Looking after your percutaneous endoscopic jejunostomy tube (PEJ)

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What is a PEJ?

A PEJ is a soft tube placed through your skin into a part of your small bowel called the jejunum. This allows food and water to enter directly into your bowel, avoiding using your stomach. The term ‘PEJ’ describes the way it is placed.

Why do I have a PEJ?

You have this tube because you are unable to take enough food into your stomach to keep you healthy. This could possibly be due to feeling sick, an operation that you have had or because you cannot swallow safely.

How long do I need to have my PEJ?

Many people require a PEJ long term but you will be regularly reviewed by a dietitian who will advise how long you may require your tube. If you are able to eat and drink normally, your tube can be removed. This will be decided by your medical team and dietitian.

How long does my tube last for?

Your PEJ tube can last for years if it is well cared for.

You may require an endoscopy to replace your tube. Arrangements for this can be made by your GP or the nutrition nurse specialists.

One way of increasing the life of your tube is to leave the clamp undone when the end connector is in place. This prevents the clamp squashing the tube. You can also change the place the clamp sits along the tube to avoid squashing the same part of the tube each time.

How do I clean my PEJ and the skin around it?

For the first week:

• Remove the dressing the day after your tube is inserted, as this is no longer required.
• Clean the tube and site daily.
• Carefully clean under the outside bumper and around the site using neat Octenisan body wash, then cleanse with warm water and dry well.
• Apply the Bactroban/ Naseptin ointment around where the tube exits the skin.
• It is important not to move the outside bumper for the first week as keeping it in place helps the site to heal.

After the first week:

• It is no longer necessary to use the Octenisan and Bactroban/ Naseptin. Still clean daily with warm soapy water.
• You can now move the outside bumper along the tube to make cleaning the site easier. Make sure you replace the bumper approximately 2mm from the skin so that the tube does not slide in and out.
• Do not forget to clean the back of the bumper.

Can I have a bath?

For the first two days after your tube is placed do not have a bath or shower, instead wash using the Octenisan body wash.

For the rest of the first week you may have a shallow bath or a brief shower using the Octenisan body wash. Do not soak/ immerse the tube and exit site.

After the first week, if the skin around your site is clean and dry, you may return to your normal bathing routine. If you have any concerns please contact either your company nurse or the nutrition nurse specialists.

How do I manage my tube?

It is important to move your tube once a week to stop the bumper getting stuck. To do this, follow these instructions:

• Wash your hands with soapy water and dry well.
• Release the triangular bumper by opening the clip, remove the tube from the groove and slide back the triangular bumper away from the skin.
• Clean the tube, bumper (front and back) and stoma area with soapy water.
• Push the tube in two to four centimetres – do not twist the tube.
• Gently pull the tube back until resistance is felt.
• Place the triangular bumper back in its normal position, reinsert the tubing into the groove and close the clip carefully.

What do I need to look out for?

You need to look at your site regularly to check for signs of infection. The things to look out for are:

• redness
• pain
• discharge which is yellow and smelly

If you notice these signs, contact your GP, company nurse or the nutrition nurse specialists.

It is also possible for the skin at the exit site to become pink and/or lumpy and it may bleed easily. This may be an overgrowth of tissue which can be easily treated with a special dressing or ointment. Again, contact your GP, company nurse or the nutrition nurse specialists if you are worried.

• leaks of fluid around the tube
• pain on feeding or flushing your tube
• new bleeding

If you have any of the above signs stop feeding immediately and telephone for urgent advice.

Monday to Friday, 08:30 (8:30am) to 16:00 (4pm) – nutrition nurse specialists 03457 623632

Out of hours – Please contact your GP or NHS 111. If you cannot wait to be seen by your GP, please contact your local hospital’s emergency department.