Nasojejunal Tube Usage Guidelines

Purpose and Placement

Nasojejunal tubes are designed to deliver enteral nutrition directly into the jejunum, bypassing the stomach, and are indicated for patients with gastric reflux, delayed gastric emptying, or those who must be nursed flat 1, 2
The American Gastroenterological Association recommends using NJ tubes for feeding in patients who require bypassing of the stomach, with a success rate of 83% for blind bedside placement and 94-97.6% for endoscopic guidance 3, 4, 5
NJ tubes are fine bore (6-10 French gauge) and are not designed for the mechanical stress of suction, according to the European Society for Clinical Nutrition and Metabolism 2

For patients requiring both jejunal feeding and gastric decompression, the American College of Gastroenterology recommends using a specialized dual-lumen tube or placing separate tubes for each function 1, 2
The European Society for Clinical Nutrition and Metabolism advises against using NJ tubes for suction, as it may cause damage to the jejunal mucosa, fluid and electrolyte imbalances, and potential tube collapse or damage 6, 2
If a patient with an NJ tube develops distension or vomiting requiring decompression, consider placing a separate NG tube rather than applying suction to the NJ tube, as recommended by the American Society for Parenteral and Enteral Nutrition 6

Applying suction to an NJ tube could cause damage to the jejunal mucosa, fluid and electrolyte imbalances, and potential tube collapse or damage, with a high rate of dislodgement (15-42% without bridling) 6, 2
The American Gastroenterological Association recommends monitoring for and replacing electrolytes when any form of gastrointestinal suction is used, with a strength of evidence rated as high 6

Early post-pyloric enteral tube feeding (ETF) is generally safe and effective in postoperative patients, even if there is apparent ileus, according to the European Society of Parenteral and Enteral Nutrition 7
NJ feeding should be considered within 1-2 days of surgery in severely malnourished patients, 3-5 days in moderately malnourished patients, and within seven days in normally or over-nourished patients who are NPO, as recommended by the American Society for Parenteral and Enteral Nutrition 7
All NJ tubes are fine bore (6-10 French gauge) and some have a shorter second lumen for gastric aspiration, as described by the Gut journal 8
The position of an NJ tube should be confirmed by x-ray 8-12 hours after placement, as auscultation and pH aspiration techniques can be inconclusive, according to the American Gastroenterological Association 7

If enteral feeding is likely to be needed for more than 4-6 weeks, consider percutaneous gastrostomy or jejunostomy placement, as suggested by the European Society of Gastrointestinal Endoscopy 7
Long-term NG and NJ tubes should usually be changed every 4-6 weeks, swapping them to the other nostril, as recommended by the Infectious Diseases Society of America 7
Some evidence suggests considering percutaneous placement as early as 14 days after initiation of enteral feeding, according to the Society of Critical Care Medicine 7

All decisions regarding enteral tube feeding should involve full consultation with the healthcare team and family, with consideration of ethical issues and the patient's best interests, as stated by the American Medical Association 9