Can a Nasojejunal (NJ) tube be used for suction?

Nasojejunal (NJ) Tubes Should Not Be Used for Suction

Nasojejunal tubes are designed for enteral feeding into the small intestine and should not be used for suction, as this could lead to serious complications including mucosal damage and electrolyte imbalances. 1, 2

Purpose of NJ Tubes vs. Nasogastric (NG) Tubes

NJ Tubes: Designed for Feeding

• NJ tubes are specifically designed to deliver enteral nutrition directly into the jejunum, bypassing the stomach 1
• They are indicated when there are problems with gastric reflux, delayed gastric emptying, or in unconscious patients who must be nursed flat 1
• NJ tubes are fine bore (6-10 French gauge) and are not designed for the mechanical stress of suction 1

NG Tubes: Appropriate for Suction

• Larger bore NG tubes (not fine bore feeding tubes) should be used when gastric aspiration or decompression is required 2
• NG tubes for suction are specifically designed with appropriate strength and diameter to withstand the negative pressure of suction 1

Placement Differences

NJ Tube Placement

• NJ tubes are placed beyond the pylorus into the jejunum using various techniques:
  • Blind bedside placement (with 83% success rate) 1
  • Endoscopic guidance (94-97.6% success rate) 3, 4
  • Fluoroscopic guidance 1
  • Various assistive devices (magnets, electromagnetic transmitters) 1

Specialized Dual-Lumen Options

• For patients requiring both jejunal feeding and gastric decompression, specialized dual-lumen tubes exist 5
• These tubes have a distal port for feeding in the jejunum and a proximal port for gastric decompression 5
• This design allows for simultaneous feeding and suction through separate channels 5

Complications of Inappropriate NJ Tube Suction

• Applying suction to an NJ tube could cause:
  • Damage to the jejunal mucosa due to the negative pressure against the more delicate small intestinal wall 2
  • Fluid and electrolyte imbalances from excessive small bowel secretion removal 2
  • Potential tube collapse or damage due to the fine bore design not being intended for suction 1, 2
  • Risk of tube migration or dislodgement due to the mechanical forces of suction 6

Clinical Recommendations

• For patients requiring both jejunal feeding and gastric decompression:
  • Use a specialized dual-lumen tube with separate channels for feeding and suction 5
  • Alternatively, place both an NJ tube for feeding and a separate NG tube for gastric decompression 1
• For patients requiring only decompression, use an appropriately sized NG tube rather than an NJ tube 1, 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 2

Common Pitfalls to Avoid

• Never apply suction to fine bore feeding tubes (whether NG or NJ) as they may collapse or damage the intestinal mucosa 1, 2
• Avoid using NJ tubes for medication administration if the medications require gastric pH for absorption 1
• Be aware that NJ tubes have a high rate of dislodgement (15-42% without bridling) which could be exacerbated by suction 3, 6
• Monitor for and replace electrolytes when any form of gastrointestinal suction is used 2

In summary, while NJ tubes are valuable for providing enteral nutrition in specific clinical scenarios, they should not be used for suction. If both jejunal feeding and gastric decompression are required, either use a specialized dual-lumen tube or place separate tubes for each function.