NJT Placement

Nurse-Led NJT Placement: A Practice Change for Nurses in a Pediatric BMT Unit

Project Leader: Temima Oratz, BSN RN | Clinical Nurse, Level 3

Institution: Children’s Healthcare of Atlanta, Inc. | Atlanta, Georgia

Grant Type: APHON Evidence-Based Practice Grant

Year Awarded: 2018


The oncology nurse is acutely aware that nutritional support, in the f01m of supplemental feedings, is imperative to successful outcomes for the pediatric patient undergoing bone marrow transplantation (BMT). Unfortunately, what can frequently occur with enteral feeding via nasogastric tube (NGT) placement is a greater risk of vomiting the feeding and the NGT, thereby necessitating high utilization of total parenteral nutrition (TPN) during the acute BMT period. TPN is not without its own risk of complications, as there is a greater risk of catheter-related bloodstream infections, which in this population can be life-threatening. The use of a nasojejunal tube (NJT) can increase the efficiency of enteral feeds for this population, leading to a decreased use of TPN. The cmTent policy for our institution’s BMT unit is to have NJTs placed under fluoroscopy by the Radiology department. This practice is a banier for the severely neutropenic population who are unable to leave the BMT unit. The objective of this project is to demonstrate an education program to equip pediatric oncology nurses with skills to place NJT at the bedside. Nurses who are selected will be trained in evidence-based methodology for blind NJT placement utilizing an age-height measurement to determine the appropriate tube length. Only after successfully demonstrating the skill of two placements will the NJT-Expe1i Registered Nurse be allowed to place the NJT independently. Placement will first be verified the same as NGT per current hospital policy, and then NJT placement will be verified by a p01iable x-ray at the end of the insertion process. This change of practice will be evaluated after 10, 25, and 50 bedside NJT insertions to monitor overall success in the pediatric BMT population and to assess for an increase in enteral feeds and a decrease in the amount of TPN.