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Gastrostomy-Jejunostomy
Tube Care
http://www.cincinnatichildrens.org/health/info/abdomen/home/gastro-jejuno-tube.htm*
*This
Webpage no longer exists but as the info here is really good I’ve left it in.
**Please note that this is just general information. Please get specifics
for your child’s gjtube care from your home care nurse.
What do I need to know about my child's
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. This tube is used to vent your child's stomach for
air or drainage, and/or to give your child an alternate way for feeding. You
will use the J-tube 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 tube stays in your child's stomach
because there is a balloon or a plastic bumper at the end of the tube inside the
stomach. 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. The tube should be able to move in and out
of the child's stomach just slightly. The plastic disc should be snug against
the skin, but it should not cause pressure.
In both pictures there is a small tube (the
J-tube) sticking out of a large tube (the G-tube)**. There is also a white
connector piece that holds the J-tube inside the G-tube. This connector has a
rubber ring inside of it that tightens around the J-tube and holds it in place.
It needs to be screwed tight enough to keep the J-tube from coming out, but not
too tight as it can pinch the J-tube closed.
·
Procedure
Supplies
Soap and water
Cotton swabs
Hydrogen peroxide (H2O2)
Clean gauze pads
Scissors
Regular-tip syringe (12 cc)
20 cc's water for flushing
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
using cotton swabs. Then rinse the skin using clean tap water and cotton swabs.
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. Try not to move the disc when
cleaning. Do not pull the disc up. It should always stay close to your child's
stomach.
5. If there is any drainage at the disc, cut a slit in a clean 4x4 gauze piece
and place it around the tube under the plastic piece. Do not use more than one
4x4 under the disc. Again, do not pull the disc up.
Flushing the g-tube
Take the screw cap off the end of
the J-tube. Using a 12 cc regular-tip syringe, slowly push about 5 cc's of warm
clean tap water into the tube. Repeat this every 4-6 hours, after every feeding,
and after all medications to keep the tube clean and open. This syringe may be
washed in warm soapy water and reused.
To flush the G-tube with the 12 cc syringe,
slowly push about 10 cc's of warm clean tap water into the side opening or
G-port of the connector.
Giving medication or feeding
Medications are usually given
through the G-port. Irrigate the G-port with 5-10 cc's of water before and after
giving each medication.
Feedings are usually given through the
J-port. Before feeding, check to make sure the J-tube is clear by slowly pushing
5 cc's of water through the J-port.
·
Giving medicines
If medicines are liquid, mix with warm water to make about 10-20 cc's (about 1
tablespoon) and slowly push them into the G-port with a 12 cc regular-tip
syringe. Then slowly flush the tube with about 10 cc's of warm tap water.
·
For pills, crush the medicine
into a powder and mix with about 10-20 cc's of warm water. (Note: Check with
your child's doctor first before crushing medications.) For capsules, open and
dissolve powder in 10-20 cc's of warm water. Using the syringe, slowly push the
medicine through the G-port, then flush the tube with about 20 cc's of tap
water.
Note: If you are told by the doctor to give
medicine through the J-tube, use the same directions but give medicines through
the J-port.
·
Protecting the tube
Do not allow your child to pull on
the tube. Keep the child's T-shirt over the tube. One-piece, snap T-shirts work
best for infants and toddlers. Most children get used to the tube after a while,
but until they do, they may need to wear elbow splints to prevent them from
pulling at the tube. Ask your child's doctor about obtaining a splint if
necessary.
·
An alternate way to cover the
tube is to place an ACE® wrap or stretchy gauze over it.
·
Be sure to keep the cap on the
end of the J-tube to keep the tube from leaking. If you lose this cap, you can
get a replacement cap called a PRN adaptor (also called a heparin lock cap or
injection site cap).
Problem solving
The following are emergency problems
that can occur with a G-J tube. For an emergency, take your child to the
emergency room.
|
Emergency Problem |
What to do before coming to the Emergency Room |
|
G-J tube is forcefully pulled out. |
If bleeding occurs, press on the site with a clean soft
cloth. |
|
G-J tube breaks off or is cut off at the skin. |
Put a gauze or clean cloth bandage over the part of the
tube still in the child. |
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 his/her 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, 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 3 or more times a
day.) |
Call your child's doctor. |
|
Skin or scar appears to be growing where tube enters
skin. |
Clean as per instructions. Call your child's doctor. |
|
J-tube is clogged. |
Try to slowly push warm water into the tube with a 12 cc
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. |
|
J-tube is pulled out of the G-tube. |
Don't feed your child. Don't try to put the tube back.
Call your child's doctor. |
|
Leaking occurs where the connector and G-J tube meet. |
Check to see if the connector fits tightly into the
G-tube. If the fit is loose, try to push the connector a little further
down into the G-tube. If it still leaks, call your child's doctor. |
|
End of G-tube splits where connector goes into the
G-tube. |
Call your child's
doctor. |
|
The connector is pulled out of the G-tube slightly (not
more than 1 inch). |
Try to gently push the connector back into the G-tube. If
you can't push it back in or if the connector pulls out farther than 1
inch, call your child's doctor. |
|
If your child is vomiting feedings or his/her stomach is
bloated, the J-tube may not be in the right place. |
Call your child's doctor. If he/she feels that the tube
is out of place, you may need to schedule an appointment for an X-ray. |
|
J-tubes need to be placed about every 3-4 months. One
sign that the J-tube needs to be replaced is if the tube becomes stiff
or sluggish when flushing it. |
If your child's tube needs to be changed, call your
child's doctor to schedule this. |
Patient Education Program II 2062 11/90
Reprinted 2/96
Revised 9/98
Health Topics Legal Disclaimer
If you or your child experiences
unusual, unexpected or severe side effects from following the procedures or
directions contained in this document, we advise you to immediately call your
primary care physician, your local emergency room, or in cases of extreme
adverse reaction or side effects, call 911 or your local emergency number.
Pediatric care is constantly improving and
dealing with new challenges. New ideas, practices and research prompt continuous
changes in our understanding and recommendations. These pages represent our best
efforts but are in no way meant to replace the critical dialogue and
recommendations of your pediatrician or health care professional. Information
within "Health Topics" is believed to be reliable and generally in accord with
the standards accepted at the time of publication. However, the possibility of
human error and changes in medical sciences prevent the authors and Cincinnati
Children's Hospital Medical Center from offering these pages as anything more
than starting points for care decisions and educational insights that parents,
pediatricians, health care professionals and children must make together.
If you believe you, your child, or someone
you know, suffer from the conditions described herein, please see your health
care provider. Do not attempt to treat yourself, your child, or anyone else
without proper medical supervision.
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