G-J or G-T Displacement (< 18 years)
G-J or G-T Displacement (< 18 years)

Consult interventional radiology for replacement

Discharge, close follow up with PMD

Surgery consultation

Diet NPO

G-J tube?

Iohexol (omnipaque) or Iopamidol (isovue) dye study

Consult surgery for replacement

Procedure to preserve stoma opening

  • Obtain 10 Fr Foley or smaller to fit stoma
  • Insert 2 inches, using lubricant, but do not force
  • Do not inflate balloon
  • Tape Foley to abdomen and do not use

Immature tube or difficult replacement?

Able to aspirate gastric contents?

Wait 10 min, reposition patient and again try to aspirate gastric contents

Inclusion Criteria
  • GT or GJ tube removed that requires replacement
Exclusion Criteria
  • Fragile, complex medical patients (e.g. cardiac/single ventricle physiology patients)
  • Toxic appearing
  • Severe infection at the gastrosomy site

Replace gastrotomy tube. Do not use a q-tip or use force to insert GT into tract

Consult surgery or interventional radiology

Determine original service who placed tube and if this is the first replacement OR there is an immature tract

Original service

Immature

Mature

Interventional radiology

≤12 wks

>12 wks

Surgery

≤6 wks

>6 wks

Consider sending the patient home with a replacement GT or a 10F Foley and lubricant that the parent can place if the GT/GJ tube dislocates in the future and they cannot replace the GT/GJ.

Important historical questions

  • What service originally placed the tube?
  • When was the date of surgery/procedure?
  • When did the tube become dislodged (if known) and the circumstances when it came out?

Gastrotomy tube replacement

  • Check the balloon of the new G-tube for leaks (3 to 5 mL of water into the balloon port)
  • Place water soluble gel on the tip of the G-tube
  • Using gentle, constant pressure, insert the tube into the tract (~1 inch). Do not force, it may take a minute or two for it to enter the tract. Do not use a q-tip or other object.
  • Inflate the balloon with 3-5 mL of water
  • Gently pull up on the G-tube until you feel tension of the balloon on the abdominal wall




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