NG OR NJ TUBE: WHICH IS WHICH? CONFUSING RIGHT!
Written by Jodie Pilgrim / Patient and Advocate
Chances are you are reading this because you have or are about to have an NG or NJ feeding tube placed or you may be heading down this path. Here you will find information that hopefully might put your mind at ease and answer any questions you may have about tube feeding.
A feeding tube is a medical device used to provide nutrition to people who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. They are usually made of polyurethane or silicone. The diameter of a feeding tube is measured in French Units (each French unit equals ⅓ mm). They are classified by site of insertion and intended use.
There is a lot of confusion surrounding Nasogastric (NG) and Nasojejunal (NJ) feeding tubes and the differences between the two. With Gastroparesis you will find the NJ tube is more commonly used as it bypasses the stomach to help alleviate your Gastroparesis symptoms. An NG tube does not bypass your stomach and any feeds will end up in your stomach and you may continue to have Gastroparesis symptoms.
The thought of feeding tubes can be quite frightening at first and many of us really try to avoid having one. Sometimes we are not able to manage our Gastroparesis which leads to weight loss and malnutrition, leading to other health complications.
Feeding tubes can be used for various lengths of time depending on your needs which is normally determined by your Doctor, Specialist and Dietician.
A lot of us won’t admit it, but we also worry and get very anxious about having a tube stuck to our face and what other peoples reactions may be. Just leaving the house with our tube can cause a lot of anxiety in itself, not to mention learning how to live with this new way of feeding.
We need to remember that our tube is a way for our body to receive the nourishment it desperately needs due to the severeness of our Gastroparesis symptoms. It is a way to get Nutrition. You can eat your safe foods in conjunction with your tube feeds if your Gastroparesis symptoms allow for this.
Being a “Tubie” or having a “Nose Hose” can be difficult especially if it is your first time. Here you’ll find some information about NG and NJ feeding tubes, how they are different and some helpful tips.
NASOGASTRIC FEEDING TUBE (NG)
If you can’t eat or swallow, you may need to have a Nasogastric tube inserted. This process is known as Nasogastric (NG) intubation. During NG intubation, your doctor or nurse will insert a thin plastic tube through your nostril, down your esophagus, and into your stomach. Once this tube is in place, your doctor or nurse can give you food and medicine through an NG tube. They can also apply suction to it, allowing them to remove contents from your stomach.
Your Doctor or Nurse can also use an NG tube to:
- remove a sample of your stomach contents for analysis
- remove some of your stomach contents to the relieve the pressure on an intestinal obstruction or blockage
- remove blood from your stomach
- administer medication
If you need to have an NG tube inserted, it will probably happen in a hospital. In some cases, you may get the tube inserted at home. In most cases, you won’t need to take any special steps to prepare. Right before it’s inserted, you may need to blow your nose and take a few sips of water.
Your Doctor, Nurse, or other Care Provider will insert your NG tube while you’re lying down in a bed with the head elevated or sitting in a chair. They will likely ask you to bend your head, neck, and body at various angles as they thread the tube through your nostril, down your esophagus, and into your stomach. These movements can help ease the tube into position, without causing you too much pain or discomfort. They may also ask you to swallow or take small sips of water when the tube reaches your esophagus to help it slide into your stomach.
Once your NG tube is in place, your care provider should take steps to check its placement. For example, they might try to draw fluid out of your stomach. Or they might insert air through the tube, while listening to your stomach with a stethoscope. You will have an X-ray performed to ensure your tube has been placed in the correct position.
To keep your NG tube in place, your care provider will likely secure it to your face with a piece of tape. You can reposition it if it feels uncomfortable.
If you can’t eat or drink, NG intubation and feeding can help you get the nutrition and medications you need. NG intubation can also help your doctor treat an intestinal obstruction in ways that are less invasive than intestinal surgery. They can also use it to collect a sample of your stomach contents for analysis, which can help them diagnose certain conditions.
