Gastrostomy Tube Replacement Periprocedural Care

Updated: May 26, 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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Periprocedural Care

Equipment

Ideally, the patient arrives in the emergency department (ED) with the dislodged gastrostomy tube (G-tube). The same tube or same type of tube can be placed. The fact that the G-tube was dislodged often indicates a malfunction with that particular tube (eg, balloon rupture); thus, a new tube should be used. When information on the tube type is not available or known to the patient, a dedicated feeding tube suffices. If no feeding tube is accessible, a Foley catheter (≥16 French) can be used temporarily until a dedicated feeding tube can be placed.

Before G-tube replacement, gather the following items:

  • Gloves
  • Stethoscope
  • G-tube or Foley catheter
  • External bolster
  • Lubricant
  • Syringe that fits tube for air insufflation
  • Syringe that fits tube for saline inflation (if balloon is involved)
  • Saline
  • Suture material
  • Needle driver
  • Scissors

Certain tubes require specialized plugs, connectors, and clamps, which should be specified on the packaging insert. In addition, some tubes necessitate the use of a hemostat, endotracheal tube stylet, guide wire, or other support to assist tube passage.

Two types of catheters are depicted in the images below.

Commonly used by radiologists, Cope loop catheters Commonly used by radiologists, Cope loop catheters (illustrated with a metal introducer stiffener) are easily placed into the stomach. However, their small lumina and small side holes predispose them to catheter occlusion.
Commonly used for surgical, endoscopic, and radiol Commonly used for surgical, endoscopic, and radiologic gastrostomy access, balloon catheters provide secure intraluminal retention and are simple to place and replace.
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Patient Preparation

Anesthesia

G-tube replacement generally requires no anesthesia. If the skin site is sore, local administration of lidocaine or bupivacaine can decrease discomfort associated with tube replacement. For more information, see Local Anesthetic Agents, Infiltrative Administration.

Positioning

G-tube replacement is most easily performed with the patient in a comfortable recumbent position.

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