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

GJ 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


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 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
After 4 p.m., reach out to RAD/IR via Epic on-call finder

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

Call x57080 after 8 a.m. for same day add-ons. Assures patient gets first available slot.

Dye Study


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 (Clogged GJ tube, granulation tissue, site infection, leakage etc.)
Posted: May 2013
Revised:  July 2023
Editors: Clinical Pathways Team