Daily Bolus of LR: Dislodged G-Tubes

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August 24, 2011 by dailybolusoflr

Dislodged G-Tubes

 

·         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   Gloves

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   Lubricant

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

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