Jejunostomy feeding in Pediatrics

Jejunostomy feeding is the method of feeding directly into the small intestine. In this procedure, the feeding tube is passed into the stomach, through the pylorus and into the jejunum.

Equipment Needed

• 50-60 mL Asepto syringe
• Ounce glass
• Sterile water
• Prepared formula brought to room temperature
• Clamp
• Protective bed covering
• Enteral feeding bag and tubing/ enteral feeding pump (optional)
• Gloves

Preparation of Child and Parents

• Explain the procedure to parents and child as appropriate.
• Elevate the child’s bed to semi-Fowler’s position to prevent aspiration and to facilitate digestion. In case of infants, they can be held in mother’s lap as like regular feeding with head of baby in crook of mother’s arm.
• Pacifier can be kept in mouth of infant for nonnutritive sucking unless contra indicated.

Procedure for Jejunostomy feeding

• Wash hands and wear gloves.
• Prepare the measured amount of formula in appropriate container.
• Place the protective bed covering under tubing to protect bedding and clothes.
• Remove clamp or plug from the feeding tube.
• Check the placement by aspirating the contents with syringe.
• Connect syringe or enteral bag or pump tubing to jejunostomy tube.
•  Flush the tubing with at least 3 mL of sterile water to clear the lumen
• Fill the syringe with formula and release the feeding tube to allow formula to flow through (in the case of enteral tube or pump, open the regulator clamp and adjust flow rate).
• When syringe is three-quarters empty, add more solution.
• Instill the required amount of water to flush the tubing once the feeding is about to finish.
• Pinch the tubing and remove the syringe / enteral bag and clamp (or cap) the feeding tube.
• Burp the infant and position the child to right side with head end elevated.

Aftercare

• Discard the soiled supplies according to hospital policy.
• Clean all reusable articles dry and keep ready for next feeding.
• Document the procedure in nurses’ record:
• Amount, color, and consistency of contents aspirated before feeding
• Type and amount of feeding formula
• Child’s response to the procedure
• Findings of jejunostomy tube site assessment
• If any medication is administered, details of name, dose, frequency, etc.

Nursing Considerations

• The formula should have low osmolality and at room temperature.
• The prepared formulas should not be kept for more than 24 hours.
• Formula can be administered intermittently or continuously as needed.
• In case of continuous feeding, assess the child frequently for abdominal distension.
• The formula should be liquid for easy feeding and preventing lumen block.
• Flushing of tube should be as per hospital policy.

Guidelines for Flushing the Jejunal Feeding Tubes

• Jejunal feeding tubes should be flushed regularly to maintain patency. Since there is a repeated blockage of tube due to narrow lumen, flushing can be done at least every 6 hours. Common flushing should be done:
• Before feeding
• After completion of feeding
• Before and after administering medications through tube
• Every fourth hourly if the tube is not used
• Before changing each bottle in the case of continuous feeding
• Sterile water must be used to flush tubing to prevent infection.
• The amount of water for flushing should be based on child’s fluid balance and size:
• Older children: 3-5 mL
• Newborn: 1-3 mL

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
4. Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840

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