What is a PEG-J?

A PEG-J is a gastrostomy tube, which is inserted directly through the abdominal wall and into the stomach. It has silicone bumper on the inside of the stomach to secure the tube internally and a plastic fixation device on the external abdominal wall, which secures the tube externally – also known as an external fixator. Through the gastrostomy tube, there is a thinner extension tube called a jejunal extension, which is placed into the jejunum (small bowel). PEG-J tubes have both a gastric port and a jejunal port on the end of the tube.

Why do I need a PEG-J?

A PEG-J is used to feed a person into their jejunum if they are unable to eat or drink enough to maintain their weight. A PEG-J tube delivers nutrition, hydration and medications directly to your jejunum. Sometimes if gastrostomy feeding is not tolerated, this may be changed to a PEG-J with agreement from your doctor. As the tube has access to the stomach, it can be used to release trapped air in the stomach (sometimes called venting or gastric decompression).

How will my PEG-J feeding tube be inserted?

Following information and consent, the procedure to insert a PEG-J is undertaken in the hospital. If you have a gastrostomy that will be replaced with a PEG-J, this will also be completed in hospital, usually in the endoscopy department.

How long will my PEG-J last for and how will my PEG- J feeding tube be replaced?

The PEG-J tube lifespan can vary depending on use and care of the tube and they tend to last several years before needing replacement. However, the jejunal extension may need to be replaced more regularly if this dislodges. The replacement of the whole tube, or just the jejunal extension can usually be done as a day case in endoscopy.

Initial tube care

After the PEG-J tube has been placed, the dressing can be removed 24-hours after tube insertion.

If you experience pain on feeding or external leakage of stomach contents, or if fresh bleeding is noted within 72-hours of a PEG-J tube insertion, stop feeding and urgently contact and attend your nearest accident and emergency department.

Daily PEG-J care

Checking position

Your PEG-J tube needs to stay in correct position to make sure feed is delivered safely. Your tube should not be rotated, as this could cause the jejunal extension to move into your stomach.

The tube has centimetre (cm) markings on it. Every day, check that the cm marking at the level of your skin is the same. It is important that the tube does not move. If the cm marking changes, this may be an indicator the tube has moved. If the cm marking at skin level has changed, please do not use the tube and contact your enteral feed company nurse for advice.

Do not move the external fixation plate for the first 14-days, to allow the stoma (hole) tract to heal.

The tube is held in the correct position with the external fixation plate and a bumper on the inside of your stomach. It is very important that your tube is not rotated as this could cause the jejunal extension to migrate to your stomach.

Cleaning your PEG-J tube

• Wash your hands according to your hand hygiene leaflet.
• Gently remove any dressing the day after tube insertion.
• Every day, carefully clean around the gastrostomy site (also known as stoma), under the external fixation plate and around the tube and clips with water and a disposable cloth or gauze and dry.
• When the area settles at around 10 to 14 days, it may be cleaned with a mild soap and water and then dried.o   You may have a shower; be careful not to direct the flow of water directly at the stoma site. Cap off the end of the tube prior to showering. If you can only have a bath, it is important to avoid soaking the stoma. Please make sure that the water level lies below the stoma site.o   You may have a deep bath or go swimming after the site has healed, generally after about two to three weeks. Make sure the tube is secured and capped.o   Do not use creams or talcum powder near or around the stoma site – to reduce the risk of irritation and breakdown of the tube.

If you experience any of the following symptoms, it could indicate that the site is infected. Please contact your GP, enteral feed company nurse or community nurse for advice if you notice: 

• oozing or odour coming from the stoma site
• redness
• soreness
• raised area
• you have a temperature or feel unwell.

Weekly PEG-J tube care required

PEG-J tubes need regular care to keep the stoma healthy and prevent infection.

• Wash your hands before and after caring for your tube.
• Carefully clean the skin daily around the PEG-J site (stoma), the external fixation plate and the tube with water and a disposable cloth or gauze and dry well to reduce the risk of soreness and infection. When the stoma (skin around your tube) has healed completely it may be cleaned with a mild soap and water, and then dried.
• Check the stoma daily for signs of infection .
• Once the stoma has healed completely (usually after 14 days) you may shower, bath or swim, but may need to cover the site with a dressing – please contact your enteral feeding company, community children’s nurse, community nurse or the HEN Team if you need further guidance.
• Do not use creams or talcum powder (unless advised/ prescribed) near or around the stoma site to avoid the risk of skin irritation and breakdown of the tube.
• If the site is dry then no dressing is needed. There may be a small amount of discharge around the stoma for 10 to 14 days after insertion. If you are worried about this, please ask your enteral feeding company nurse, community nurse or community children’s nurse for a dressing and advice.

Fourteen days after insertion, you need to advance the tube weekly, unless otherwise directed by the doctor who placed the tube. It is important to help healing and reduces the risk of the tube sticking to the stoma tract and embedding in the stomach wall. This is called buried bumper syndrome and could result in a hospital admission.

To advance your PEG-J

1. Clean your tube site as per instructions above.
2. Check the external tube cm marker and make a note of this.
3. Move the external fixation plate away from the body.
4. Advance (push your tube into the stomach gently) by 2 to 3cm, then pull this gently back to its original position. Your tube cm marker should match from the check before.
5. Return external fixation plate to its original position, recommended to be 0.5 to 1cm away from the skin.
6. This needs to be done at least once a week.

It is very important that your tube is NOT rotated as this could cause the jejunal extension to move back into your stomach.

How do I feed using my PEG-J tube?

Liquid feed will be administered into your jejunum via a feeding pump connected with tubing called a giving set. The jejunum is narrower and less expandable than the stomach, so feed must be given slowly. Follow your dietitian's care plan and contact them if you have difficulty.

Flushing your PEG-J tube

If you are not using your tube for feeding or medication, make sure both the gastric and jejunal ports are flushed daily with cooled boiled water to prevent blockage. Consult your dietitian for the correct amount. To flush your tube:

How do I feed using my PEG-J tube?

Liquid feed will be administered into your jejunum via a feeding pump connected with tubing called a giving set. The jejunum is narrower and less expandable than the stomach, so feed must be given slowly. Follow your dietitian's care plan and contact them if you have difficulty.

Flushing your PEG-J tube

If you are not using your tube for feeding or medication, make sure both the gastric and jejunal ports are flushed daily with cooled boiled water to prevent blockage. Consult your dietitian for the correct amount. To flush your tube:

Troubleshooting

We hope your enteral feeding journey is as smooth as possible. However, we know that problems can occur. Below are common issues, with advice on how to proceed if they do.