What is a gastrostomy-jejunostomy tube?

A gastrostomy-jejunostomy tube - commonly abbreviated as "G-J tube" - is a tube that is placed into your child's stomach and small intestine. The “G” portion of this tube is used to vent your child's stomach for air and / or drainage, as well as give your child an alternate way for feeding. The “J” portion is used primarily to feed your child.

The word "gastrostomy" comes from two Latin root words for "stomach" (gastr-) and "new opening" (-stomy). "Jejunostomy" is made up of the words for "jejunum" (or the second part of the small intestine) and "new opening."

The G-J tube stays in place in your child's stomach because there is a balloon or a plastic bumper at the end of the tube inside the stomach securing it to the stomach wall. There is a smaller tube (the J-tube) that will go into the jejunum via the same opening in the stomach wall, secured by the same balloon.

There is a plastic disc around the tube outside of the child's body. This keeps the tube from sliding in and out of the opening. This plastic disc should not slide around on the tube and should be snug against the skin (the space between the bottom of the disc and the stomach should be about the depth of a dime), but it should not cause pressure. The tube should be able to move in and out of the child's stomach just slightly.

On the outside of the body, you will find three ports at the end of the tube labeled: gastric, jejunal and balloon. Your doctor or nurse will give you further instructions for their use.

Supplies

• Clean work area
• Soap and water
• Hydrogen peroxide (H₂O₂)
• Clean gauze pads
• Catheter tip syringe (35 ml)
• Water for flushing the tube

Procedure

Cleaning and dressing the wound:

1. Wash your hands with soap and water.
2. Remove the old dressing. Look at the area where the tube enters the skin. Check for redness, swelling, green or yellow liquid drainage, or excess skin growing around the tube. A small amount of clear or tan liquid drainage is normal. See the problem-solving list in the last section for what to do if you notice any of these things.
3. Clean the skin under the plastic piece around the tube with soap and water or during bath time / shower. Then rinse the skin using clean tap water and dry thoroughly.
4. To clean crusted drainage off of the skin, tube or disc, use half-strength hydrogen peroxide (1 tablespoon hydrogen peroxide mixed with 1 tablespoon water) and cotton swabs. Dry with a clean cotton swab.
5. If there is any drainage at the disc, place one two x two softwick piece under the plastic disc.
6. Do not rotate a jejunal tube. This can cause kinking.

Flushing the Tube

To flush the G-J port of your tube, slowly push warm clean tap water into the side opening of the G-port or J-port of the connector. The syringe may be washed in warm water, air dried and reused.

Medication or Feeding

Your doctor or nurse will give you instructions through what port medications and feedings should be given. Be sure to follow their instructions carefully. Do not mix medications unless you are instructed to do so by your doctor.

Protecting the Tube

Keep your child from pulling on their tube. There are several different ways of securing a G-J tube. Your child's doctor or nurse will discuss these with you. Here are some suggestions:

• Keep the tube taped or pinned to the diaper or shirt.
• Keep the child's T-shirt over the tube. One-piece, snap T-shirts work best for infants and toddlers.
• An alternate way to cover the tube is to use an ACE wrap or stretchy gauze over it.
• Most children get used to the tube after a while, but until they do, they may need to wear elbow splints if necessary.
• Be sure to keep the end of the tube closed as directed.

Problem Solving

The following is an emergency problem that can occur with a G-J tube. For an emergency, take your child to the emergency room.

Emergency problem: G-J tube is forcefully pulled out.

Before coming to the Emergency Room: If bleeding occurs, press on the site with a clean, soft cloth. The opening in the stomach may close within hours, so it is important not to wait before coming to the Emergency Room. When a G-J tube is replaced, it is important to verify that the tube is in the right place by taking an X-ray. Be sure to bring the tube with you to the Emergency Department.

The following are non-emergency problems that can occur with your child's G-J tube. Remember to notify your child's doctor if your child will miss a feeding because of a problem with their G-J tube.

Problem	What to Do
G-J tube site is red and sore or has green or white liquid where the tube enters the skin.	Clean as per instructions. Call your child's doctor. If your child also has a fever, (greater than 100.4) this is an emergency. Call your child's doctor immediately.
G-J tube site is leaking large amounts of clear and / or mucus-like liquid. (Large amounts = soaks a 4x4 gauze three or more times a day.)	Call your child's doctor or nurse.
Skin or scar appears to be growing where tube enters skin.	Clean as per instructions. Call your child's doctor or nurse.
J-tube is clogged.	Try to slowly push warm water into the tube with a 10 ml regular-tip syringe. Use slow, easy pushing. Never try to push any object into the tube to unclog it. If you are unable to unclog the tube, call your child's doctor or nurse.
If your child is vomiting feedings or their stomach is bloated, the J-tube may not be in the right place.	Check the marking on the tube to see if it has moved. Call your child's doctor. If the doctor feels that the tube is out of place, you may need to schedule an appointment for an X-ray.
MIC-KEY G-J tubes need to be replaced about every six months.	If your child's tube needs to be changed, call your child's doctor or nurse to schedule this or call Radiology through the Cincinnati Children's operator at 513-636-4200.

Additional Information

(To be completed with the help of your healthcare team.)

My child has a _____________ (type of tube).

My child's tube size is _______fr. with a balloon volume of _____ ml.

This information is necessary if the tube needs to be replaced. If your child has a balloon catheter type tube, please check for level of tube placement every day. If the length of the tube seems much less than normal then call your nurse or doctor.

It is important to allow your infant to have pleasant sensations during feeding. This can be done by allowing them to suck on a pacifier during the feeding and by talking to and allowing them to face you during the feeding. You may even hold your child at this time.

Always call your doctor or nurse if you have any questions or problems.

Phone numbers:

MD ______________ Nurse ____________ Home Health _________