.
2. Make sure the clamp is closed and remove the cap from the end of your jejunostomy tube.
3. Attach the syringe to your jejunostomy tube and open the clamp. Slowly press down the plunger in the syringe to flush the water into the tube. Using the clamp helps to avoid air entering your small bowel which could make you feel uncomfortable and bloated.
4. Remove the syringe and recap your jejunostomy tube. Wash the syringe as directed.