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When placing PEG-J tube in obese patients, all anatomical structures must be identified prior
to placement.
When placing PEG-J tube, observe all institutional guidelines regarding gastroscopy,
including removal of dentures.
PEG-J or FLOW-J replacement is recommended every three months or as recommended
by physician.
INSTRUCTIONS FOR USE
Tube Placement
1. After introducing gastroscope, insufflate stomach and examine mucosa. Determine if
mucosa is free of ulcerations or bleeding before proceeding. Important: This gastro-
jejunal feeding tube (J-tube) is fully radiopaque and can only be used with appropriate
Cook PEG tube. Ideally, PEG tube should be placed in antrum or low in body of stomach to
ease insertion.
2. Remove feeding adapter and twist lock or cable tie se curing external bolster from previously
placed Cook PEG tube. X mark on PEG tube should be at end. If not, tube should be cut at X
mark.
(See fig.1)
3.
Place non-spiked biopsy or alligator forceps through gastroscope and push forceps
through PEG tube from stomach until it is seen exiting tube.
4.
Generously lubricate wire guide with water-soluble lubricant, especially at tip.
5. Place air plug over wire guide and grasp floppy tip end of wire guide with forceps.
(See fig. 2)
6. Pull wire guide and forceps back into tube and place air plug securely in end of PEG tube to
minimize air leakage.
(See fig. 3)
7. Insufflate stomach to provide better visualization of pylorus.
8. Advance gastroscope with wire guide and forceps through pylorus and into second portion
of duodenum.
9.
Straighten wire guide by holding tension at both ends. Advance wire guide and
forceps to third portion of duodenum.
10.
Generously lubricate J-tube with water-soluble lubricant, especially at tip.
11. Remove air plug from G-tube, then place J-tube over wire guide.
(See fig. 4)
12. While maintaining tension on wire guide, slowly advance J-tube over wire guide. Continue
advancement until it dislodges forceps from wire. Note: J-tube should move distally when it
dislodges forceps from wire.
13. Remove forceps from scope and plug feeding adapter firmly into PEG tube.
(See fig. 5)
14. Endoscopically verify J-tube position.
15. Aspirate air, then remove scope in a rotating fashion to minimize dragging effect
on J-tube.
16. Verify that J-tube has not backed through pylorus into stomach.
(See fig. 6)
Note: A cable tie
may be placed around proximal gastrostomy tube at feeding adapter to avoid inadvertent
removal of J-tube from PEG.
17. Carefully remove wire guide while observing endoscopically. Once again verify that J-tube
has not fallen back into stomach, then remove gastroscope.
18. Using a 60 cc piston irrigation syringe, flush 50 cc of water through yellow J-tube port
on feeding adapter. Tube should flush easily if properly placed. Note: Red G-tube port on
feeding adapter is used to access stomach.
19. Replace twist lock or cable tie on external bolster of PEG tube, being careful not to crimp
tube. Important: Use twist lock or cable tie to secure pivotal bolster to tube. This will help
prevent future migration of tube and reduce need to constantly reposition or pull on tube.
Warning: Excessive traction on gastric feeding tube may cause premature removal, fatigue
or failure of device.
