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 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.

This type of tube may be placed 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

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, therefore feeding can be a lengthy daily process.

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 into this part of the gut by flushing the tube with cooled boiled water via a reusable syringe and using good hand washing 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 contact and attend your nearest A&E.

Important information about your jejunostomy tube

• If your jejunostomy feeding tube has an external fixation plate do not loosen it, and do not remove any stitches attaching it to the skin unless told to do so, as this is holding your feeding tube in the correct position.
• If any stitches fall/grow out there is an increased risk of the jejunostomy tube becoming dislodged or falling out. Stitches will need to be replaced as a matter of urgency or you will need another method of securing your tube safely. Please contact us for advice, or for out of hours please attend your local A&E.
• Do not turn the tube as this may dislodge
• If the tube becomes dislodged or falls out, urgently attend your nearest A&E.

Checking the jejunostomy

Tube position

It is important to make sure your jejunostomy tube stays in position and does not move. This can be achieved by measuring and recording the marking where the tube exits the skin 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. If you notice the tube has moved, please call us for advice.

Complications

Check the jejunostomy site daily. The following could indicate that the site is infected or the tube is displaced:

• oozing or odor coming from the site
• redness
• swelling and irritation
• soreness or skin breakdown
• excessive movement in and out of the jejunostomy

If you experience any of the above please call your community nurse, GP or the Home Enteral Nutrition (HEN) Team.

Cleaning your jejunostomy

• Wash your hands before and after caring for your
• Gently remove the dressing 24 hours after tube
• Carefully clean daily around the jejunostomy site, the external fixation device 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.
• After 14 days you may have a shower or Cap off the end of the tube prior to showering or bathing and dry well afterwards.
• Once the stoma has healed completely you may swim, but may need to cover the site with a dressing – please contact the HEN Team or your community nurse for details.
• Do not use creams or talcum powder 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 community nurse for a dressing and advice.

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 make sure you flush the tube at least once a day with cooled boiled water to prevent the tube from blocking. Please contact your dietitian to advise you on the amount required.

Method

• Wash your hands
• Place all the equipment you require on a clean surface, such as 50ml single use syringe and measured cooled boiled water in a jug or cup.
• Check that the position of the feeding tube is
• Draw up the required amount of water into your syringe.
• Make sure the clamp is closed and remove the cap from the end of your jejunostomy tube.
• 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.
• Remove the syringe and recap your jejunostomy tube. Wash the syringe as directed.