G, GJ, J Tube Complications Clinical Pathway — Inpatient

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GJ or G Tube Displacement

Inpatient with a percutaneous or surgical G, GJ
or J tube and suspected site complication

Identify the type and maturity of G/GJ/J tube in LDA

G Tubes, GJ Tubes, J Tubes
Initial vs. replacement tube*
* Please contact General Surgery if unable to determine who placed the G/GJ/J tube or if the G/GJ/J tube was placed by an outside hospital.

Basics of tube/stoma care:

Devices for securing a tube and dressings
Keep site dry
Treat skin around stoma like other healthy skin – soap + water daily with minimal lotion

Bedside clinician (RN, MD, APP) comprehensive site assessment:
- Clean the stoma and site
- Check the tube fit (tight vs. loose)
- Contact unit-based resource (e.g., CNS, Skin Champion, APP)
- Document the site with images in Epic Media tab by CNS, APP, FLOC

Erythema around stoma

Granulation tissue

Leaking

Irritant dermatitis

Enlarged stoma/keyhole

Prolapse

Notify the Appropriate Service
Information about the inserting/managing service is located in the LDA in Epic. See a sample LDA.
To notify the appropriate service, see contact information below and Sample ISBARQ.

Replacement G tubes/J tubes initially placed by General Surgery
Initial G tubes/J tubes placed by General Surgery	Call General Surgery for problems with these tubes: Weekdays between 9 a.m. – 4:30 p.m.: PHL Gen Surg Gtube in Epic On-Call Finder If NP in General Surgery is not available: Gen Surg Cnslt ED/IP in On-Call Finder For the N/IICU: call the Surgical NP in the N/IICU, call #20132
Initial G tubes placed by IR and all GJ tubes	Call IR for problems with these tubes Weekdays 8 a.m. – 4 p.m.: call #53255 Weekdays 4 p.m. – 6 p.m.: call #57080 Weeknights between 6 p.m. – 8 a.m., Weekends, Holidays: Rad/IR in On-Call Finder
Replacement G tubes that were initially placed by IR	Call GI & Nutrition for problems with these tubes: PHL GI Gtube Nurse in Epic On-Call Finder
All Tubes at KOPH	Call KOPH Gen Surg Cnslt 1st Contact via Epic Chat

Reviewed by Children's Hospital of Philadelphia Clinical Care Committee: May 2019
Posted: May 2019
Revised: July 2023

Authors:
- M. Acord, MD;
- M. Stetzer, CWOCN;
- J. Crawford, ACCNS-P;
- L. Thompson, PA-C;
- J. Hillman, CRNP;
- L. Jang, CRNP;
- A. Boroughs, CWOCN;
- K. Rhodes, CRNP;
- C. Ehritz, ACCNS-P;
- M. Ryan, MD;
- P. Laje, MD

Editors: Clinical Pathways Team

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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Clinical Pathway for Management of Gastrostomy Tube Complications

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