What are the Guidelines for J-Tube Protocol?

A jejunostomy tube (J-tube) is used when a patient cannot ingest enough food orally to maintain a healthy weight. Feeding through a J-tube or G-tube (gastrostomy tube) is called parenteral nutrition and, when all feeding takes place through the tube, total parenteral nutrition. This procedure is done in a hospital setting; however, some patients continue to receive nutrition through the tube upon return home. The tube is also used to administer medications. It is essential for caregivers to understand and provide proper care.

Surgical Procedure

• A J-tube is inserted through the abdomen into the second part of the small bowel, the jejunum. This procedure is performed either laparoscopically or through an open surgical technique. After placement, the external J-tube site is treated with antibiotic ointment and covered with dressing. An abdominal binder is used to protect the area.

In the Hospital

• Once the procedure is complete, a nurse or dietary expert explains proper care of the tube, using a feeding pump and whatever feeding solution is best for a patient's particular needs. The care team begins feeding through the tube once the patient has stabilized from surgery.

Daily Routine

• Once the patient returns home, the tube must be checked, cleaned and dressed on a once-a-day basis. The daily routine consists of checking for redness, swelling, cracked skin and drainage from the tube. The patient should ensure that bath or shower water is kept away from the tube. Showers or baths can resume normally after four to six weeks. Hands must always be thoroughly washed before and after handling the J-tube.

Cleaning and Dressing

• Cleaning the tube is done with mild soapy water and a clean washcloth or cotton. The tube is then rinsed and dried well. The tube site may remain undressed if it is healed and no drainage is present. Otherwise, dressing is replaced on a daily basis using instructions given in the hospital. The patient must then secure the tube to clothing or skin with paper medical tape to prevent damage to the tube and jejunum.

Feeding

• A feeding pump is used to introduce food into the tube. The patient's medical team arranges for a visiting nurse or home health organization to provide the pump and instructions for use. This professional should be on hand to provide assistance with maintaining the tube and feedings.

Flushing

• Flushing is performed with lukewarm water to prevent clogs in the tube. This is done both before and after each feeding or medication administration. If feeding is continuous, flushing is performed every four to six hours throughout the day. If the tube is not used on a particular day, it must be cleaned at least once during that day.

Medications

• Medications are crushed and mixed with water, then inserted into the tube with a syringe. When administering medications, the tube must be flushed with 30 mL water between each medication and after all medicines are administered. To prevent tube clogs, medications must not be mixed together. Medications should never be added to the feeding solution.

Problems

• The patient should contact the surgeon if the tube falls out, gets clogged or develops connection problems or leaks. Symptoms that indicate infection, such as fever, chills, redness or swelling around the tube site should be reported immediately to the medical team, as should hardness, pain or bleeding of the abdomen.