Looking after your percutaneous endoscopic gastrostomy - jejunum (PEG-J) tube

What is a PEG-J?

A PEG-J is a soft tube placed through your skin into your stomach with an extension going into part of the small intestine, the jejunum. The term describes the way it is placed:

• percutaneous – through the skin
• endoscopic – the equipment used to examine the stomach
• gastrostomy – opening into the stomach
• jejunal – an extension through the PEG into the jejunum

Why do I have a PEG-J?

You may have this tube for the following reasons:

• inability to safely swallow enough food to keep you healthy
• vomiting or stomach ache due to food not emptying properly from your stomach

The PEG-J provides a safe route for you to receive all the nutrients you require without either choking on your food or being sick.

How long do I need to have my PEG-J?

Most people require a PEG-J long term as their swallowing remains unsafe or they remain unable to tolerate feeding into their stomach. However, you will be regularly reviewed by a dietitian to see how much feed you require.

How long does my tube last?

If it is well cared for, a tube can last up to five years. You may require an endoscopy to replace your tube if it becomes damaged or worn. Arrangements for this can be made by your GP or the nutrition nurse specialists.

One way of increasing the life of your tube is to leave the clamp undone when the end connector is closed. This prevents the clamp putting constant pressure on the tube. You can also change the position of the clamp along the tube to avoid pinching the same area each time.

How do I clean my PEG-J and the skin around it?

For the first week:

• Remove the dressing the day after your tube is inserted; this is no longer required.
• Clean the tube and site daily.
• Carefully clean under the outside bumper and around the site using neat Octenisan body wash, then cleanse with warm water and dry well.
• Apply the Bactroban/ Naseptin ointment around where the tube exits the skin.
• It is important not to move the outside bumper for the first week as keeping it in place helps the site to heal.

After the first week:

• It is no longer necessary to use the Octenisan and Bactroban/ Naseptin. Still clean daily with warm soapy water.
• You can now move the outside bumper along the tube to make cleaning the site easier. Make sure you replace the bumper approximately 2mm from the skin so that the tube does not slide in and out.
• Do not forget to clean the back of the bumper.

Can I have a bath?

For the first two days after your tube is placed do not have a bath or shower, instead wash using the Octenisan body wash. For the rest of the first week, you may have a shallow bath or a brief shower using the Octenisan body wash. Do not soak/ immerse the tube and exit site. After the first week, if the skin around your site is clean and dry, you may return to your normal bathing routine.

If you have any concerns, please contact either your company nurse or the nutrition nurse specialists.

How do I manage my tube?

It is important to insert your tube once a week to stop the bumper in your stomach getting stuck against your stomach wall. To do this, follow these instructions:

• Wash your hands with soapy water and dry well.
• Release the triangular bumper by opening the blue clip, remove the tube from the groove and slide back the triangular bumper away from the skin.
• Clean the tube, bumper (front and back) and stoma area with soapy water.
• Push 2cm to 4cm of the tube into the stomach but do not turn or twist the tube as this may displace or cause coiling of the jejunal extension.
• Gently pull the tube back until resistance is felt.
• Place the triangular bumper back in its normal position, reinsert the tubing into the groove and close the fixation catch carefully.

Why are there different ports?

• The gastric and jejunal ports allow the tube to be used for more than one thing at a time.
• The gastric port can be used for drainage. A bag can be attached to it to reduce symptoms of vomiting. It can also be used to administer medications.
• The jejunal port is for feeding directly into the small bowel; this can help prevent vomiting or reflux.

What if I start to feel sick when I am feeding?

• If you begin to feel nauseous or are sick when you are feeding this may be caused by the longer part of the tube flipping out of the jejunum and back into the stomach.
• If you are concerned, please stop your feed, give a water flush and contact your company nurse who can check this for you by doing a simple test.
• If the tube has flipped back into the stomach, you will need an appointment for this to be replaced in Endoscopy.

What do I need to look out for?

You need to look at your site regularly to check for signs of infection. The things to look out for are:

• redness
• pain
• discharge which is yellow and smelly

If you notice these signs, contact GP, your company nurse or the nutrition nurse specialists.

It is also possible for the skin at the exit site to become pink and/or lumpy and it may bleed easily. This may be an overgrowth of tissue which can be easily treated with a special dressing or ointment. Again, contact your GP, company nurse or the nutrition nurse specialists if you are worried.

• leaks of fluid around the tube
• pain on feeding or flushing your tube
• new bleeding

If you have any of the above signs, stop feeding immediately and telephone for urgent advice:

• Monday to Friday 08:30 (8:30am) to 16:00 (4pm) – call the nutrition nurse specialists on 01223 216037
• Out of hours – please contact your GP. If you cannot wait to be seen by your GP, please contact your local hospital’s emergency department.

Home delivery company 24-hour helpline

• Abbott Hospital to Home: 0800 018 3799
• Nutricia Homeward: 03457 623 632
• Fresenius Homecare: 0808 100 1990