August 24, 2011 by dailybolusoflr
· Dislodged gastrostomy tubes are a common presentation to the ED
· For tubes that are not-mature (less than 1 month old), attempts at manipulation of the tract should be done cautiously if at all (some resources state a week is enough time to mature the tube tract, but in patients with poor wound healing, it can take up to 2-3 weeks
· During communications with skilled nursing facilities that call for transfer, immediate attempts at re-placement of the G-tube, or with a foley catheter, should be recommended. This is the due to the rapid closure of these tracts. Even a matter of hours can be enough time for the stoma to shrink so that dilation will be needed to replace a tube of equivalent size.
· Important questions to ask:
o How long has this tract been here?
o Is this a G tube or a J tube? G tubes placed in the jejunum can lead to intestinal obstruction when the balloon is inflated.
o Is there significant pain, drainage or evidence of infection around the stoma?
o Do you have your old tube? This can help you figure out what size to replace and in what organ it terminates.
· What you will need:
o A replacement tube or foley catheter (foley catheters should not be left for more than a month b/c stomach acid degrades the latex!)
o A syringe and saline to inflate the balloon (most G tubes will tell you how many cc’s to insert on them)
o A syringe and stethoscope to check placement in the stomach (like an NG tube)
o Viscous lidocaine (a nice gesture to apply with a cotton tipped applicator beforehand)
· Confirming placement (options):
o Similar to NGT placement
o Aspiration of gastric contents
o 25-30 cc of water soluble gastrografin placed in to the G tube 1-2 minutes before AXR (most commonly recommended)
Ref: Chapter 40 in Roberts and Hedges 5th ed