Displaced G-tube: Difference between revisions

Revision as of 17:43, 31 January 2016

Displaced Gastrostomy Tube

Background:

The percutaneous gastrostomy tube (PEG) is commonly indicated in:

patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing
oropharyngeal or esophageal obstruction
major facial trauma

A PEG may also be placed for:

passive gastric decompression
mechanical apposition of the stomach to the abdominal wall to prevent hiatal herniation.

Most PEGs are 18F to 28F and may be used for 12-24mo.

General complications include:

wound infection
necrotizing fasciitis
peritonitis
aspiration +/- pneumonia
leaks
dislodgment
bowel perforation
enteric fistulas
bleeding
gastric outlet obstruction
small bowel obstruction
ileus
esophageal or gastric perforation
buried bumper syndrome
fistula
gastric herniation through the stoma

Displacement is estimated to occur in 1.6-20% of patients with PEG tubes.

Anatomy:

The G-tube creates a connection via a hollow tube, from the gastric lumen, through the gastric wall and peritoneum, and through the abdominal wall.

Management of the Displaced Tube:

Within 2-4 weeks of insertion: do not attempt to replace the tube, as this many not represent sufficient time for full epithelialization of the percutaneous tract. Instead, urgent general surgical, gastroenterology, or radiology consult is recommended.

If the PEG tube has been in place for more than 2-4 weeks, reinsertion should be attempted as soon as possible, as mature stomas close rapidly (within minutes to hours).

Replacement tubes should be of the same size as the initial tube.
If the original size is unknown, a 16 or 18 French G tube or a Foley catheter may generally be used.

To replace a tube:

1. Deflate the balloon

2. Lubricate the tube with lidocaine jelly

3. Reinsert the tube along the tract. Never force the tube. Forcing the tube may separate the stomach from the abdominal wall and result in intraperitoneal placement of the G tube.

4. Inflate the ballon with NS

5. Apply gentle traction to position the balloon against the gastric wall

6. Confirm positioning. Options include:

Inject 20-30mL of water-soluble contrast [Gastrografin], then obtain an upright abdominal XR.
Inject of 10cc NS through the tube under direct ultrasound visualization of the stomach.
Check tube fluid: gastric fluid pH is normally <4.

Disposition:

Tubes in place less than 2-4 weeks need urgent surgical, gastroenterology, or radiology consult.

Otherwise, tubes may be reinserted as described above, with urgent surgical, gastroenterology, or radiology consult if the tube is not replaced easily.

References

<Corbett* S.A. (2014). Systemic Response to Injury and Metabolic Support. InBrunicardi F, Andersen D.K., Billiar T.R., Dunn D.L., Hunter J.G., Matthews J.B., Pollock R.E. (Eds), Schwartz's Principles of Surgery, 10e. Retrieved January 23, 2016 fromhttp://accessmedicine.mhmedical.com.foyer.swmed.edu/content.aspx?bookid=980&Sectionid=59610843./>

<DeLegge, M.H. Gastrostomy tubes: Complications and their management. UpToDate. Accessed: 01/23/16. Last updated: Apr 15, 2015. https://www-uptodate-com.foyer.swmed.edu/contents/gastrostomy-tubes-complications-and-their-management?source=search_result&search=gastrostomy+tube&selectedTitle=2~142/>

Authors:

@@ Line 68: / Line 68: @@
 ==See Also==
-https://wikem.org/wiki/Clogged_feeding_tube
+*[[G-tube complications]]
+*[[Clogged feeding tube|Clogged G-tube]]
+*[[Displaced G-tube]]
+*[[Infected G-tube]]
+*[[Leaking G-tube]]
 ==References==