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Troubleshooting G-tubes & J-tubes: Common scenarios / Tips & Tricks

Replacing a G-tube should only take a few minutes, but taking an accurate history and performing a focused physical examination is important. The most important historical points are: (1) how long has the patient had a G-tube, (2) any problems with administering feedings or medications through the tube, (3) and how long has the G-tube been out. A new G-tube needs about 2 -3 weeks to form a tract. If the G-tube is new, notify the physician who placed it. Replacing a G-tube in a new site that has not formed a tract may cause separation of the stomach from the abdominal wall.

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Articles of Interest

The Threes of G's - Troubleshooting the PEG Tube

If it was placed >3 weeks ago, you are ok (remember: "PEG" has 3 letters; so 3 weeks is the dividing line); full epithelialization of tract. If placed <3 weeks ago, call for backup; may need IR/Surgery/GI replacement.

Gastric Outlet Obstruction Caused by Foley Catheter: A Complication when Substituting for Commercial Gastrostomy Tubes

The technique of using percutaneous endoscopic gastrostomy (PEG) for long-term enteral feeding is well established and commonly used. While the technique is relatively safe and simple, the gastrostomy tube itself may deteriorate or malfunction, requiring a replacement tube. We present a case of a 58-year-old woman who was found to have gastric outlet obstruction from the inflated balloon of a Foley catheter being used as a replacement for her PEG tube. This case illustrates a potential complication of using a Foley catheter in place of commercially available gastrostomy tubes.

Gastric Tube Replacement Procedure

How often do you do a Gastric Tube replacement procedure? For us, it’s not often enough to be experts, so we brought back Whit Fisher to talk us through the options and his “MacGyver” tips.

Gastrostomy tube replacement

Place a Foley catheter until gastrostomy replacement possible (can use smaller size if indicated)

How to replace a gastrostomy tube - Peds

Gastrostomy tube dislodgment and malfunction are top causes for G-tube related ED visits in pediatric patients so it is important to understand how to replace a G-tube. Gastrostomy tubes can be placed surgically or endoscopically. It is important to determine how the G-tube was placed and how long ago. It typically takes ~3 months for the tract between the skin and the stomach to mature. If the G-tube has been in for less than 3 months, it’s a good idea to talk with the department who placed it (i.e surgery or GI) before you mess with it.

Train Yourself: G-tube Replacement

G-tube dislodgement is a common emergency department presentation, particularly in the pediatric population, since children are prone to pulling on their G-tubes and often do not understand the dangers of doing so.

Troublesome G-Tubes

Most sources agree that the gastrocutaneous tract formed by GT placement is fully matured by approximately 4-6 weeks. If the tube has been in place for <4 weeks, bedside replacement should not be attempted as there is a high likelihood of perforation or false tract creation leading to peritonitis from gastric leakage or introduction of feeds directly into the peritoneal cavity.

Unlocking the MIC-KEY: Understanding and Troubleshooting Low-Profile Gastrostomy Tubes

A PEG tube commonly refers to all G/GJ-tubes regardless of placement technique. PEG tubes have long tubing and are often the device used for initial placement. A MIC-KEY, a trademarked name, commonly refers to a lower profile gastric tubes (or “button,” (Image 2)) that sits at the level of the skin. Instead of the longer tube seen in PEG tubes, low-profile buttons come with an extension set that is attached for feeding (Image 3) and can be disconnected for comfort in between feeds.