J-tube use? Clueless!!

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    I floated the other night and had a patient with a j-tube, which I havn't dealt with since lab in nursing school. What is the best most basic routine for giving meds through the tube (they were suspensions) and what about all the flushing and such? He was on a pump for continuous feeding that did the flush automatically. What's different about a peg tube, which I also havn't dealt with.
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    Try this site. There are all kinds of enteral tubes. I'm like you I hardly ever dealt with them. I do know that the smaller J tubes don't require aspiration.

    http://www.springnet.com/ce/p012b.htm
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    In short, remember the Gi tract, esophagus, stomach, duodenum, jejunum, ileum and then colon.

    PEG tube= percutaneous endoscopic gastric tube. Placed in the stomach, primarily for tube feedings.

    J-Tube = Jejunem tube, placed in the jejunum, primarily for tube feedings.

    Why the difference? Some patients are at higher risk for aspirations and J-tubes lessen that risk do to placement of tube feedings farther down the GE tract. In addition, sometimes they may want extended healing time or resting of the doudenum or stomach do to surgery, disease, etc. and opt for a J-tube.

    In general they are somewhat the same. Depending on port configuration, you may have medication ports, etc. Typically you check for residual content Q 4 hours. I flush the port with 5 - 10 cc water after medications to confirm something didn't get stuck and that all medications entered the bowel. Check with your policy and procedure manual.

    Absolutely, check the chart and confirm you are dealing with gastric tubes, there are many more tubes that exit the abdomen, T-tubes, fistulas, drainage tubes, etc. which do not enter the gut and are for output only !

    There is more to it than that, hope this refreshes your memory.
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    They are the same in the sense that they both go down into the GI tract.

    The G-tube (gastric) sits in the stomach and you would pull a residual on that Q4 hours, while you have feed running. If you are not running feed then there is no need to check residual.

    J tube goes down to the jejunum. You do NOT check a residual on this tube.

    On both you flush pre and post to giving meds. Some meds are notorious for clogging the tubes, so flush. You also need to consider that, if the patient can tolerate it, they should have some FREE water instilled Q shift. If they got the tube down they are probably not drinking. I like to give around 200 hundred total, meds and water, on my time, if no order is written. Usually the doc will order how much they want.....240 per shift is common.
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    Are we so different from everyone else? For G-Tubes, we do not routinely check residuals. About the only time we check residuals is PRIOR to beginning feeds for the first time after the tube has been placed or when the patient has been npo for some time. We very rarely check during feeds (unless there's some intolerance) and definitely not q 4 hours. Just curious?????
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    The norm in my long term care facility was for flushes and residual checks q 4 hours for G-tubes. I can't remember if we had any J tubes at any point. But for any tube I like try to juggle the med schedule for the same time as the flush. That way you can use the larger flush amount to really clear out that tube (and sometimes borrow a bit to dilute that suspension too so it goes down better--some are very thick) and that helps to keep them running cleaner.
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    Well, since you hadn't had one since school, and were only floating, you probably won't have one again for sometime, but here is a hint for giving meds in a J-tube (or peg tube for that matter) to ensure almost guaranteed clot free administration. I take all of the meds and crush them up to a fine powder (or as good as you can get)... then I get this boiling hot water we have from these little taps next to the regular sink and put a little bit (about 4 oz) in a cup with the meds. I let them dissolve and soak for about 10-15 minutes, stirring them with a tongue depressor to keep them dissolving. Then, I put about 8 more oz of water in with them (cool), and take them to give. I flush the tube first with a warm but not hot water, then take the syringe without the stopper in it and pour the med solution in, then flush with about 25 cc more warm water...when I am done it is good as new and I have never had a clot or blockage from the meds. Also, a friend of mine told me she uses clear soda or cranberry juice (apparently the bubbles and / or acid help) to flush and keep the tube patent...Just some nice little hints that help for the future!!
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    THE FACILITY I WORK IN HAS A POLICY FOR J-TUBE FEEDING/MED ADMINISTRATION, FIRST MEDS CAN NOT BE MIXED, SO IN SOME CASES WE HAVE AS MANY AS TEN MEDICATION CUPS, THEN SUSPENSIONS HAVE TO BE MIXED WITH 30CC WARM WATER TO THIN THEM, WE TRY TO GET ALL ORDERS IN SUSPENSION FORM, HOWEVER IF WE CAN'T FOR ANY REASON, PILLS HAVE TO BE CRUSHED TO A FINE POWDER AND MIXED WITH THE 30CC WARM WATER, THEN WE FLUSH THE TUBE WITH 30CC WARM WATER BEFORE AND AFTER THE MEDICATION. UNLESS WE HAVE SPECIFIC DR. ORDER FOR COLA, GINGER-ALE, OR CRANBERRY JUICE, WE ARE NOT ALLOWED TO USE THEM, ONLY WARM WATER. I HOPE THIS HELPS YOU THE NEXT TIME YOU FLOAT TO THE UNIT WITH A TUBE FEEDER, OR IF YOU GET ONE ON YOUR UNIT. FIRST THING, DON'T BE AFRAID OF SOMETHING DIFERENT, YOU MADE IT THREW SCHOOL, JUST REMEMBER YOUR BASICS, AND CHECK YOUR FACILITY POLICIES YOU CAN'T GO WRONG.
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    If a medication needs to be stored at room temperature, then dissolving it in boiling water doesn't seem wise. If storing a med in a hot car makes it lose efficacy, it is possible that boiling water would make it useless. Have you talked to your pharmacist?

    Just a thought.
  12. 0
    On my unit I work with peg tubes/J-tubes almost on a daily basis. You pretty much treat them both the same. It is very important to flush to prevent them from stopping up. Coke works well to unstop a tube because of the carbonation and acidity eat away at what is stopping up the tube. I always check residuals every time I place meds in or at least twice a shift. Most people who have tubes are not active and are famous for getting obstructions and illeus, in fact it is quite common. By checking the residual, you make sure everything is working properly. I like to give extra water/juice to my patients because I think of it like offering water/juice to my nonpeg tube pts. Some older people get dehydrated easily, and extra fluids help. Also, some of my patients who are mentally there, but still need a peg state they can taste what goes in there tube, and they like the juice. We have been known to put Jell-O and melted popsicles in their tube. As far as dissolving the meds before placing them in the tube, I have done that before but I used room temp. water.


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