NASOJEJUNAL FEEDING TUBE (NJ)
A Nasojejunal or NJ-tube is similar to an NG-tube except that it is threaded through, bypassing the stomach and into the jejunum, the middle section of the small intestine. These types of tubes are used for individuals who are unable to tolerate feeding into the stomach, due to dysfunction of the stomach, impaired gastric motility, severe reflux or vomiting. These types of tubes must be placed in a hospital setting.
The tube is generally placed by an interventional radiologist under a continuous x-ray procedure known as fluoroscopy. The tube is placed into the nose and advanced down through the esophagus and stomach. It is passed through the pylorus, which is the valve between the stomach and small intestine, until it reaches the jejunum, which is the middle part of the small bowel. This procedure may be done while you are awake or you may be placed under light sedation and have it inserted in a hospital theatre setting. An x-ray will be performed to ensure your tube has been placed in the correct position.
If you have been unable to orally intake food for a period of time it is likely you will spend a few days in hospital after having your tube placed. Once you start your tube feeds you will have bloods taken to ensure you are not showing signs of re-feeding syndrome. Re-feeding Syndrome can be defined as shifts in fluids and electrolytes that may occur in malnourished patients. These shifts result from hormonal and metabolic changes and need to be monitored once you begin your tube feeds. Generally your feeds will be started at a low millilitre rate per hour and slowly your hourly rate will be increased. You may experience “dumping” where your feeds pass very quickly and you may experience diahrrea or you may experience some constipation while your body adjusts to your new feeds. Remember, when your hourly ml rate is increased and you are feeling any discomfort or feel the hourly ml rate is too high, DON’T hesitate to inform the Nurses, Doctor, Specialist and Dietician. Hourly feed rates can be adjusted and it is important you find the hourly rate that agrees with you and your body. Some of us may only be able to tolerate a small hourly rate while others are able to tolerate a high hourly rate. You hourly feed rate will determine how many hours you will be hooked up to your feeds.
You will be taught how to use your new feeding system either in the Hospital or a Nurse may come to your home to show you how everything works. Your feeds and supplies will be available through a special program that your hospital Dietician should register you for with companies who supply the products you will need.
To lower your risk of complications from NG/NJ intubation and feeding:
- brush your teeth regularly
- clean your nose frequently
- tape the tube securely to your face
- check the tube for signs of leakage, blockage, and kinks. If any of these occur you should make your way to the nearest Hospital Emergency Department
- elevate your head during feedings and for an hour afterwards
- watch out for signs of irritation, ulceration, and infection in the nostril and throat
- make sure all your supplies are handled in a clean and sanitary way
- you may feel soreness and discomfort in the nostril and throat. Lozenges and throat sprays containing numbing agents are available at most Chemists to help with this
- if you are still able to orally eat small amounts of your safe foods make sure they are soft, blended, mashed or cut in to very small pieces
- If you have an NJ tube and have been vomiting while on tube feeds it is possible the end of the tube has been dislodged from the small intestine and moved up in to the stomach due to the muscle movement of vomiting. You should have this checked out as soon as possible with your Doctor or Specialist as you may need to have your tube replaced or adjusted if the end of your tube has moved up in to your stomach.
Try not to be afraid if it is suggested you may need a feeding tube. Try not to worry about what others think. Feeding tubes give us and our bodies the opportunity to receive the nourishment we need. There are special backpacks, or ways to adjust normal backpacks to carry your tube feeding system so don’t think you will be house bound by your new way of feeding. There are many support groups you can join where many other members are “Tubies” who can offer support, tips and friendship because they understand.
Gastroparesis: The Inside Story: https://www.facebook.com/groups/TheInsideStoryAU/
Gastroparesis Australia: https://www.facebook.com/gastroparesisaustralia/
You may have a “Nose Hose” and some people may stare but REMEMBER….it just makes you that little bit more interesting!!!!!