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


  • 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


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 and 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. (57080)
  • Assures patient gets first available slot

Dye Study


IR Contact
  • Weekdays: 8 a.m. – 4 p.m., #53255
  • Weeknights, weekends, holidays and 4 p.m. – 8 a.m., Rad/IR via Epic On-Call Finder

Other Considerations

Clinical Pathway for Management of Gastrostomy Tube Complications (Clogged G-J tube, granulation tissue, site infection, leakage etc.)
Posted: May 2013
Revised:  May 2021
Authors: C. Jacobstein, MD; D. Albert, RN; P. Mattei, MD; A. Cahill, MD; J. Lavelle, MD; D. Hiller, RN; P. Reynolds, RN