Gastrostomy Tube Complications - Revision history

Neil.m.young: Redirected page to G-tube complications

2016-01-31T18:27:40Z

← Older revision		Revision as of 18:27, 31 January 2016
Line 1:		Line 1:
	~~===Background===~~		#REDIRECT[[G-tube complications]]
	*Four components: tube, internal bolster, external bolster, and ports
	*External bolster very important as distal migration of tube with peristalsis can result in bowel obstruction and perforation
	*Sizes range from 12 to 24 Fr

	~~==Complications==~~

	~~===Dislodged Gastrostomy Tube===~~
	*Tracts may close within hours if relatively new tube
	*Foley catheters function well as temporary replacements
	*Procedure:
	**Obtain Foley size comparable to original tube
	**Lubricate tube liberally
	**Advance tube no more than 8-10 cm (in adult) to avoid entering esophagus, duodenum
	**Should not be significantly painful, require dissection, or considerable force
	**Pass smaller size tube if necessary to maintain tract without forceful insertion
	**Slowly inflate balloon, careful not to inflate balloon to max volume
	**Aspirate gastric contents to confirm placement
	**Place external bolster with these options:
	***Retention suture much like in chest tube placement
	***T-bar from 3cm section of another foley
	****Apply T-bar before insertion
	****Cut hole on either side of 3 cm section, just large enough for replacement tube to be passed through
	****Pull through replacement tube with hemostats
	**Tube may be used for feedings if:
	***Free flowing contents to gravity drainage
	***Tube contrast KUB (gastrograffin) without extravasation
	**Arrange for surgical outpt f/u within 24-48 hrs
	*Special considerations
	**Some tubes have circuitous route (Witzel), making tract difficult to approach
	**Small percutaneous endoscopic jejunostomies (PEJ) tubes are not replaceable
	**Extravasation in contrast KUB requires holding feeds and c/s with surgeon
	**Simple cellulitis around external site - PO antibiotics and good wound care
	**Obtain surgical c/s if replacement difficult

	~~===Nonfunctioning Gastrostomy Tube===~~
	~~====Differential====~~
	*Replacement for:
	**Fractured tube
	**Tube with ruptured balloon
	*Kinked tube may need only external bolster replacement
	*Clogged tubes should be gently irrigated first
	**Water, NS, or carbonated drink
	**Consultants may use enzymatic slns, or dislodge with endoscopic snares, biopsy forceps, etc
	**DeClogger® plastic wand with screw thread, tunneled into tube in clockwise fashion
	~~====Removal of tube====~~
	*Remove tube if mature tract and if unable to unclog
	*Determine type of tube, as most are removable with gentle traction
	**Most internal T-~~bars or soft caps deform with gentle traction~~
	**Internal balloon devices simply need to be deflated, but if balloon doesn't deflate:
	***Try cutting tube close to ports with hemostat in place to prevent inward migration
	***OR guidewire may be placed into balloon port to puncture balloon
	*If cannot remove with with gentle traction, c/s surgeon that placed tube
	*'''DO NOT''' simply cutting the tube at the skin and pushing remained of tube into pt to pass through GI tract
	**May cause bowel obstruction and perforation
	**Only choose this option in c/s with primary surgeon
	~~====Fresh or Immature Tracts====~~
	*New tubes should not be manipulated without c/s with the specialist that placed it
	*Clogged tube may need to remain in place to finish stenting tract
	*Inadvertent removal of tube ~~through fresh tract may lead to peritoneal contamination and subsequent peritonitis~~
	**If spillage of contents possible, pt needs admission, antibiotics, and observation for development of peritonitis
	**Tract will need to close spontaneously, and replacement PEG in 7-10 days

	~~==Sources==~~
	*Gastrostomy Tube Replacement, in Reichman, EF: Emergency Medicine Procedures, ed 2. New York, McGraw-Hill, 2013, (Ch) 64.

