J Tube Placement (Jejunostomy)

What is a J tube (jejunostomy tube)?

A J tube (jejunostomy tube) is a feeding tube that a healthcare provider places in the midsection of your small intestine (jejunum). It’s a long-term feeding tube that you can use at home. Most people who need a jejunostomy tube will use it for at least six weeks. Some people may continue to use it for life.

The procedure to place the tube in your jejunum is called a jejunostomy. This is what the tube is named for. If your healthcare provider decides that a J tube is the right treatment for you, they’ll create a small opening in your abdomen for the tube to go in. The tube will stay in place for as long as you need it.

Why would you need a jejunostomy (J tube)?

You might need a feeding tube to get nutrients and medicine into your digestive tract if you can’t get them by eating. Different types of feeding tubes connect to your digestive tract in different ways. A J tube goes directly into your small intestine through your abdomen. You might need this type of tube if:

• You can’t have a tube that goes through your nose. Nasal tubes work well in the short term, but not in the long term. They’re not as discreet or as comfortable to move around with.
• You can’t have a tube that goes into your stomach. This might be the case if a medical condition makes your stomach or duodenum (the upper part of your small intestine) unusable.

Some conditions that might require a jejunostomy tube include:

• Long recoveries from trauma or illness that affect how well your stomach works
• Motility issues, like swallowing problems, gastroparesis or severe GERD
• Obstructions in your upper GI tract, like a tumor or scar tissue (stricture)
• Severe malnutrition due to a long-term disease
• Surgery on your upper GI tract

Sometimes, healthcare providers place a J tube to deliver medicine. Medications that you take orally are sometimes more effective when they bypass your stomach and go directly to your small intestine. Your provider might try delivering your medicine this way if the oral way isn’t working well enough.

What is the procedure to place a J tube?

The procedure to place a J tube is called a jejunostomy. A jejunostomy is a minor procedure that creates a new opening (ostomy) in your intestine (jejunum) for the tube to go in. It goes in through another new opening in your abdomen (a stoma). Your surgeon will create these openings and then place the tube.

How is J tube placement done?

There are different ways of performing a jejunostomy to place a J tube. Some of these methods include:

Percutaneous endoscopic jejunostomy (PEJ)

This method uses endoscopy to place the J tube through your skin (percutaneously). A gastroenterologist guides a lighted enteroscope into your jejunum. The light allows them to locate it through your abdominal wall. They make a small incision over it to reach your jejunum.

Laparoscopic jejunostomy

This method uses laparoscopic surgery, a minimally invasive surgery technique. A surgeon makes three small incisions in your abdomen and places a laparoscope inside. The laparoscope transmits to a screen. Your surgeon operates with long, skinny instruments through the incisions.

Open surgery jejunostomy

Open surgery means your surgeon makes one larger incision in your abdomen instead of several small ones. Your surgeon will locate your jejunum and bring it to the surface of your abdomen. They’ll place the tube inside your jejunum and close the wound around the tube.

Your condition and your surgeon’s expertise will determine the type of procedure you have. Sometimes, a jejunostomy happens as part of a larger surgical procedure. Your surgeon will tell you what to expect and how to prepare for your procedure. In many cases, you can expect to go home on the same day.

What are the risks of the procedure?

Any surgery carries a small risk of complications, like infection or accidental injury to one of your organs. But these are uncommon. Most complications from having a J tube develop after the procedure and during daily use. These mostly relate to the J tube itself or the type of feeding formula you use.

What happens after a jejunostomy?

Once your J tube is in place, you can use it for six to 12 months before you’ll need to replace it. Your healthcare team will show you how to clean and care for your J tube and your stoma. A dietitian will determine the best feeding formula for you to use. Not all foods or medicines can be used with a J tube.

How long is the recovery from a jejunostomy?

It takes about two weeks for your stoma to heal. Until then, you’ll need to keep it dry and change the dressings daily. You’ll have some pain at the site, but it will get better each day. You can start feeding on the first day. Your healthcare team will make sure the feeding goes smoothly before sending you home.

How long will I need a J tube?

How long you need to use your J tube will depend on the reason you need it. If your condition improves, your healthcare provider can remove your J tube and close your jejunostomy with a minor procedure. If you continue to benefit from having a J tube, you can replace the tube as many times as you need to.

What do I need to know about using a J tube?

Living with a J tube is a significant life change. On one hand, getting the nutrition and medication you need may improve your health enough to allow you to do more than before. On the other hand, you’ll have to adjust your routine around the practicalities of feeding. Here’s what you need to know:

• Enteral feeding is slow. Your intestine can’t process as much food at once as your stomach can. J tube feeding is a slow, steady drip. It can take many hours at a time to get the nutrition you need. In some cases, it takes all day. You might need to carry a portable feeding pump with you.
• You need to flush it often. Your J tube will come with a syringe you can use to flush it with warm, sterile water. It’s important to flush it before and after every use to keep it clean and prevent it from getting clogged. If it gets clogged, you’ll likely need to get a new one.
• Your stoma will need ongoing care. It’s not uncommon for a J tube to irritate the skin around your stoma. Movement can cause friction, and even small amounts of leakage from the tube can burn the skin. Your healthcare team will show you how to clean and protect your skin.
• You need to be careful with movement. You can move around with a J tube. But if you want to move vigorously, you should take steps to secure the tube. Consider close-fitting underclothes. A J tube can fall out somewhat easily. If it falls out, don’t wait. Call your provider right away.

What are the potential complications of having a J tube?

Complications that can happen after your jejunostomy include:

• Digestive difficulties: Some people have symptoms like nausea, diarrhea or abdominal pain when they first start tube feeding. Your dietitian might need to adjust your feeding formula.
• Food poisoning: Infection is a risk if your feeding formula gets contaminated by germs. Your healthcare team will explain how to protect your food stores and your J tube from germs.
• Nutritional imbalances: Some people show signs electrolyte imbalances, acid-base imbalances (like acidosis) or nutrient deficiencies after starting tube feeding. Your dietitian can address this.
• Stoma complications: The skin around your stoma can get irritated and may develop a type of scarring called granulation tissue. Your healthcare provider will need to remove the tissue.
• Tube blockage: Not flushing your J tube out often enough can lead to a blockage. When J tubes get clogged, they’re hard to safely unclog. Your healthcare provider might have to replace it.
• Tube dislodgement: If your tube falls out, see your provider right away. Your jejunostomy can close quickly. If it dislodges from your intestine and leaves a hole, it’s even more serious.
• Tube displacement: If your surgeon fails to place or secure the tube correctly, it could migrate upward. This could lead to aspiration — food drifting up into your airways — and pneumonia.

When should I call my healthcare provider?

See your provider if:

• You feel food drifting up into your esophagus
• You have new or worsening abdominal pain
• You have ongoing gastrointestinal symptoms
• Your stoma looks irritated or develops scar tissue
• Your tube falls out
• Your tube gets blocked