G-J or G-T Displacement (< 18 years) - Curbside

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Evidence
Total Notes: 4
Evidence

1 Gastrostomy tubes

GT and GJ tubes are common feeding methods in many pediatric patients. A frequent complication of these devices is that they can be accidentally removed (on average 1 ED visit per patient per year). Although there are risks associated with replacement of the tube, a majority of patients have the tube replaced with no difficulty.



References:
  1. Long-term outcomes of infants and children undergoing percutaneous endoscopy gastrostomy tube placement.
    McSweeney ME, Jiang H, Deutsch AJ, Atmadja M, Lightdale JR,
    J. Pediatr. Gastroenterol. Nutr. 2013 Nov;57(5):663-7.
  2. Gastrostomy tube-related complaints in the pediatric emergency department: identifying opportunities for improvement.
    Saavedra H, Losek JD, Shanley L, Titus MO,
    Pediatr Emerg Care 2009 Nov;25(11):728-32.
  3. A guide to the management of common gastrostomy and gastrojejunostomy tube problems.
    Soscia J, Friedman JN,
    Paediatr Child Health 2011 May;16(5):281-7.

2 G-tube replacement

G-tube replacement should be accomplished with the least invasive method. In patients where the tube has been out of the stoma for several hours, closure of the stoma may occur. Serial dilations with increasing sized Foley catheters may be necessary. Forcing or excessive manipulation may be associated with an increased risk of false tract creation and should be avoided.



References:
  1. Gastrostomy tube replacement in a pediatric ED: frequency of complications and impact of confirmatory imaging.
    Showalter CD, Kerrey B, Spellman-Kennebeck S, Timm N,
    Am J Emerg Med 2012 Oct;30(8):1501-6.
  2. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review.
    Schrag SP, Sharma R, Jaik NP, Seamon MJ, Lukaszczyk JJ, Martin ND, Hoey BA, Stawicki SP,
    J Gastrointestin Liver Dis 2007 Dec;16(4):407-18.
  3. Gastrostomy complications in infants and children: a comparative study.
    Peters RT, Balduyck B, Nour S,
    Pediatr. Surg. Int. 2010 Jul;26(7):707-9.

3 Confirmatory imaging

Although severe complications are possible with any replacement of at GT, they are generally rare if proper technique is used and gastric contents are able to be aspirated. High risk patients include those with their first replacement, immature pathway tract or difficulty with GT replacement. In these cases (an other high risk situations or populations) the use of a confirmatory imaging with radiographic contrast material is recommended.



References:
  1. Gastrostomy tube replacement in a pediatric ED: frequency of complications and impact of confirmatory imaging.
    Showalter CD, Kerrey B, Spellman-Kennebeck S, Timm N,
    Am J Emerg Med 2012 Oct;30(8):1501-6.
  2. Peritonitis after gastrostomy tube replacement: a case series and review of literature.
    Taheri MR, Singh H, Duerksen DR,
    JPEN J Parenter Enteral Nutr 2011 Jan;35(1):56-60.
  3. The sky blue method as a screening test to detect misplacement of percutaneous endoscopic gastrostomy tube at exchange.
    Suzuki Y, Urashima M, Yoshida H, Iwase T, Kura T, Imazato S, Kudo M, Ohta T, Mizuhara A, Tamamori Y, Muramatsu H, Nishiguchi Y, Nishiyama Y, Takahashi M, Nishiwaki S, Matsumoto M, Goshi S, Sakamoto S, Uchida N, Ijima M, Ogawa T, Shimazaki M, Takei S, Kimura C, Yamashita S, Endo T, Nakahori M, Itoh A, Kusakabe T, Ishizuka I, Iiri T, Fukasawa S, Arimoto Y, Kajitani N, Ishida K, Onishi K, Taira A, Kobayashi M, Itano Y, Kobuke T,
    Intern. Med. 2009;48(24):2077-81.
  4. Peritonitis following percutaneous gastrostomy in children: management guidelines.
    Kimber CP, Khattak IU, Kiely EM, Spitz L,
    Aust N Z J Surg 1998 Apr;68(4):268-70.
  5. Iohexol and iopamidol: second-generation nonionic radiographic contrast media.
    Kawada TK,
    Drug Intell Clin Pharm;19(7-8):525-9.

4 Provider replacement of g-tube

Until the g-tube tract has fully granulated and matured, there is an increased risk of false tract replacement of tube with subsequent peritonitis, sepsis and other severe complications. In patients with new tubes proper selection of the provider most skilled to replace the tube is necessary.



References:
  1. The who, what, why, and how-to guide for gastrostomy tube placement in infants.
    Burd A, Burd RS,
    Adv Neonatal Care 2003 Aug;3(4):197-205.
  2. A guide to the management of common gastrostomy and gastrojejunostomy tube problems.
    Soscia J, Friedman JN,
    Paediatr Child Health 2011 May;16(5):281-7.