Enteral Tube Program
Home Care Instructions after Placement of a Gastro-Jejunal (G-J) Tube
Your child is going home with a gastro-jejunal feeding tube commonly called a “G-J tube”. A G-J tube is a tube placed through the abdomen directly into the stomach and then passes into the small intestine (also called the small bowel).
This tube is used to vent your child’s stomach for air or drainage and/or to give your child an alternate way to give food and fluid because he or she is unable to take enough by mouth. Some children cannot tolerate feedings directly into the stomach and receive all of their feedings into the jejunal part of the small intestine where nutrients are absorbed.
The G-J Tube
A G-J tube is a single tube that passes through the abdominal surface, into the stomach and down into the second part of the small intestine (the jejunum) see Figure 1. The tube stays in your child’s stomach because there is a balloon inflated inside the stomach to help “hold” it in place.
The tube is made up of different sections: see Figure 1
- A round plastic disk or flange around the tube, which should sit snugly against the skin so the tube, will not slide in and out of the opening. The tube should move in and out of the opening a little bit so it will not cause pressure to the area.
- A balloon that will sit inside the stomach which helps to hold the tube in place when inflated.
- Three access ports at the end of the tube:
- one goes directly to the stomach (G tube port)
- a second one goes directly into the jejunum
- (J tube port)
- a third that goes to the balloon (Balloon port)
These are all clearly labeled and your nurse or doctor will give you specific instructions for their use.
- soap and water
- ¼ strength hydrogen peroxide (1 tablespoon peroxide to 3 parts water), only needed if you/your child has dry crusted drainage around tube.
- cotton tipped swabs
- gauze or foam pads
- catheter tipped syringe (60 ml.)
- water for flushing the tube
- Wash your hands, then remove the old dressing.
- Carefully check the area around the tube once a day. Check for possible signs of infection such as redness, swelling, green or yellow drainage. The area right around the tube may be slightly pink with some crusted drainage. This is normal. See the section on "When to Call Your Child's Doctor or Nurse."
- Clean the skin under the plastic disk and around the tube daily with mild soap and water or during bath time, unless your nurse or doctor instructs you not to tub bath. Then rinse the skin using clean tap water and dry completely. Please Note: If there is any crusted drainage on the skin, tube or disk, use quarter strength hydrogen peroxide on cotton swabs to remove. Dry with a clean cotton swab or gauze. It may be helpful to place one gauze under plastic disk to “wick” drainage and avoid crusting.
- Check the length of the tube daily. If the length seems much more or less than usual it may have moved. Call your nurse or doctor to discuss what you can do and if you need to be seen or have an x-ray done to check placement.
- Do not turn or rotate a G-J Tube. This can cause an enlargement of the opening which may result in leakage of stomach juices onto the skin or possibly twisting of the tube itself.
- Stabilize the G-J tube securelyso that your curious child will not be able to pull at the tube. There are several ways to do this. Your child’s nurse or doctor will show you how to do this. Here are some suggestions:
- Tape across the tube’s plastic disk or flange, as well as a dressing (if needed) onto the abdominal skin(see Figure 2).Next wrap tape 3-4 times around the tube above the plastic disk to stop the tube from sliding through the disk and into the stomach, which may result in blocking the stomach juices from emptying into the bowel.
- Dress your child in one piece clothing or one piece snap underwear. This will cover the tube and help prevent it from being pulled out.
- Cover the abdominal area with stretchy gauze or an ACE wrap.
Protecting the Tube from Falling Out
- Your child may be as active as usual during non-feeding hours.
- G-J tubes should be able to move in and out of the opening just slightly. If there is too much movement, the stoma opening or the tract leading to stomach may become enlarged, stomach juices may leak out causing skin irritation or rashes, or the tube may possibly falling out! This usually will not happen if the tube’s plastic disc is securely taped against you/your child’s skin and the tube is stabilized.
Please note: If there is excess movement of the tube in and out of the tract, call your/your child’s nurse to discuss if the disc needs to be adjusted or the tube needs to be stabilized more securely.
- Check the amount of fluid in the balloon once a week, as instructed by the nurse or doctor. Do this on the same day each week. This will help prevent the tube from falling out.
Please Note: Use only sterile or distilled water for balloon inflation.
Giving Feedings and Medications
- Your child’s doctor or nurse will work with you to make a feeding plan that is best for your child.
- Flush the G-J tube with warm water before and after giving feedings and medications. This will minimize the possibility of blocking the tube and interactions between formula and medications. Use a 60 ml syringe.When your child is receiving continuous feedings, flush the tube with warm water every 4 hours or as instructed by your doctor or nurse. They will tell you how much water to use. This is a very important step because G-J tubes clog easily.
