Displaced G-tube: Difference between revisions
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===Within 2-4 Weeks of Insertion=== | ===Within 2-4 Weeks of Insertion=== | ||
*Do not attempt to replace the tube | *Do not attempt to replace the tube | ||
*This many not represent sufficient time for full epithelialization of the percutaneous tract | |||
*Urgent general surgical, gastroenterology, or radiology consult is recommended | *Urgent general surgical, gastroenterology, or radiology consult is recommended | ||
===More Than 2-4 Weeks=== | ===More Than 2-4 Weeks=== | ||
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#Lubricate the tube with lidocaine jelly | #Lubricate the tube with lidocaine jelly | ||
#Position the patient reclined in bed to decrease abdominal pressure and relax abdominal wall musculature | #Position the patient reclined in bed to decrease abdominal pressure and relax abdominal wall musculature | ||
#Reinsert the tube along the tract | #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 | |||
#*If unable to replace g-tube, attempt one size smaller or a foley catheter | #*If unable to replace g-tube, attempt one size smaller or a foley catheter | ||
#Inflate the balloon with NS (amount written in milliliters on the port) | #Inflate the balloon with NS (amount written in milliliters on the port) | ||
#Apply gentle traction to position the balloon against the gastric wall | #Apply gentle traction to position the balloon against the gastric wall | ||
#Adjust the external bolster against the skin with approximately 1cm of mobility and secure with tape and gauze | #Adjust the external bolster against the skin with approximately 1cm of mobility and secure with tape and gauze | ||
#Not recommended to place gauze between external bolster and skin | |||
#Confirm positioning. Options include: | #Confirm positioning. Options include: | ||
#*Inject 20-30mL of water-soluble contrast [Gastrografin], then obtain an upright abdominal XR | #*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 | #*Inject of 10cc NS through the tube under direct ultrasound visualization of the stomach | ||
#*Check tube fluid: gastric fluid pH is normally <4 | #*Check tube fluid: gastric fluid pH is normally <4 | ||
==Disposition== | ==Disposition== | ||
Revision as of 11:53, 11 August 2016
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
- 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
- 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
Clinical Features
- G-tube fully removed or partially removed with deflated balloon exposed
Differential Diagnosis
G-tube complications
Evaluation
- Clinical diagnosis
Management
Within 2-4 Weeks of Insertion
- Do not attempt to replace the tube
- This many not represent sufficient time for full epithelialization of the percutaneous tract
- Urgent general surgical, gastroenterology, or radiology consult is recommended
More Than 2-4 Weeks
- Reinsertion should be attempted as soon as possible
- 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
Replacing a G-Tube
- Deflate the balloon
- Lubricate the tube with lidocaine jelly
- Position the patient reclined in bed to decrease abdominal pressure and relax abdominal wall musculature
- 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
- If unable to replace g-tube, attempt one size smaller or a foley catheter
- Inflate the balloon with NS (amount written in milliliters on the port)
- Apply gentle traction to position the balloon against the gastric wall
- Adjust the external bolster against the skin with approximately 1cm of mobility and secure with tape and gauze
- Not recommended to place gauze between external bolster and skin
- 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