ED Pathway for Care of the Child
with GJ or G Tube Displacement
Related Pathway
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
Triage
Preserve stoma on all patients
Determine if:- New vs. established tract
- Tube has ever been changed
New | 6 weeks |
---|---|
Established | ≥ 6 weeks |
First tube replacement must be performed by service who created the tract and be confirmed by dye study.
- 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
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
- Review Low-profile Feeding Tubes and Extension Sets
- Replace MIC-Key tube with
AMT MiniONE - Call General Surgery with questions/concerns
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.
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
Clinical Pathway for Management of Gastrostomy Tube Complications (Clogged GJ tube, granulation tissue, site infection, leakage etc.)
Evidence
Educational Materials