- A pump must be used for Jejunostomy tube feedings
- You CANNOT bolus feed into a jejunostomy tube
Considerations:
- Be sure to take steps to ensure patient privacy when performing procedure
- The unlikely risk with jejunostomy tube feedings is aspiration of formula into the lungs, be sure the student is positioned properly with head elevated at least 30 degrees
- Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
Supplies:
- Adaptor with tubing and clamp
- Feeding solution in container (bag) at room temperature
- 60 ml catheter-tipped syringe
- Pump
- Warm tap water, if prescribed
- Pole to hold feeding container
- Student’s Individualized Health Plan (IHP) and/or healthcare provider’s orders
- Review healthcare provider’s order including:
- the type of formula
- amount
- infusion type and rate
- frequency of administration
- residual volume checks
- amount of water used to flush the tube
- Explain the procedure to child at his/her level of understanding
- Wash hands
- Assemble equipment and place on a clean surface
- Position child either sitting or supine with head up at least 30 degrees
- Ensure that the clamp is not resting on the student’s skin
- Put on gloves
- Observe abdomen for signs of tube malposition or obstruction/clogging of jejunostomy tube such as difference in external tube length compared to baseline measurements or abdominal distention
- If student has abdominal distention do not administer feeding and contact parent/guardian and healthcare provider
- Pour feeding/fluids into feeding container, run feeding through tubing to the tip and clamp tubing
- Hang container on pole at height required to deliver prescribed flow
- If pump is used, place tubing into pump and set flow rate
- Open safety plug and insert tubing into the J-tube
- Open clamp on tubing
- Turn on pump to prescribed rate
- When prescribed volume of feeding is completed, clamp feeding bag tubing and remove
- Attach catheter-tipped syringe and flush tubing with 5ml of water or prescribed amount
- Disconnect syringe
- Connect cap or plug to J-tube
- Keep the child in a feeding position for at least 30 minutes after completing feeding, if required
- Wash syringe and tubing with soap and warm water and put in home container
- Catheter tip syringe and feeding extension tubing can be used repeated times for up to 24 hours
- Remove gloves
- Wash hands
- Document assessment, interventions, and outcomes in student’s healthcare record
- Follow up with parents/guardian and healthcare provider, as needed
Resources:
MIC Transgastric-Jejunal Feeding Tubes http://www.halyardhealth.com/media/128697/u5918_brochure.pdf
MIC Enteral Feeding Tubes and Accessories
http://www.kchealthcare.com/media/2886710/u4850_mic_enteral_tubes.pdf
Bankhead, R., Boullata, J., Brantley, S., Corkins, M., Guenter, P., Krenitsky, J., Lyman, B., Metheny, N.A., Mueller, C., Robbins, S., Wessel, J. (2009). Monitoring enteral nutrition administration. In: A.S.P.E.N. enteral nutrition practice recommendations. Journal of Parenteral and Enteral Nutrition, 33(2), 162-6.
References:
Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at:
http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf
Porter, S., Haynie M.D., Bierle, T., Caldwell, T. & Palfrey, J. (1997). Children and Youth Assisted by Medical Technology in Educational Settings. Guidelines for Care. Second Edition. Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624
Simons, S., Remington , R. (2013). The Percutaneous Endoscopic Gastrostomy Tube: A Nurse’s Guide to PEG Tubes. MedSurg Nursing; 22(2):77-83.
University of Wisconsin Hospitals and Clinics. (2012). Caring for Your J-tube. Available at: http://www.uwhealth.org/healthfacts/B_EXTRANET_HEALTH_INFORMATION-FlexMember-Show_Public_HFFY_1104449363413.html
Acknowledgment of Reviewers:
Lori A. Duesing, MSN, RN, CPNP-AC
Advanced Practice Nurse
Department of Gastroenterology
Children’s Hospital of Wisconsin
Kathy Leack, MS, RN, CNS
Advanced Practice Nurse
Children’s Hospital of Wisconsin
Page last updated: April 6, 2015