ED Pathway for Care of the Child with G-J or G-Tube Displacement

G-J or G-Tube Displacement

PRESERVING STOMA

  • Place 10 Fr Foley if family has not done so
  • Use lubricant, insert 2 inches, do not force
  • Do not inflate balloon
  • Tape Foley to abdomen
  • Do not use Foley, keep NPO
arrow

Triage

Preserve stoma on all patients

Determine if:
  •  Immature vs. mature tract
  •  Tube has ever been changed
  Immature Mature
IR ≤12 wks >12 wks
Surgery ≤4 wks >4 wks

First tube replacement must be performed by service who created the tract

Tube replacement must be confirmed
by dye study

arrow
arrow

MD/CRNP/RN Assessment

  • Tube information
  • Hydration, medication needs
  • Consider IR sedation needs
arrow
arrow
arrow
arrow
G-Tube - Immature Tract or First Tube Replacement
arrow
G-Tube - Mature Tract
All G-J Tubes
Surgery Consult
IR Consult
arrow
arrow
Surgeon replaces tube
Dye study
IR replaces tube Confirms replacement
RN confers with attending
RN replaces tube
arrow
Confirm placement by aspiration of gastric contents
IR Consult
arrow
IR replaces tube Confirms replacement

Dye Study

Indications
Procedure

Contacting IR

WD   7A-7P   #32071
WE   7P-7A    Page IR Extend

Other Considerations

Clogged G-J tube
Granulation Tissue
Site infection
Leakage

Posted: May 2013
Authors: C. Jacobstein, MD, D. Albert, RN, S. Peck, CRNP, K. Barnaby, CRNP P. Mattei, MD,
A. Cahill, MD, J. Lavelle, MD