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

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

MD/CRNP/RN Assessment

  • Tube information
  • Hydration, medication needs
  • Consider IR sedation needs
G-Tube - Immature Tract or First Tube Replacement
G-Tube - Mature 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, admit to appropriate care area for AM replacement
  • Consider EDECU
FLOC should call IR at 7AM (32071)
  • Assures patient gets first morning slot

Dye Study

Indications
Procedure

Contacting IR

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

Other Considerations

Clogged G-J tube
Granulation Tissue
Site infection
Leakage

Posted: May 2013
Revised: October 2016, April 2017, February 2018
Authors: C. Jacobstein, MD; D. Albert, RN; S. Peck, CRNP; K. Barnaby, CRNP; P. Mattei, MD; A. Cahill, MD; J. Lavelle, MD