G, GJ, J Tube Complications Clinical Pathway — Inpatient

Related Pathways

GJ or G Tube Displacement

Inpatient with a percutaneous or surgical G, GJ
or J tube and suspected site complication

Identify the type and maturity of G/GJ/J tube in LDA

G Tubes, GJ Tubes, J Tubes
Initial vs. replacement tube*
* Please contact General Surgery if unable to determine who placed the G/GJ/J tube or if the G/GJ/J tube was placed by an outside hospital.

Basics of tube/stoma care:

Devices for securing a tube and dressings
Keep site dry
Treat skin around stoma like other healthy skin – soap + water daily with minimal lotion

Bedside clinician (RN, MD, APP) comprehensive site assessment:
- Clean the stoma and site
- Check the tube fit (tight vs. loose)
- Contact unit-based resource (e.g., CNS, Skin Champion, APP)
- Document the site with images in Epic Media tab by CNS, APP, FLOC

Erythema around stoma

Granulation tissue

Leaking

Irritant dermatitis

Enlarged stoma/keyhole

Prolapse

Notify the Appropriate Service
Information about the inserting/managing service is located in the LDA in Epic. See a sample LDA.
To notify the appropriate service, see contact information below and Sample ISBARQ.

Replacement G tubes/J tubes initially placed by General Surgery
Initial G tubes/J tubes placed by General Surgery	Call General Surgery for problems with these tubes: Weekdays between 9 a.m. – 4:30 p.m.: PHL Gen Surg Gtube in Epic On-Call Finder If NP in General Surgery is not available: Gen Surg Cnslt ED/IP in On-Call Finder For the N/IICU: call the Surgical NP in the N/IICU, call #20132
Initial G tubes placed by IR and all GJ tubes	Call IR for problems with these tubes Weekdays 8 a.m. – 4 p.m.: call #53255 Weekdays 4 p.m. – 6 p.m.: call #57080 Weeknights between 6 p.m. – 8 a.m., Weekends, Holidays: Rad/IR in On-Call Finder
Replacement G tubes that were initially placed by IR	Call GI & Nutrition for problems with these tubes: PHL GI Gtube Nurse in Epic On-Call Finder
All Tubes at KOPH	Call KOPH Gen Surg Cnslt 1st Contact via Epic Chat

Reviewed by Children's Hospital of Philadelphia Clinical Care Committee: May 2019
Posted: May 2019
Revised: July 2023

Authors:
- M. Acord, MD;
- M. Stetzer, CWOCN;
- J. Crawford, ACCNS-P;
- L. Thompson, PA-C;
- J. Hillman, CRNP;
- L. Jang, CRNP;
- A. Boroughs, CWOCN;
- K. Rhodes, CRNP;
- C. Ehritz, ACCNS-P;
- M. Ryan, MD;
- P. Laje, MD

Editors: Clinical Pathways Team

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Clinical Pathway for Management of Gastrostomy Tube Complications

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