	~~[[Category:GI~~]]

Kxl328: /* Dislodged Gastrostomy Tube */

2016-01-09T20:41:48Z

Dislodged Gastrostomy Tube

← Older revision		Revision as of 20:41, 9 January 2016
Line 23:		Line 23:
	****Cut hole on either side of 3 cm section, just large enough for replacement tube to be passed through		****Cut hole on either side of 3 cm section, just large enough for replacement tube to be passed through
	****Pull through replacement tube with hemostats		****Pull through replacement tube with hemostats
	***Tube my be used for ~~feeds~~ if ~~there is free~~ flowing contents to gravity drainage		**Tube may be used for feedings if:
	***~~May obtain tube~~ contrast KUB ~~to confirm placeent~~		***Free flowing contents to gravity drainage
			***Tube contrast KUB (gastrograffin) without extravasation
	**Arrange for surgical outpt f/u within 24-48 hrs		**Arrange for surgical outpt f/u within 24-48 hrs
	*Special considerations		*Special considerations
	**Some tubes have circuitous route (Witzel), making tract difficult to approach		**Some tubes have circuitous route (Witzel), making tract difficult to approach
	**~~Not all~~ percutaneous endoscopic jejunostomies (PEJ) tubes are replaceable~~, especially the small Fr ones~~		**Small percutaneous endoscopic jejunostomies (PEJ) tubes are not replaceable
	**Extravasation in contrast KUB requires holding feeds and c/s with surgeon		**Extravasation in contrast KUB requires holding feeds and c/s with surgeon
	**PO antibiotics and good wound care ~~for simple cellulitis around external site~~		**Simple cellulitis around external site - PO antibiotics and good wound care
	**Obtain surgical c/s if replacement difficult		**Obtain surgical c/s if replacement difficult

Kxl328 at 20:38, 9 January 2016

2016-01-09T20:38:44Z

← Older revision		Revision as of 20:38, 9 January 2016
Line 18:		Line 18:
	**Aspirate gastric contents to confirm placement		**Aspirate gastric contents to confirm placement
	**Place external bolster with these options:		**Place external bolster with these options:
	***Retention suture much like in chest tube placement~~, but with slack for movement~~		***Retention suture much like in chest tube placement
	***T-bar from 3cm section of another foley		***T-bar from 3cm section of another foley
	****Apply T-bar before insertion		****Apply T-bar before insertion

Kxl328 at 20:37, 9 January 2016

2016-01-09T20:37:58Z

← Older revision		Revision as of 20:37, 9 January 2016
Line 12:		Line 12:
	**Obtain Foley size comparable to original tube		**Obtain Foley size comparable to original tube
	**Lubricate tube liberally		**Lubricate tube liberally
	**Advance tube ~~while meeting only mild resistance~~ no more than 8-10 cm to avoid ~~leaving stomach into~~ esophagus, duodenum		**Advance tube no more than 8-10 cm (in adult) to avoid entering esophagus, duodenum
	**Should not be significantly painful, require dissection, or considerable force		**Should not be significantly painful, require dissection, or considerable force
	**Pass smaller size tube if necessary to maintain tract without forceful insertion		**Pass smaller size tube if necessary to maintain tract without forceful insertion

Kxl328 at 20:37, 9 January 2016

2016-01-09T20:37:07Z

← Older revision		Revision as of 20:37, 9 January 2016
Line 4:		Line 4:
	*Sizes range from 12 to 24 Fr		*Sizes range from 12 to 24 Fr

	==Complications		==Complications==

	===Dislodged Gastrostomy Tube===		===Dislodged Gastrostomy Tube===
	*Tracts may close within hours if relatively new tube		*Tracts may close within hours if relatively new tube

Kxl328: Created page with "===Background=== Four components: tube, internal bolster, external bolster, and ports External bolster very important as distal migration of tube with peristalsis can result..."

2016-01-09T20:36:41Z

Created page with "===Background=== *Four components: tube, internal bolster, external bolster, and ports *External bolster very important as distal migration of tube with peristalsis can result..."

