What is a naso-jejunal (NJ) tube?

An NJ tube is a thin tube that is placed via the nose (naso) into the small bowel (jejunum) for feeding. An NJ tube is used to help meet your food and fluid needs, when you are unable to eat and drink at all, or eat and drink enough, to maintain your weight. An NJ tube is usually used for a short period of time, up to approximately 90 days. You may also be prescribed medicines through the naso-jejunal tube.

Why do I need a feeding tube to go into my small bowel (jejunum)?

You may be tube-fed into the small bowel if you are unable to eat and drink, or can’t be tube-fed into your stomach. For example, if you have a history of severe acid reflux, delayed stomach emptying, frequent vomiting or stomach cancer.

How is the tube placed?

Usually you will talk with a specialist doctor and, if in agreement, go ahead and have the tube placed in hospital, usually in the radiology department. The tube will be placed through your nose, down the gullet (oesophagus), through the stomach, and into your small bowel (jejunum). An X-ray will be used to check the tube has been placed in the correct position. A mark may be made on the tube near your nose to help you keep a check on its position. Tape is usually used on your nose and cheek to help secure the tube. Sometimes the doctor may offer a nasal bridle to secure the tube in place; this can reduce the risk of the tube dislodging.

My tube information on discharge from hospital (ask nurse or doctor to complete this):

Care of a naso-jejunal (NJ) Tube

Using a pump to feed through my tube

As you are being tube fed into the small bowel, the risk of infection is higher because the stomach (and protective stomach acid) is bypassed. Containers of sterile feed can be obtained on prescription via your GP. Your dietitian will calculate what type of feed you need, and how much. When feeding, you will need to have the naso-jejunal tube attached to a pump using tubing called a ‘giving set’ for the duration of feeding. The feed container is held with the pump on a stand. If you wish to walk around it is possible to carry the pump and feed container in a backpack.

As the small bowel is narrow and does not expand, the option of administering feed by a syringe (known as ‘bolus feeding’) is generally not recommended, because you can feed too much at a time, and make yourself feel unwell. A pump delivers the feed more slowly and reduces the risk of feeling unwell.

Flushing my tube with water

Because the NJ tube is very thin, it will need to be flushed before and after having feed, before and after medications and every four hours to reduce the risk of blocking during long hours of feeding, unless otherwise advised by your dietitian/health care professional. We recommend you use cooled-boiled water for this, to help reduce the risk of infection. Instructions on how to prepare and use cooled-boiled water are in a separate leaflet.

Eating and drinking

If you have been told it is safe to do so, you may still be able to eat and drink when you have a naso- jejunal tube placed. Please follow your doctor’s advice.

Hand washing

Please ensure you wash your hands correctly before touching the tube to administer feed, medication or flushes. Please see separate leaflet on handwashing technique.

Checking the position of my tube before each feed

Please be sure you or your carers are proficient with checking the tube’s position prior to giving any feed, medication or water via your naso-jejunal tube. If you do not feel confident or need training please call your feed company nurse. Please be aware of what actions are required if your tube appears to have moved, to reduce the risk of being fed into your stomach or fluids inadvertently entering the lungs.

To check the position of your tube:

• Check the centimetre (cm) marking at the nostril is the same as previous checks
• Ensure there is no coiling of the tube at the back of the throat by opening your mouth wide and looking at the back of your throat in a mirror.

If you suspect the tube may have moved out of your small bowel, stop feeding and do not use it. Seek advice from your nurse or doctor, or HEN Service. In an emergency, call 999.

What if I have problems feeding through my naso-jejunal tube?

First double check the written information from your dietitian on the rate and volume of your feed; if you have problems with this please contact the HEN Service.

If you have any vomiting of feed, please stop the feed and seek further advice from HEN Service, or your feed company nurse if out of hours, as the tube may have dislodged into your stomach.

If you have problems with your pump, please contact your feeding company to troubleshoot.

Getting my tube replaced

Your naso-jejunal tube may need to be replaced if it blocks, moves into your stomach, or if it has been in place for as long as the manufacturer suggests.

Your tube can only be replaced in hospital.

Please keep to hand details of the date it was placed (and hence when it is due to be replaced), the size and length of tube and how to contact the hospital in case you need your tube replacing.