These instructions are for Children’s Hospital of Philadelphia (CHOP) patients who receive nutrition through a tube that is placed in the nose and ends in the intestines, also known as an NJ (nasojejunal) tube.

Important information about NJ (nasojejunal) feeding tubes:

• A NJ tube is a small tube passed through the nose and into the intestines to feed children who cannot get enough nutrients eating by mouth.
• The NJ tube is inserted in the Department of Interventional Radiology.  During the procedure, the healthcare provider will use X-ray to place the tip of the tube in the small intestine (jejunum).
• Your child’s tube should not interfere with their normal activities.  Your child can bathe, swim, and sleep as usual. It is important to try to avoid any pulling of the tube so it does not come out or move out of place.

Instructions for taping the tube:

• It is important to secure the tube with tape to prevent it from falling out or moving out of place.
• There are numbers along the tube.  Your provider will tell you what number should be showing at the edge of your child’s nostril.
• Mark the tube at this number with a permanent marker or a piece of tape. Use this mark so you know if the tube has moved.
• If the tape that holds the NJ tube becomes loose, you must secure the tape to prevent the tube from falling out or moving. Follow the steps below:
  1. Measure and cut the Duoderm™.
  2. Measure and cut the Tegaderm™ to the correct size.
  3. If using a skin barrier, apply it to the skin where you will be putting the Duoderm.
  4. Peel backing off the Duoderm to uncover adhesive.

  5. 

     Place the Duoderm on your child's cheek.
  6. Place the NG tube on top of the Duoderm.
  7. Peel the backing off the Tegaderm to uncover adhesive.
  8. Place the Tegaderm over the tube onto the Duoderm.
  9. When retaping the tube, hold the tube firmly in place to prevent movement. After retaping, check the mark you have made on the tube to determine if the tube has moved.

Instructions to prevent the tube from clogging:

• Flush the tube after each feeding as you have been taught, after giving medicine, and every 2-4 hours throughout the day.  Follow these instructions even if your child is on continuous feedings.
• Some medicines, such as those in bead form, for example opened Prilosec® capsules, can clog the tube.  Do not use the tube to give your child these medicines.   
• Ask your doctor which medicines can be given through the NJ tube.

Instructions for a clogged NJ tube:

1. Attach a 5ml syringe with warm water to the end of the feeding tube adapter.
2. Try to flush the tube.  
3. If you are unable to flush, pull back on the plunger of the syringe.  Try to flush and pull back up to 5 times.
   • If this does not work, use the Clog Zapper® kit as you were taught.  Clog Zapper is a ready-to-use kit containing a food-grade powder that helps break up clogs in feeding tubes.  Clog Zapper contains maltodextrin, a type of sugar. If your child is on a ketogenic diet, they will need microlipids once the tube is unclogged. Talk to your healthcare provider about how much to give. Clog Zapper also contains coconut and should not be used in those with tree nut allergies.
   • If this does not work, call your healthcare provider.  

Instructions if the NJ tube falls out or cannot be unclogged:

1. Stop the feed.
2. Contact your healthcare provider.  They will send a prescription to Interventional Radiology for a tube replacement.
3. Contact Interventional Radiology to schedule the tube replacement.

Instructions for emergencies:

It is important to have a plan in place if your child’s tube comes out and they need immediate medical attention.  Your healthcare provider will explain what you should do for your child.

Examples when immediate medical attention is needed include if your child:

• Cannot go without fluids.  
• Cannot skip a dose of medicine - ask your healthcare provider about which of your child’s medicines cannot be skipped.
• Has a known metabolic disease.

Children in the categories above need to go to the emergency room for care until a replacement NJ tube can be placed. 

Contact your healthcare provider with any questions or concerns or if:

• Your child is vomiting formula.
• The tube is leaking.
• The tube has an odor.
• You cannot unclog the tube with Clog Zapper.
• The tube is out of place.

If you have any questions about your child’s health, please contact your child’s healthcare provider. This document is intended only to provide general educational information and is not intended as medical advice or treatment. Please consult with your healthcare provider prior to use, as some of this information may need to be adapted for your child’s specific needs. It is the responsibility of your healthcare provider to advise you on the appropriate use of this information. If you/your child are not already a CHOP patient, this document does not create a doctor-patient relationship between you/your child and CHOP. CHOP is not responsible for any outcomes you/your child might experience from your use of this document. This document is provided "AS IS", WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, express or implied. If this document refers to any drugs or medical devices, it is the responsibility of your healthcare provider to check the FDA status prior to use. If this document includes references to drug dosing, please do not rely on this document. Your healthcare provider should check the package insert for each drug before use. Hyperlinks used within this document may not be translated into other languages.

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