New page

===Background===
*Four components: tube, internal bolster, external bolster, and ports
*External bolster very important as distal migration of tube with peristalsis can result in bowel obstruction and perforation
*Sizes range from 12 to 24 Fr

==Complications
===Dislodged Gastrostomy Tube===
*Tracts may close within hours if relatively new tube
*Foley catheters function well as temporary replacements
*Procedure:
**Obtain Foley size comparable to original tube
**Lubricate tube liberally
**Advance tube while meeting only mild resistance no more than 8-10 cm to avoid leaving stomach into esophagus, duodenum
**Should not be significantly painful, require dissection, or considerable force
**Pass smaller size tube if necessary to maintain tract without forceful insertion
**Slowly inflate balloon, careful not to inflate balloon to max volume
**Aspirate gastric contents to confirm placement
**Place external bolster with these options:
***Retention suture much like in chest tube placement, but with slack for movement
***T-bar from 3cm section of another foley
****Apply T-bar before insertion
****Cut hole on either side of 3 cm section, just large enough for replacement tube to be passed through
****Pull through replacement tube with hemostats
***Tube my be used for feeds if there is free flowing contents to gravity drainage
***May obtain tube contrast KUB to confirm placeent
**Arrange for surgical outpt f/u within 24-48 hrs
*Special considerations
**Some tubes have circuitous route (Witzel), making tract difficult to approach
**Not all percutaneous endoscopic jejunostomies (PEJ) tubes are replaceable, especially the small Fr ones
**Extravasation in contrast KUB requires holding feeds and c/s with surgeon
**PO antibiotics and good wound care for simple cellulitis around external site
**Obtain surgical c/s if replacement difficult

===Nonfunctioning Gastrostomy Tube===
====Differential====
*Replacement for:
**Fractured tube
**Tube with ruptured balloon
*Kinked tube may need only external bolster replacement
*Clogged tubes should be gently irrigated first
**Water, NS, or carbonated drink
**Consultants may use enzymatic slns, or dislodge with endoscopic snares, biopsy forceps, etc
**DeClogger® plastic wand with screw thread, tunneled into tube in clockwise fashion
====Removal of tube====
*Remove tube if mature tract and if unable to unclog
*Determine type of tube, as most are removable with gentle traction
**Most internal T-bars or soft caps deform with gentle traction
**Internal balloon devices simply need to be deflated, but if balloon doesn't deflate:
***Try cutting tube close to ports with hemostat in place to prevent inward migration
***OR guidewire may be placed into balloon port to puncture balloon
*If cannot remove with with gentle traction, c/s surgeon that placed tube
*'''DO NOT''' simply cutting the tube at the skin and pushing remained of tube into pt to pass through GI tract
**May cause bowel obstruction and perforation
**Only choose this option in c/s with primary surgeon
====Fresh or Immature Tracts====
*New tubes should not be manipulated without c/s with the specialist that placed it
*Clogged tube may need to remain in place to finish stenting tract
*Inadvertent removal of tube through fresh tract may lead to peritoneal contamination and subsequent peritonitis
**If spillage of contents possible, pt needs admission, antibiotics, and observation for development of peritonitis
**Tract will need to close spontaneously, and replacement PEG in 7-10 days

==Sources==
*Gastrostomy Tube Replacement, in Reichman, EF: Emergency Medicine Procedures, ed 2. New York, McGraw-Hill, 2013, (Ch) 64.

[[Category:GI]]

Gastrostomy Tube Complications - Revision history

Neil.m.young: Redirected page to G-tube complications

Kxl328: /* Dislodged Gastrostomy Tube */

Kxl328 at 20:38, 9 January 2016

Kxl328 at 20:37, 9 January 2016

Kxl328 at 20:37, 9 January 2016

Kxl328: Created page with "===Background=== *Four components: tube, internal bolster, external bolster, and ports *External bolster very important as distal migration of tube with peristalsis can result..."

Kxl328: Created page with "===Background=== Four components: tube, internal bolster, external bolster, and ports External bolster very important as distal migration of tube with peristalsis can result..."