Gastrostomy Tube (G-Tube) - Management
• Clear, soft, graduated tubing held in place w/ plastic mushroom-shaped ring/balloon in stomach (~3 cm deeper in obese pts)
• May be replaced at bedside after epithelialized track forms (~2-4 wks; delayed by malnutrition, steroids, immunosuppression)
• Gastrojejunostomy (GJ) tubes have 3 access ports: G tube port, J tube port and balloon port
• Secured with vertical Hollister device
• Venting means access port is attached to a foley bag so contents/gas can flow out as needed
- Only tube feeds and elixir meds should be given through J tube
- Attach 3cc syringe w/ warm H2O to female Leur adaptor. Push or pulse plunger to force through debris. Flush w/ 30 cc warm H2O to ensure not clogged.
- Can also try Seltzer, ginger ale, Coca-Cola. If persistent, can try pancrealipase (Viokase) with sodium bicarb
• Leaking: retract balloon or mushroom back to skin level; do NOT insert larger size tube (can cause stoma to enlarge), call service who placed G tube if persistent
• Migration: can cause N/V (w/ or w/o feeds), dumping syndrome. Confirm placement w/ tube injection study (30-60 mL gastrograffin f/b KUB)
• Falling out: replace w/ similar-sized Foey or feeding tube. Obtain tube study as above.
• Local site infection: try topical abx +/- antifungal before PO (cephalexin, clinda)
• Granulation tissue: check tube size (not too long or short); treat w/ warm compresses and silver nitrate (w/ barrier cream on surrounding nl skin to protect)
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