Naso-Jejunal (NJ) Tubes

Before the Procedure

If your child is old enough to understand and is alert, he or she will be told what is going to happen and why. They’ll be encouraged to hold very still during the feeding tube placement. A nurse may help hold your child while the tube is being placed. Parents might want to offer a reward or a treat to encourage their children to cooperate with the nurses. Providing older children a distraction, such as an iPad, book, or toy may help take their mind off the procedure.

If your child is a baby or toddler, they may be swaddled in a blanket for greater comfort.

Infants and children respond best if a parent is there beside them, offering consolation and support. If you don’t feel like you can do this, it’s OK. You can leave the room and return after the procedure is done.

During the Procedure

An NJ tube can be placed in a variety of ways. Your child may be taken to a special procedure room in the IR (Interventional Radiology) department, may be taken after the tube was placed to get an x-ray, or may not have to be taken to another room at all, based on the equipment available at the facility. When a special room isn’t needed, placement is done at the child’s “bedside.”

Tube placements done by nurses at your child’s bedside may include a piece of equipment called a CORTRAK*. This device allows the staff to watch the tube’s passage on a screen. If used, your child will have a triangle-shaped sensor unit placed on the lower chest area and you can be present to watch. If the facility you’re in does not have this device, nurses may still place the tube at bedside, repositioning your child as needed, during the procedure. The tube will pass through the nose and throat, into the esophagus, down into the stomach and finally be guided through the small opening (called a pylorus) into the small intestine. This procedure may take several minutes.

Please know that the procedure isn’t comfortable, and your baby will cry some. This doesn’t mean anything is wrong.

After the placement is done, the tube will be taped onto the cheek. Your nurse may mark the tube with ink at the nose so they can know if moves. If a CORTRAK* device wasn’t used, your child may be taken to have an x-ray to verify placement of the tube.

After the Procedure

It’s normal if your baby or child has a stuffy nose or a little discomfort after the procedure, so don’t be alarmed. Pain medication usually isn’t needed.

Most NJ feedings run 24 hours a day, especially at first. Depending on the tolerance of the formula and the rate, it’s possible that this rate might be increased to allow several hours off the pump every day.
You’ll want to watch your child and make sure they don’t remove the tube, since babies and children sometimes will try. You won’t be taught how to replace the tube at home. The care team will discuss tube replacement with you.

Ask the nurse any questions you may have before you go home. You might even want to keep a list of questions with you, such as how to give feedings, what problems you should watch for, who to contact if you have questions, and what supplies you’ll need and where to get them. Even if your child isn’t allowed to take liquid by mouth, you’ll still want to practice oral care and should ask for or get an infant swab or toothbrush to have on hand to clean your baby’s mouth.

One more tip: in some cases, you’ll need to give medications down the NJ tube. If so, ask if the medicine needs to be diluted first. You’ll also need to flush the tube before and after giving the medicine to prevent clogging.

Your First Day at Home

The first thing you’ll want to do when you get home is find a place to store supplies that is out of your child’s (or siblings’) reach. If your child need a feeding pump, keep the tubing off the floor so no one can trip over it. Be sure to protect the feeding tubing from pets and siblings.

Check the tube several times a day and make sure it hasn’t moved. This could happen if your child throws up or is uncomfortable and tries to remove the tube. If you see formula at your child’s mouth or in fluid that’s thrown up, call your child’s care team. This may indicate that the tube isn’t in the right place anymore. Also make sure the tube remains securely taped to prevent it from slipping out.

Keep your urgent, emergent handout on hand for quick reference.

Remember: the first day at home after any big change is going to require some adjustment. But before long, you’ll become more used to what to do and how to do it and you’ll develop a new routine that’s second nature to you.

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