Gastrostomy tube replacement

Background

• Any individual presenting to Emergency Department (ED) with a dislodged gastrostomy should be considered as “Urgent” (within 60 minutes)

1. Identify when gastrostomy tube placed:

≤2 weeks: Cover stoma site and contact Gastroenterology/Radiology immediately.

≥2 weeks: Replacement by treating Doctor in the ED. See procedure for replacement below.

2. Assess if tube in situ:

No existing tube/Foley catheter keeping stoma site open

• Action: Attempt to keep stoma site open, exerting minimal force on insertion as per clinical judgment*
• *If unfamiliar with replacement, ensure Foley catheter insitu
• Options:
  • Gastrostomy replacement, see below for guidelines
• or
  • Place a Foley catheter until gastrostomy replacement possible (can use smaller size if indicated)

Existing tube/Foley catheter keeping stoma site open

• Action: Gastrostomy replacement, see below for guidelines

3. Commence procedure for replacement below

Note: If unsuccessful with gastrostomy replacement cover stoma site and contact Gastroenterology/Radiology immediately.

Procedure for replacement

Preparation for placement:

1. Aim to Identify French Size of Gastrostomy: Different French size may be required to fit current stoma
2. Source Tube from stock on ED or patient may have replacement
3. Positioning, ensure the patient is lying on flat bed/reclining chair
4. Aseptic technique
5. Inspect the tube prior to use:
   1. Fill the balloon with 5 ml or 20 ml of water, depending on balloon volume. This is printed on the inflation valve
   2. Completely deflate the balloon after inspection
   3. Check the external fixator to see that it slides up and down the shaft of the tube
6. Remove the existing tube if insitu by removing all water from balloon
7. Clean the stoma with normal saline
8. Close the feeding port on the new tube

Placement

1. Lubricate the tip with water-based lubricant or at least moisten the tip with water. Do not use a petroleum-based oil or jelly
2. Guide the lubricated tip through the stoma and into the stomach .The replacement tube must be able to move freely in and out of the abdomen
3. Inflate the balloon with sterile water. Balloon volume as per manufacturer’s instructions, this maybe printed on the inflation valve. Never inflate the balloon with air. Never overinflate the balloon
4. Withdraw the tube, until tension is felt from the balloon contacting the stomach wall
5. Slide the external fixator down the shaft of the tube until there is a space of ~5mm between the stoma and the fixation plate. Excessive tension should not be applied and the external fixator should not be sutured in place
6. Check that the tube is in the correct position by aspirating gastric contents with a syringe and testing aspirate on pH indicator paper. If in doubt of position, have a gastrograffin study performed

Links

• http://www.corpakmedsystemsuk.com/Learning_Center/learning-center.html
• Print copy this guideline