Patient Instructions: Low-Profile Balloon Jejunostomy Tube placed by Interventional Radiology

These instructions are for Children’s Hospital of Philadelphia (CHOP) patients with low-profile J tubes, such as Mic-key^® button J tubes (jejunostomy tubes).

Important information:

A low-profile J tube (jejunostomy tube) is placed directly into the small intestine (jejunum). Low profile means the tube lies flat on the belly. This type of tube is for children who cannot have feedings or medicines go into their stomach, and do not need to drain or vent their stomach. Your child needs to be specially measured for this type of tube.
A balloon filled with water holds the tube in place. The balloon port is not to be used for feeding or medicine. The inside of the feeding port has a one-way valve that works like a trap door. When the valve is closed, nothing can pass through the tube. To open the valve to give feedings or medicines, a special tube called an extension set, is attached. The extension set connector locks into the feeding port of the low-profile balloon J tube
About every 3 months, you will need to call Interventional Radiology to schedule your child for a routine tube change. The tube will also be measured for correct size.
Your child’s tube should not interfere with their normal activities. They can bathe, swim, play and sleep as usual. This kind of tube works especially well for the active child because there is nothing hanging out to get caught on and the tube is easily hidden under clothing.

Low-profile balloon J tube

Instructions for attaching the extension set:

Hold the J tube button firmly between your thumb and index finger. Match up the black line on the extension set with the black line on the low-profile tube.
Push the extension set connector into the feeding port, and, while keeping pressure on the tube, turn it ½ to ¾ of a turn in the direction of the arrow. This opens the valve.
If the connector does not turn easily, make sure that it is pushed in fully and that there is nothing blocking the opening to the feeding port.
If the tube is turned more than ¾ of a turn, the valve may break.
When a feeding is finished, flush the tube, remove the extension tubing, and close the cap.
Remove the extension set to prevent your child from pulling on the tube.

Instructions for cleaning the extension set:

Wash the extension set in warm, soapy water after each use.
Rinse well and hang to dry.
Ask your homecare company how many sets you will receive each month. This will let you know how often you can change the extension set.

Instructions for skin care:

Wash around where the tube is inserted, known as the stoma site, and surrounding skin with mild soap and water every day, or more often if needed. Be gentle. Scrubbing can slow down healing or cause skin breakdown. Rinse with water and dry well. It is normal to have a little yellow-brown drainage and redness at the opening.

Call your child’s healthcare provider if you see:

Rash with red dots on the edges
Signs of infection: increased redness, swelling, yellow-green drainage with a bad smell at the stoma, pain
Open areas of skin around the stoma
Bleeding at the stoma site
Bleeding, painful, or growing granulation tissue around the stoma
Increased leaking at the stoma site

Instructions for leaking at the stoma site:

If there is leaking at the stoma site, check the amount of water in the balloon.
- Hold the J tube button against the belly and pull back on the balloon port with the syringe that comes in your J tube kit. Check the amount of water that you have pulled into the syringe.
- If there is less than the usual amount, add water.
- Keep your thumb on the syringe plunger while removing the syringe from the balloon port. This will keep water in the balloon as you remove the syringe instead of flowing back into the syringe.
Balloon volumes are different based on size and type of tube. Talk to your healthcare provider about the right amount of water for your child’s tube. Never have more than the maximum recommended amount of water in the balloon. If you add too much water to the balloon, it may break or cause a blockage in the intestine.
If leaking continues, call Interventional Radiology.
While you are waiting to get instructions, keep your child’s skin dry by changing any wet gauze or dressing under the tube as needed.
Protect the skin around the stoma with a skin barrier, such as Vaseline^®, A&D^® ointment, diaper cream or Cavilon™ No Sting Barrier Film (if your child is over 1 month of age).

Instructions for treating granulation tissue:

Granulation tissue is a type of scar tissue that forms when the body is trying to heal itself. Because the feeding tube stoma is a new opening, your child’s body naturally may try to close it by growing this tissue. Some children have granulation tissue that grows very quickly, while others have no problem with it at all. Granulation tissue is dark pink or red. Sometimes it can cause leakage and skin irritation. It may also bleed or cause pain. If this happens contact your healthcare provider.

If you see granulation tissue starting to grow, discuss it with your healthcare provider at your next visit.
If the granulation tissue around the tube is bleeding, painful, or growing quickly, contact your healthcare provider for an appointment. They may prescribe a cream that you can use at home, or they may treat it in the office with a medicine called silver nitrate. These medicines shrink the granulation tissue. Granulation tissue may return and need to be treated with medicine again.

Instructions for a clogged tube:

Try to prevent the tube from clogging. J tubes can clog easily and need to be flushed with 5-10 ml of water every 2-4 hours throughout the day, after all feedings, and before and after all medicines.
If the tube becomes clogged, attach a 5 ml oral syringe with warm water to the end of your feeding tube. Try to flush the tube. If you cannot flush, pull back on the plunger of the syringe. Repeat this push and pull action up to 5 times. If you still cannot flush the tube, try using warm water in a 3 ml or 1 ml oral syringe and repeat the above steps.
If you still cannot flush the tube, use the Clog Zapper® kit as you were taught. Clog Zapper is a ready-to-use kit containing a powder that helps break up clogs in feeding tubes. Clog Zapper contains maltodextrin, a type of sugar. If your child is on a ketogenic diet, they will need microlipids once the tube is unclogged. Talk to your healthcare provider about how much to give. Clog Zapper also contains coconut and should not be used in those with tree nut allergies.
If this does not work call Interventional Radiology.

Instructions if the J tube comes out:

No matter how long your child has had a J tube, the stoma can close very quickly.

Put water-soluble lubricant on the end of the tube. Insert the end of the tube into the stoma about 1 to 2 inches. Do not force the tube if you meet resistance. Tape the tube in place. The tube will keep the stoma from closing.
Do not feed your child through the tube.
Call Interventional Radiology right away.

Call your CHOP team with any questions or concerns.

If you have any questions about your child’s health, please contact your child’s healthcare provider. This document is intended only to provide general educational information and is not intended as medical advice or treatment. Please consult with your healthcare provider prior to use, as some of this information may need to be adapted for your child’s specific needs. It is the responsibility of your healthcare provider to advise you on the appropriate use of this information. If you/your child are not already a CHOP patient, this document does not create a doctor-patient relationship between you/your child and CHOP. CHOP is not responsible for any outcomes you/your child might experience from your use of this document. This document is provided "AS IS", WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, express or implied. If this document refers to any drugs or medical devices, it is the responsibility of your healthcare provider to check the FDA status prior to use. If this document includes references to drug dosing, please do not rely on this document. Your healthcare provider should check the package insert for each drug before use. Hyperlinks used within this document may not be translated into other languages.