Please Note: Do not use syringes smaller than 60 ml to flush the tube. They could cause the tube to break.
- The gastric (stomach) part of your child's tube should be flushed once a day, if not in use. Your child’s doctor or nurse will tell you how and when to do this.
- It is best to give medications into the gastric part of the tube, since it is wider and is less likely to get blocked than the jejunal part of the tube. However, this is not always possible. Ask the doctor or nurse what is best for your child.
- Use liquid medications whenever possible. Speak with your Pharmacist about solutions and suspensions that may be available. If pills must be used, crush them into a fine powder. Then mix the medicine with a teaspoon of water. Do not crush coated or time-released pills.
Please Note:To crush pills, use the back of a spoon or a pill crusher. Ask your pharmacist about pill crushers.
- Do not mix one medication with another.
- Do not put medications in feedings.
- Change the feeding bag set every day
- Have your child sit upright and play quietly when receiving feedings during waking hours.
- It is important for your child to have pleasant sensations during feeding. Your nurse or doctor can give you suggestions such as, sucking on a pacifier, gently stroking their cheeks, talking and interacting with them during feedings.
- For nighttime feedings, place your child on his or her side. Elevate the head of the bed by putting a pillow under the mattress.
- If there is leakage around tube resulting in skin that is red or sore, or has a prickly rash, call your child’s nurse or doctor. They may need to prescribe an antifungal ointment or powder for it to heal.
- If the G-J tube site is leaking large amounts of enteral feeding (soaking 4 x 4 inch gauze 2 or more times a day), call your child’s nurse or doctor.
- If the G-J tube becomes clogged, try to slowly flush it with 10 ml of warm water. Never try to push anything into the tube to unclog it.
- If you cannot unclog the tube, call your child’s doctor or nurse. You may need to return to the hospital to have it replaced in the X-ray department.
If the G-J tube falls out:
- Do not try to replace the tube if it falls out. The tube must be replaced by a doctor. When the G-J tube is replaced it is important to verify that the tube is in the right place, by taking an x-ray.
- Cover the opening with gauze and tape in place.
- Bring your child to the Emergency Room at Children’s Hospital within 1-2 hours to have the tube put back in. Bring the tube with you to the hospital if possible so that we will know the exact size and type of tube that fell out.
- If you cannot get to the Children's Hospital emergency room within 2 hours, call your Children's Hospital doctor. You may have to go to a hospital closer to you to have the tube put back in. If the opening (stoma) on the abdominal surface was created within the past few months it could close up so it is important not to wait if the tube is out for more than a few hours.
Instructions for GJ tubes placed by Interventional Radiology
? All GJ tubes placed by the interventional radiology department are scheduled for ROUTINE REPLACEMENT.
? The scheduled replacements are completed on an individual basis.
? If you/your child’s tube was converted from a G-tube tube to a GJ tube you will be scheduled for the first replacement in one month.
- The tube will be inspected by the interventional radiology physician who will determine when the next replacement should occur.
- An appointment is needed for the replacement. The hours are Monday through Friday 7:30AM to 4PM.
Instructions for problems with the GJ Tube
? For tube emergencies call the interventional radiology office at 617-355-6579 as early as possible to schedule the replacement Monday through Friday7:30AM to 4PM.
? GJ tubes will be replaced 7 days a week during the hours of 7:30AM to 4PM. Please follow these instructions on how to reach interventional after hours, weekends and holidays:
1. For tube emergencies call 617-355-6000 and ask for the interventional radiologist on call. Have the on-call physician paged between the hours of 7:30AM and 4PM. If you wait until 4PM the GJ will be replaced the next day.
2. If the emergency occurs after 4PM but before 7:30AM go to the Children's Hospital, Boston emergency department OR notify your attending physician. The interventional radiologist will be notified of your emergency after 7:30AM.
(Note: Please make sure that you follow the instructions given to you by your attending physician on how to maintain the stoma if the GJ is out of the stoma BEFORE calling the interventional radiology department.)
- Your child will miss a feeding or medication because of a problem with their G-J tube,
- You are unable to unclog the tube,
- The end of tube splits where adaptor connects to it,
- The tube is leaking,
- Your child starts coughing, choking, or vomiting with feedings,
- Your child shows other signs of feeding intolerance such as:
- abdominal pain
- the opening or surrounding skin has:
- redness or rash,
- pus or drainage around opening,
- swelling and tenderness,
- foul odor,
- fever of 101° F or greater;
- You have any questions or concerns.