A jejunostomy tube (J-tube) is a soft, flexible medical device used to deliver nutrition and medication directly into the jejunum, the middle section of the small intestine. The tube is placed through the skin of the abdomen. This method, called enteral feeding, bypasses the upper gastrointestinal tract, including the stomach, and is intended for individuals unable to safely consume adequate calories and fluids by mouth for an extended period.
Why is a Jejunostomy Tube Necessary?
The decision to use a J-tube is made when feeding into the stomach, such as with a gastrostomy (G-tube), is not possible or carries significant risk. Bypassing the stomach is primarily done to prevent aspiration, a dangerous condition where stomach contents enter the lungs. The tube’s distal placement in the small intestine significantly lowers this risk.
J-tubes are indicated for patients with impaired stomach function, such as gastroparesis, or those experiencing severe, chronic vomiting or reflux that makes gastric feeding intolerable. They may also be placed following extensive upper gastrointestinal surgery, like a gastric resection, to ensure the patient receives necessary nutrition during recovery.
The small intestine’s primary role is the absorption of nutrients. A J-tube delivers specialized liquid formula directly to this site, ensuring the body receives the required calories, protein, and fluids even when the stomach is compromised or needs to be kept empty. While a G-tube is often the first choice for long-term feeding access, the J-tube is specifically utilized when the clinical necessity dictates feeding past the stomach.
How the J-Tube is Placed
Placement of a jejunostomy tube, a procedure called a jejunostomy, creates a small opening, or stoma, through the abdominal wall into the jejunum. This procedure is performed in a hospital setting under anesthesia, and the specific technique chosen depends on the patient’s health and the reason for placement.
Surgical Placement
Surgical placement may be done via a traditional open incision or a minimally invasive laparoscopic method. The surgeon directly places the tube into the jejunum and secures it to the abdominal wall.
Percutaneous Endoscopic Jejunostomy (PEJ)
PEJ is a less invasive technique where a gastroenterologist guides a flexible endoscope through the mouth and stomach into the small intestine. The endoscope helps identify the correct location for the stoma on the abdominal surface. The tube is then passed through the abdominal wall and secured into the jejunum.
Administering Feedings and Medication
Using a J-tube requires specific techniques because the small intestine processes food differently than the stomach. Unlike the stomach, the jejunum cannot accommodate large volumes of formula quickly. Feedings are administered slowly over several hours, often using a continuous drip method with an electronic pump to regulate the flow rate.
Some patients may tolerate bolus feedings, where a specific volume is delivered over a shorter period using a syringe, but this must be determined by a healthcare provider. To maintain patency, the tube must be flushed with warm water before and after every use. Failure to flush is the main cause of blockages.
Medication administration requires careful preparation to prevent clogs. Liquid medications should be used when possible. Solid pills that can be crushed must be thoroughly dissolved in water before administration. Sustained-release or enteric-coated medications must never be crushed, as this alters their action and can damage the tube. A water flush of five to ten milliliters is necessary between each individual medication to clear the tube and prevent drug interactions.
Site Care and Troubleshooting
Daily care of the stoma is important for preventing skin irritation and infection. The skin around the tube should be cleaned at least once daily with mild soap and warm water, gently removing any drainage or crusting. The area must then be dried completely, as moisture can lead to skin breakdown and the growth of granulation tissue.
A dressing should be changed whenever it becomes wet or dirty. If the tube has an external bumper or disc, ensure it is positioned correctly against the skin to minimize movement. Excessive movement can enlarge the stoma opening, leading to leakage of digestive fluids that irritate the skin.
Troubleshooting complications is part of safe management. Tube clogging is common; attempt to clear it by gently pushing and pulling warm water through the tube with a syringe. If the blockage persists, contact a healthcare provider.
Leakage around the stoma is frequent, often caused by the tube being dislodged or the stoma site being too large. Signs of infection require immediate medical attention. If the J-tube accidentally comes out, seek care immediately, as the stoma tract can close rapidly.
Signs of infection include:
- Increased redness
- Swelling
- Warmth
- Severe pain
- Foul-smelling discharge