GJ or G-Tube Displacement Clinical Pathway — Emergency Department

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Provider Resources

Related Pathway

G, GJ, or J Tube Complications, Inpatient

GJ or G Tube Displacement

Preserving Stoma

Place same French (Fr) size foley as Fr tube in stoma. Progress 1 size smaller until able to place foley into stoma
Use lubricant, insert
2 inches, do not force
Do not inflate balloon
Tape Foley to abdomen
Do not use Foley, keep NPO

ED Triage

Preserve stoma on all patients

Determine if:

New vs. established tract
Tube has ever been changed

IR and General Surgery
New	< 6 weeks
Established	≥ 6 weeks

First tube replacement must be performed by service who created the tract and be confirmed by dye study.

MD/CRNP/RN Assessment

Tube information
Hydration, medication needs
Consider IR sedation needs

G Tube — New Tract or First Tube Replacement

G Tube - Established Tract

All GJ Tubes

Surgery Consult

IR Consult

Surgeon replaces tube
Dye study

IR replaces tube Confirms replacement

Replacing the G tube:

Attending physician/fellow will dilate the stoma to current G tube size
RN will replace the G tube as directed by the ED attending physician/fellow

G tube dislodgment while in ED:

RN replaces G tube if available,
or uses foley stoma preservation process as above
Informs attending physician/fellow

Low-profile G tube extension set connection issues (not due to ENFIT ports):

Review Low-profile Feeding Tubes and Extension Sets
Replace MIC-Key tube with
AMT MiniONE
Call General Surgery with questions/concerns

Place immediate order for GJ replacement

See IR G to GJ Tube Change Order Set

After 4 p.m., reach out to RAD/IR via Epic on-call finder

Determine if replacement can occur same day. If not, consider EDECU if possible or appropriate care area for IR procedure in the a.m.

Call x57080 after 8 a.m. for same day add-ons. Assures patient gets first available slot.

Dye Study

Indications
Procedure

IR Contact

Weekdays: 8 a.m. – 4 p.m., x57080
Weeknights, weekends, holidays and 4 p.m. – 8 a.m., Rad/IR via Epic On-Call Finder

Other Considerations

Clinical Pathway for Management of Gastrostomy Tube Complications (Clogged GJ tube, granulation tissue, site infection, leakage etc.)

Posted: May 2013
Last Revised: November 2024

Authors:
- C. Jacobstein, MD;
- P. Mattei, MD;
- A. Cahill, MD;
- J. Lavelle, MD;
- D. Hiller, RN;
- P. Reynolds, RN

Editors: Clinical Pathways Team

Evidence

Troubleshooting the Pediatric Gastrostomy

Educational Materials

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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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ED Pathway for Care of the Child with GJ or G Tube Displacement

Evidence

Educational Materials

ED Pathway for Care of the Child
with GJ or G Tube Displacement