What is the treatment for a dislodged Jejunal (J) tube?

Management of Dislodged Jejunal (J) Tube

When a jejunostomy tube becomes dislodged, it generally must be replaced to achieve correct positioning, as dislodgement is one of the most common complications of jejunostomy tubes (occurring in up to 12% of cases). 1

Immediate Assessment

• Evaluate for signs of peritonitis, sepsis, or decompensation which would require surgical exploration 1
• Determine how long the tube has been in place, as maturation of the tract affects management approach 1
• Check for abdominal pain, distension, fever, or signs of infection at the insertion site 1

Management Algorithm Based on Tract Maturity

Immature Tract (Less than 4-6 weeks old)

• Immediate replacement is required using endoscopy or image guidance 1
• The tract may be immature, risking separation of the jejunum from the abdominal wall, potentially resulting in free perforation 1
• If recognition of dislodgement is delayed:
  • Initiate nasogastric suction 1
  • Start broad-spectrum antibiotics 1
  • Plan for repeat jejunostomy placement in 7-10 days 1

Mature Tract (More than 4-6 weeks old)

• The tube can often be replaced through the existing tract 1
• Replacement should still be performed by experienced personnel (gastroenterologist, interventional radiologist, or surgeon) 1
• Confirmation of proper placement is essential before resuming feeding 1

Replacement Techniques

• Over-the-wire method may provide longer tube longevity (up to 120 days) 1
• Image-guided or endoscopic replacement has success rates greater than 90% 1
• For gastrojejunostomy tubes, the jejunal extension often requires complete replacement when dislodged 1

Prevention Strategies

• For patients at high risk of inadvertent removal (delirium, dementia, altered mental status):
  • Consider mittens to reduce ability to grasp and pull tubes 1
  • Low-profile devices (buttons) may be beneficial as they're less likely to be dislodged 1
  • Avoid abdominal binders as they increase side torsion and risk of stoma enlargement 1
• Regular maintenance:
  • Flush tubes with water before and after feeds or medications to prevent clogging 1
  • Loosening and rotating tubes weekly helps prevent complications 1

Important Considerations

• Jejunostomy tubes have a high rate of dysfunction (22% overall complication rate) 2
• The average longevity for a jejunostomy tube is only 3-6 months before replacement is needed 1
• Common complications include:
  • Dislodgement (12%) 2
  • Clogging (6%) 2
  • Leaking (5%) 2
  • Site infections (2.8%) 2

Follow-up Care

• After replacement, monitor for:
  • Proper tube function 1
  • Signs of infection 1
  • Leakage around the tube 1
  • Adequate enteral nutrition delivery 1

Remember that jejunostomy tubes require more frequent replacement than gastrostomy tubes, with an average of 2.2 replacements per patient reported in pediatric populations 1. Early recognition and proper management of dislodgement are critical to prevent more serious complications.