GJ or G-Tube Displacement Clinical Pathway – Emergency Department

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

Provider Resources
GJ or G Tube Displacement
 
 

ED Triage

  • Preserve stoma on all patients
  • Determine if:
    • New vs. established tract
    • Tube has ever been changed
  • IR and General Surgery
    New < 6 wks
    Established ≥ 6 wks
  • First tube replacement must be performed by service who created the tract and be confirmed by dye study
 
 

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
 
 

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 GJ Tubes
Surgery Consult
IR Consult
 
 
 
 

Surgeon replaces tube

Dye study

IR replaces tube

Confirms replacement
  • Replacing the G tube
    • Attending physician/fellow will dilate the stoma to current G tube size
    • RN will replace the G tube as directed by the ED attending physician/fellow
  • G tube dislodgment while in ED
    • RN replaces G tube if available,
      or uses foley stoma preservation process as above
    • Informs attending physician/fellow
  • Low-profile G tube extension set connection issues—not due to ENFIT ports
  • Place immediate order for GJ replacement
  • See IR G to GJ Tube Change Order Set
 
 
  • Send Epic message to:
    PHL Interventional Radiology 1st Contact between 7 a.m. – 6 p.m. if admission not required for another reason
 
 
  • After 6 p.m., ensure IR order is placed
  • Admit patient
  • Inpatient team sends Epic chat at 7 a.m.

Dye Study

Indications

Procedure

IR Contact

  • Weekdays: 8 a.m. – 4 p.m., x57080
  • 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, including: clogged GJ tube, granulation tissue, site infection, leakage etc.