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

PRESERVING STOMA

  • Place same French (Fr) size foley as Fr tube in stoma. Progress 1 size smaller until able to place foley into stoma
  • Use lubricant, insert 2 inches, do not force
  • Do not inflate balloon
  • Tape Foley to abdomen
  • Do not use Foley, keep NPO

Triage

Preserve stoma on all patients

Determine if:
  • New vs. established tract
  • Tube has ever been changed
IR and General Surgery
New < 6 weeks
Established ≥ 6 weeks

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

Tube replacement must be confirmed
by dye study

MD/CRNP/RN Assessment

  • Tube information
  • Hydration, medication needs
  • Consider IR sedation needs
G-Tube - New Tract or First Tube Replacement
G-Tube - Established Tract
All G-J Tubes
Surgery Consult
IR Consult
Surgeon replaces tube
Dye study
IR replaces tube Confirms replacement
 
 
 
Replacing the G-tube:
  • Attending/Fellow will dilate the stoma to current G-Tube size
  • RN will replace the G-tube as directed by the ED Attending/Fellow
  •  
If G-tube dislodges while patient
is in ED:
  • RN replaces G-tube if available, or uses foley
  • Informs Attending Fellow
Place immediate order for G-J Replacement
  • See ED G/GJ Tube Replacement Order Set
After 5 PM and weekends, page IR Physician

Determine if replacement can occur same day. If not, consider EDECU if possible or appropriate care area for IR procedure in the a.m.

FLOC should call IR at 7 a.m. (74395)
  • Assures patient gets first available slot

Dye Study

Indications
Procedure

IR Contact
  • Weekdays: 8 a.m. – 4 p.m., #53255
  • Weeknights, weekends, holidays and 4 p.m. – 8 a.m., IR Attending on Call

Other Considerations

Clinical Pathway for Management of Gastronomy Tube Complications (Clogged G-J tube, granulation tissue, site infection, leakage etc.)
Posted: May 2013
Revised: October 2016, April 2017, February 2018, October 2020
Authors: C. Jacobstein, MD; D. Albert, RN; P. Mattei, MD; A. Cahill, MD; J. Lavelle, MD; D. Hiller, RN; P. Reynolds, RN