A nasojejunal (NJ) tube is a thin, soft tube that is put in through the nose, goes through the stomach and ends in the jejunum (jue-joo-num), a part of the small intestine.
What Do I Need to Know about an NJ Tube?
- The NJ tube is placed by a doctor while using X-ray.
- The NJ tube cannot be replaced by caregivers in the home.
- You need to use a pump to give feedings through an NJ tube.
- You cannot give a bolus feeding through the NJ tube.
- The tube is held in place with tape on the cheek.
How Do I Know the Tube Is in the Right Place?
- Put an ink mark on the tube where it comes out of the nose. This way you can tell if the tube moves in or out.
- Measure the external visible length, EVL, of the tube, from the nose to the end of the tube.
- Before giving any feedings, check the mark on the tube or measure the EVL to make sure the tube is in the right place.
How Do I Give a Feeding?
1. Wash your hands with soap and water.
2. Check the doctor’s orders for the feeding plan and instructions on how to flush the NJ tube.
3. Gather the supplies and equipment:
- Feeding pump
- Feeding administration set
- IV pole
- Farrell valve system bag (if ordered by your doctor)
- Formula
- Bottle or container to measure formula
- Small syringe (3 or 5 ml)
- Water
4. Open the feeding administration set and the Farrell bag.
- Use a new feeding administration set and Farrell bag every 24 hours.
5. Connect the bags at the “Y” junction on the Farrell bag tubing.
6. Add the formula to the bag.
7. Prime, or fill, the tubing of the feeding administration set with formula.
8. Close the clamp at the end of the Farrell bag tubing.
9. Put the tubing into the feeding pump.
10. Turn the pump on.
11. Refer to feeding pump instructions for pump programming.
- Set the rate – how fast the feedings are to go in.
- Set the dose − how much formula is to be given.
12. Check to make sure the NJ tube is in the correct place.
13. Give a small amount of water to flush the NJ tube to make sure it is open.
- Check doctor’s orders for the amount of water to use.
14. Connect the feeding administration set tubing to the feeding tube.
15. Open the clamp on the tubing.
16. Start the feeding pump.
What Other Things Do I Need to Remember?
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Keep the "Y" of the administration set / Farrell valve connection at the stomach level.
- Never add new formula to formula that is already in the feeding bag. Empty any old formula before adding new formula.
- Flush the feeding tube with 1-5 mls of water before and after giving medications. This helps to keep the feeding tube from clogging.
- It is important to allow your infant or child to have pleasant sensations during feedings (hold during feedings, suck on a pacifier, sit in a high chair, be a part of family meals).
- Ask your doctor or nurse about therapy to help improve oral skills.
What Do I Do If Formula Backs Up into the Farrell Bag?
If formula backs up into the Farrell bag, it means your child’s stomach cannot handle the feedings or there is a problem with the tubing or the feeding tube.
- First, close the clamp on the Farrell bag.
- Check your child to make sure their stomach is not swollen or bloated.
- Check the feeding tube to make sure it is not kinked.
- Check to make sure the feeding tube is not clogged:
- Disconnect the Farrell tubing from the feeding tube.
- Flush the feeding tube with a small amount of water.
- Drain the formula from the Farrell bag into a cup.
- You need to do this because you cannot control how fast the formula will flow.
- Disconnect the Farrell bag tubing and open the clamp.
- Measure the amount of formula not given.
- If child and the feeding tube are OK, raise the Farrell bag higher to avoid having formula back up into the bag.
Call Your Doctor If:
- Your child is uncomfortable or irritable with feedings.
- Your child vomits or has diarrhea.
- Your child’s stomach is swollen or bloated.
- The feeding does not go in or formula continues to back up in the Farrell bag.
- The tube has moved or comes out.