What is a jejunostomy tube (J-tube)?

A jejunostomy tube, also called a J-tube, is a surgically placed directly into your child's small intestine to help with nutrition and growth. The tube is usually a red rubber tube that is stitched at the stoma site, which is the opening in the skin. This type of tube doesn't have a balloon or mushroom end to hold it in place, so it can come out easily.

For many reasons, some children can't eat enough by mouth to grow. These children can get J-tube feedings that have enough calories and nutrients to help them get good nutrition and grow well.

How is a J-tube put in place?

A pediatric surgeon surgically places the J-tube. While your child is asleep in the operating room, the surgeon makes an incision on the belly area and makes an opening into the small intestine, called the jejunum. She then places a tube is into the opening and into the small intestine and stitches it into place.

The surgeon will place a dressing at the opening where the tube comes out. This dressing will be removed 48 hours later and replaced with a special piece — called a HOLLISTER attachment device — to keep the tube in place and keep it positioned straight up and down so that the stoma (opening) will heal well. There will be stitches placed around the tube and into the skin at the opening to the jejunum. These won't need to be removed, but will eventually come out of the skin.

Occasionally, the surgeon will use another kind of a tube — such as a MIC-KEY or BUTTON — as the J-tube.

Follow-up care

Your child's J-tube shouldn't interfere with his normal activities. He should bathe, play, swim and sleep as usual. You may find that certain clothing — such as one-piece or "bib"-type outfits — help keep the tube from catching on something and pulling out. It will also discourage your child from pulling on the tube.

Keeping the tube in place

It's very important to make sure your child's J-tube moves as little possible, not only to prevent it from falling out, but also to keep it from moving at the stoma site. The more the tube moves at the site, the larger the opening becomes. A larger opening, in turn, allows fluid to leak out. This fluid can cause skin irritation and breakdown, as well as a type of scar tissue called granulation tissue.

Here's how to minimize J-tube movement:

• If your child's J-tube is a red rubber catheter or Foley:
  • Secure the tube in place at the stoma site with a HOLLISTER attachment device. (Your child's healthcare providers will show you will how to do this.)
  • Measure the length of the tube and compare it with previous measurements. If the stoma is at least six weeks old, either pull the tube out a little or push it in a little to match the previous length measurement.
  • Secure the tube that's hanging out with a doubled-over piece of tape that is then pinned to your child's clothing.
• If your child's J-tube is a MIC-KEY tube or BUTTON tube, you may need a shorter tube, or you may need to add "spacers."

If the tube falls out, place the end of a tube into the stoma about 1 inch and tape it in place to keep the stoma from closing. Call your doctor or advanced practice nurse right away, because the site can close off in a very short amount of time.

Caring for the stoma and skin

It isn't uncommon for J-tubes to leak at the stoma site. This leakage from the small intestine can be very harsh to the skin and can quickly cause skin irritation and breakdown. That's why it's important to look at the stoma site and surrounding skin — and clean it — once daily.

Clean the stoma site daily with mild soap and water, but don't scrub; this can slow down healing or cause skin breakdown. Dry well.

When the HOLLISTER device is in place, use a cotton swab to clean around the tube at the device opening. You don't need to change it every day — only when it starts falling off or is soiled, usually about every three or four days.

You may see a type of scar tissue — called granulation tissue — forming at the stoma site. Granulation tissue, which is usually dark pink or red, has a good blood supply, so it bleeds very easily. It forms because the body wants the stoma to heal, and the tube goes through the opening and it can't heal over, so tissue grows around the tube. In some children, granulation tissue grows at a fast rate; others have no problem with it all. Granulation tissue grows faster when there's a lot of tube movement at the stoma site.

If you see some of this tissue starting to grow, do everything you can to minimize the movement of your child's tube by taping it into place to prevent movement of tube and friction; you may be shown a taping technique to hold tube in place.

If you see a large rim of granulation tissue around the tube, call your doctor or nurse for an appointment; they'll treat it in the office with a medicine called silver nitrate, which shrinks the tissue and turns the tissue gray/brown. The drainage after silver nitrate treatment may be brown or black. Because this drainage shouldn't get on the "good" skin around the tube, your child's doctor or nurse will put Stomahesive powder at the site to absorb it.

Preventing clogging

It's also important to prevent the J-tube from clogging by flushing it with 10 cc of water after each feeding and each medicine.

If the tube does become clogged, attach a 5 cc syringe with warm water to the end of the feeding tube adapter. Try to flush the tube. If you're unable to flush, pull back on the syringe plunger. Try to flush and pull back up to five times. If you still can't flush the tube, try using warm water in a 3 cc syringe and repeat the same steps.

If none of these measures work, call your child's doctor or nurse.

When to call the doctor

It's important to call your child's doctor or nurse practitioner if you see a lot of leakage or skin irritation. Call if you see:

• A rash with red dots on the edges
• Increasing redness and swelling around the stoma
• Open areas of skin around the stoma
• Bleeding at the stoma site
• Growing scar tissue (granulation tissue) around the stoma
• Increased leakage at the stoma site

It's also important to call your child's doctor if the tube becomes clogged or falls out.

You may want to write this information down in a handy place, so you have it to refer to whenever you need to call your child's doctor.

• Name of the physician who placed the tube
• Phone
• Date of initial tube placement
• Type of tube
• Size of tube
• Replacement date(s)

Reviewed by: Surgical Advanced Practice Nurses
Date: November 2008