How are gastric and jejunal tubes color coded?

Color Coding of Gastric and Jejunal Tubes

Gastric tubes are typically colored purple or blue, while jejunal tubes are typically colored yellow or white to distinguish between these different feeding access routes.

Standard Color Coding System

The color coding of enteral feeding tubes serves as a critical safety feature to prevent misidentification and improper use, which could lead to serious patient harm including aspiration, malnutrition, or medication administration errors.

Gastric Tubes

• Purple or Blue: Standard color for gastric feeding tubes (PEG - Percutaneous Endoscopic Gastrostomy)
• Used for direct feeding into the stomach
• Includes standard PEG tubes and gastric buttons

Jejunal Tubes

• Yellow or White: Standard color for jejunal feeding tubes (PEJ - Percutaneous Endoscopic Jejunostomy)
• Used for direct feeding into the jejunum
• Includes direct PEJ tubes and jejunal extension tubes (PEG-J)

Clinical Importance of Color Coding

The color distinction between gastric and jejunal tubes is crucial for several reasons:

1. Patient Safety: Proper identification prevents administration of medications or formulas into the wrong site
2. Aspiration Risk Management: Jejunal tubes (yellow/white) are specifically used for patients with high aspiration risk, gastroparesis, or gastric outlet obstruction 1
3. Medication Administration: Some medications must be administered into the stomach rather than the jejunum due to absorption requirements
4. Flow Rate Considerations: Jejunal feeding typically requires slower rates than gastric feeding

Types of Feeding Tubes and Their Applications

Gastric Feeding Options (Purple/Blue)

• Nasogastric tubes: Short-term feeding (<2-3 weeks)
• PEG (Percutaneous Endoscopic Gastrostomy): Long-term feeding (>2-3 weeks)
• Button systems: Secondary placement after PEG for cosmetic reasons 2

Jejunal Feeding Options (Yellow/White)

• Nasojejunal tubes: Short-term jejunal feeding
• PEJ (Percutaneous Endoscopic Jejunostomy): Direct access to jejunum
• JET-PEG (Jejunal Tube through PEG): Jejunal extension through existing gastrostomy 2

Clinical Decision Making for Tube Selection

The ESPEN guidelines provide a clear decision tree for selecting the appropriate feeding tube based on:

1. Duration of feeding need:

   • Short-term: Nasogastric/nasojejunal tubes
   • Long-term (>2-3 weeks): PEG/PEJ tubes 2

2. Aspiration risk:

   • Low risk: Gastric feeding (purple/blue tubes)
   • High risk: Jejunal feeding (yellow/white tubes) 2, 1

3. Surgical status:

   • Post-surgical patients may benefit from NCJ (Fine Needle Catheter Jejunostomy) 2

Safety Considerations and Verification

Proper tube placement verification is essential regardless of tube type:

• Gastric tubes: Verification through pH testing, auscultation, and radiographic confirmation when needed
• Jejunal tubes: Often require radiographic confirmation or electromagnetic guidance systems 3

For ongoing verification of tube placement:

• Mark tubes with inedible ink or adhesive tape where they exit the body
• Check tube location at regular intervals (typically every 4 hours)
• Verify placement when patients experience pain, vomiting, or coughing 4

Common Pitfalls to Avoid

1. Relying solely on color: While color coding is helpful, always verify the tube type and placement through appropriate clinical methods
2. Improper labeling: Ensure all tubes are properly labeled in addition to color coding 5
3. Ignoring displacement signs: Monitor for signs of tube displacement regardless of color coding
4. Improper flow rates: Jejunal feeding requires slower administration than gastric feeding to prevent dumping syndrome

The color coding system for gastric and jejunal tubes represents an important safety feature in enteral nutrition management, but should always be used in conjunction with proper verification techniques and clinical assessment.