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 a soft sponge filled balloon or bumper on the inside of the stomach and a firm plastic/polyurethane fixation device on the external abdominal wall which secures the tube. Through this tube, there is a thinner extension tube 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?

You may require this type of feeding tube if you are unable to eat or drink enough to maintain your body weight. It can be used either to meet all of your nutritional needs or to supplement the diet.

Jejunal feeding may be required if:

• you have trouble digesting food
• your stomach does not empty properly
• there is a problem with a blockage, either to your oesophagus (gullet) or stomach
• you suffer with severe reflux and regurgitation.

Feeding through a PEG-J tube allows for enteral feeding into the jejunum when a jejunostomy is not possible. It is often a choice for longer term jejunal feeding as the tube can be more stable than a jejunostomy tube or if you already have a gastrostomy in place. As this tube has access to the stomach and jejunum, it can be used to release trapped air in the stomach (sometimes called venting or gastric decompression) and also allows for administration of medications.   

How will my PEG-J feeding tube be inserted?

If you don’t already have a gastrostomy tube, a PEG-J will normally be inserted in the hospital. For adults this is generally done under light sedation in endoscopy. Children will require admission to hospital for this procedure to be carried out under general anaesthetic.

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

The PEG device can last up to three years, however the jejunal extension may need to be replaced every nine to twelve months. 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 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.

Tube position

It is important to ensure that your PEG-J tube stays in position to make sure the feed is delivered to the right area of the digestive system.

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.

Check the PEG tube’s position by checking the marking where the tube exits the skin. It should be the same and not change. Check this before feeding and make a note of it at least once daily.

If you cannot see the markings on the tube, then measure from where the tube exits the skin to the end of the tube cap and make a note of this length. If you notice that the tube has a longer or shorter measurement than usual, this may indicate your tube has moved and you should seek advice from either your enteral feed company nurses, community children’s nurses, community nurses or the HEN Team.

Daily tube care

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.

Weekly tube care

• 14 days after insertion, you need to advance the tube weekly, unless otherwise directed by the doctor who placed the tube. To do this, loosen the external fixation plate by unclipping it from the tube, and pull back from the skin. Clean the stoma and tube with water and dry thoroughly, push the tube in approximately 2cm and then pull the tube back by the same amount.
• Return the fixation plate to the correct position which is 0.5 to 1cm from the skin.
• It is very important that your tube is not rotated as this could cause the jejunal extension to move back into your stomach.

Complications

Please contact your enteral feed company nurse, community nurse or GP if any of the following occur, it could indicate an infection or the tube has moved:

• oozing or odour coming from the site
• redness
• swelling and irritation
• soreness or skin breakdown
• excessive movement of the tube in and out of the PEG-J site
• an increase in the length of the internal jejunal tube that you can see
• you notice that you can no longer see the jejunal tube within the PEG tube
• vomiting feed.

Feeding through your PEG-J 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 given slowly; therefore feeding can be a lengthy daily process. Please follow your care plan from your dietitian.

Flushing your PEG-J tube

If you are not using either section of your tube for feeding or medication, please make sure you flush the:

• gastric port at least once a day with cooled boiled or freshly drawn tap water
• jejunal port of your PEG-J tube with cooled boiled water at least once daily.

To avoid confusion, it may be easier to flush both ports with cooled boiled water.

By doing this it will reduce the risk of either section of the tube from blocking. Please see your feeding regimen to advise you on the amount of water required.

Method for flushing

You will need:

• a clean surface
• 60ml syringe
• measured cooled boiled water in a jug or cup

Before you begin, wash your hands and check the position of the feeding tube is correct.

Either:

• Apply the clamp or pinch tube to prevent any feed, water leaking out.
• Remove the cap from the end of the port you wish to flush.
• Remove the plunger from the syringe and attach it to your feeding tube.
• Unclamp your tube if in use.
• Use your syringe as a funnel to slowly pour the correct amount of water into your feeding tube, keeping the syringe higher than the stoma site.
• Remove the syringe and recap your tube. To reduce the risk of damage tubes are best left unclamped.
• Wash your hands and equipment.

 or

• Draw up the required amount of water into your syringe.
• Apply the clamp or pinch tube to prevent any feed water leaking out.
• Remove the cap from the end of your tube.
• Attach the syringe to your tube, if using – open the clamp, and slowly press down the plunger in the syringe to flush the water into the tube.
• Remove the syringe and re-cap the tube. Tubes are generally best left unclamped to reduce the risk of damage.
• Wash your hands and equipment.

Troubleshooting

• If your PEG-J end comes off unfortunately, this is not something that can be replaced in the community. This is because we cannot confirm that the jejunal extension tube has not moved this can only be done in hospital. Therefore, please go to the nearest A&E department or if necessary contact the HEN Team for further advice.
• If your jejunal extension comes out please attend A&E and inform us of what’s happened as we may be able to let the hospital know you are coming.
• Over-granulation is an overgrowth of new tissue on the surface of a wound during the healing process. This tissue can grow above skin level, and can be red or purple in colour and may bleed easily. If you think this is something which is affecting your stoma site please see your troubleshooting leaflet and contact your enteral feeding company nurses and community nurses in the first instance for further assessment.
• If you notice your stoma site has a combination of the following symptoms if could be a sign of infection. Please contact your GP, enteral feeding company nurses, CCN’s or community nurses in the first instance:
• • red
  • inflamed
  • discharge
  • pain
  • unpleasant odour
  • you have a temperature.
• If your tube is blocked please refer to your leaflet on feeding tube blockages.