Gastrostomy Tube Replacement

Updated: May 25, 2017
  • Author: Erik D Schraga, MD; Chief Editor: Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS  more...
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Overview

Background

Gastrostomy tube (G-tube) placement (placing a tube into the stomach) [1, 2] to provide nutrition and medication for patients unable to feed themselves was first described in the mid-19th century. Initially, this procedure was often complicated by the development of peritonitis and a high mortality. Currently, however, G-tube placement now routinely occurs with few complications when placed percutaneously and guided by endoscopy or interventional radiology techniques. [3] Neurologic disease is the most common indication for G-tube placement. [4]

Patients with dislodged G-tubes often present to the emergency department (ED) or other acute care setting to have their tube replaced. This article focuses on G-tube replacement, but the technique can be extended to duodenostomy and jejunostomy tubes as well. [5]

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Indications

A G-tube should be replaced as quickly as possible in the ED, unless the tube was recently placed.

A feeding tube tract can narrow or close within hours of tube removal.

A simple gastrostomy requires approximately 1-2 weeks to form a tract. [6] More complicated procedures, such as the Witzel tunnel, may take 3 weeks to create a mature tract.

If the tract appears fresh, immediately contact the provider who placed the tube before initiating ED replacement; operative or fluoroscopic replacement may be required.

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Contraindications

Replacing a G-tube that has not formed a tract can lead to misplacement in the peritoneal cavity. As mentioned above, simple G-tubes generally take 1-2 weeks to form a mature tract. Information on when the G-tube was initially placed should be obtained to determine whether nonoperative ED tube replacement can proceed safely.

Replacement should not be performed if any evidence of infection (see the image below), such as extensive erythema, exudate, or warmth, is appreciated around the G-tube site.

Regarding tube-site infections, most catheter-rela Regarding tube-site infections, most catheter-related infections involve local cellulitis, as shown here, with erythema and tenderness. These infections frequently respond to local wound care and oral antibiotics.
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