Looking after your transgastric-jejunal tube

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What is a transgastric-jejunal tube?

A transgastric-jejunal tube is a soft tube placed through your skin, passed through your stomach and into your small bowel. This allows for feed to enter your jejunum (small bowel) whilst also allowing for the removal of excess air or fluid from your stomach to reduce any vomiting. The stomach port can be used to give medication. The tube is held in place with a balloon.

Why do I have a transgastric-jejunal tube?

You have this tube because you are unable to safely swallow enough food to keep you healthy. You may also suffer from vomiting or ‘stomach ache’ due to food not emptying from your stomach well. It 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 tube?

Most people require a transgastric-jejunal tube 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 for?

Your transgastric-jejunal tube can last for up to two years; however, it may need changing before this. The tube will have to be changed under x-ray guidance or endoscopy by prior appointment only. This can be arranged via the nutrition nurse specialists and the Endoscopy Department during office hours.

How do I clean my transgastric-jejunal tube 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 does the balloon stay inflated?

Once a week you need to check that the balloon is still full of water. To do this:

• Fill a 10ml syringe with 10ml of cooled boiled water.
• Have another empty 10ml syringe ready.
• Hold the tube in using your spare hand (you may wish to tape the tube to your skin instead).
• Use the empty syringe to draw the water out of the balloon.
• Swap syringes and inflate the balloon with the new water.

If you find the amount of water you draw out of the balloon is less than 7ml this could be a sign that the balloon is not working properly. Please contact either your company nurse or the nutrition nurse specialists for advice.

What to do if I suspect the balloon has burst?

• Please secure the tube to your abdomen with tape.
• In office hours – Contact your community nutrition nurse or nutrition nurse specialists on 01223 216037.
• Out of hours – Wait until the next working day and contact the above.

You will require a replacement with endoscopy which the nutrition nurse specialists will arrange for you.

Why are there different ports?

• The gastric and jejunal ports allow the tube to be used for more than one thing at once.
• The jejunal port is for feeding directly into the small bowel which can help prevent vomiting or reflux.
• 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.

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, it will have to be replaced.

What else 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 your GP, 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.

Also look out for:

• 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:

Monday to Friday 08:30 (8:30am) to 16:00 (4pm) – nutrition nurse specialists on 01223 216037

Out of hours – Please contact your GP or call NHS 111. If you cannot wait to be seen by your GP, please contact your local hospital’s emergency department.