A gastrostomy-jejunostomy (GJ) tube is a specialized medical device designed to provide direct access to the digestive system for nutrition, fluids, and medications. This tube is surgically placed through the abdominal wall, extending into the stomach and then further into the small intestine. It offers a solution for individuals who cannot safely or adequately consume sustenance by mouth, ensuring they receive the necessary support for their health.
Understanding GJ Tube Anatomy
A GJ tube has a dual-lumen design with two separate access points or ports. The gastric (G) port terminates in the stomach, while the jejunal (J) port extends into the jejunum, a section of the small intestine. This arrangement allows for different substances to be delivered to specific areas of the digestive tract. The tube is held in place by an internal balloon or bumper within the stomach, with a plastic disk on the outside securing it against the skin.
The G-port provides access to the stomach. It is commonly used for venting, which helps release air or drain excess fluids, alleviating symptoms like nausea or bloating. If the stomach functions adequately, the G-port may also be used for certain medications or bolus feedings.
The J-port bypasses the stomach, delivering substances directly into the small intestine. This is beneficial for individuals with conditions like severe gastroesophageal reflux, impaired gastric emptying, or gastroparesis, where the stomach cannot properly process contents. The J-port is used for continuous feeding and medication administration to ensure absorption and prevent complications.
Administering Medications Through the J-Port
Medications are often administered through the jejunal (J) port. This approach bypasses the stomach, which is beneficial if there are issues with gastric motility, absorption, or if the medication needs to avoid the stomach’s acidic environment. Delivering medication directly to the small intestine allows for predictable absorption into the bloodstream.
When preparing medications for the J-port, liquid formulations are preferred to minimize tube blockages. If liquid forms are unavailable, solid medications like tablets must be crushed into a fine powder using a pill crusher. Certain medications, such as extended-release, sustained-release, or enteric-coated pills, should never be crushed as this can alter their release and effectiveness, potentially leading to adverse effects. Always consult a pharmacist or healthcare provider before crushing any medication.
Once crushed, dissolve the powder in about 15-30 mL of warm water to create a smooth mixture. Prepare and administer each medication separately to prevent interactions and ensure proper dosage. Before administering, flush the J-port with at least 30 mL of warm water using a 60 mL syringe to clear the tube. After administration, flush again with 30-60 mL of warm water to clear the tube and prevent clogging.
Delivering Nutrition and Fluids
Nutrition and fluids are delivered through a GJ tube, with the choice of port depending on the patient’s digestive function. Formula feeds and water flushes are administered via the gastric (G) port if the stomach tolerates them. This allows the stomach’s natural digestive processes to begin breaking down nutrients before they enter the small intestine.
For patients who cannot tolerate stomach feeds due to conditions like severe reflux, gastroparesis, or aspiration risk, continuous formula feeds are delivered directly into the jejunum through the J-port. Jejunum feedings are given continuously using a pump, as the small intestine cannot accommodate large volumes at once. Bolus feedings, which involve larger volumes over a shorter period, are reserved for the G-port.
Proper technique is important for feeding. Fill the feeding bag with formula, ensuring it does not remain at room temperature for more than four hours to prevent bacterial growth. Connect the tubing to the designated port, and deliver the feed by gravity for bolus feeds or via a pump for continuous administration. After each feeding, or at least every four hours during continuous feeds, flush the tube with warm water to prevent formula buildup and maintain patency.
Best Practices for Tube Care
Maintaining GJ tube functionality requires consistent care, especially proper flushing techniques. Regular flushing prevents tube occlusion, which can hinder nutrition and medication delivery. Flush the tube with at least 30 mL of warm water before and after each feeding and medication administration. For continuous feeds, flush every four hours. Use a 60 mL syringe for flushing, as smaller syringes can create excessive pressure that might damage the tube.
Blockages can occur, indicated by difficulty pushing fluids through the tube or by alarms on a feeding pump. If a blockage is suspected, gently attempt to clear it by flushing with warm water using a push-and-pull motion with the syringe plunger. Never use excessive force or insert any objects into the tube, as this can damage the tube or cause serious injury.
Skin care around the insertion site is important to prevent complications. Clean the area daily with mild soap and water, checking for signs of infection such as redness, swelling, unusual drainage, or a foul odor. If the tube becomes dislodged, leaks excessively, or a blockage cannot be cleared, contact a healthcare professional immediately. These issues compromise patient health and require prompt medical attention.