|Gastrostomy Tube Replacement|
Credits: 1.00 Post-Assessment Questions: 4
Release Date: 5 Oct 2020
Expiration Date: 5 May 2021
Last Reviewed: 5 May 2020
Estimated Time To Finish: 60 Minutes
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A gastrostomy tube (G-tube) is indicated in patients that need long-term pre-pyloric feeding. Endoscopic gastrostomy tube placement is now the preferred modality over surgical gastrostomy owing to a less invasive nature and faster time to start feeding. During endoscopic gastrostomy tube placement, a small incision is made over the anterior abdominal wall through which tube is placed via the push method (the tube is inserted percutaneously through the incision) or the pull technique (the tube is pulled out from the stomach through the incision). Once the tube is placed, the percutaneous tract starts maturing in about 1 to 2 weeks and is usually well formed by 4 to 6 weeks. However, in certain conditions such as severe malnutrition, immunocompromised patients, and large ascites, tract maturity is further delayed. If a PEG tube is dislodged within a month after placement, then endoscopic replacement is recommended. However, if the tube is dislodged after 4 to 6 weeks when tract maturity is expected, bedside replacement is usually sufficient. If the tube is dislodged within 4 weeks of initial placement, patients are at a significant risk of peritonitis and perforation due to peritoneal spillage of gastric contents through the immature track, and replacement should not be attempted without surgical consultation. Blind attempt to re-insert the tube or even foley placement in an immature tract can lead to inadvertent placement of the tube into the peritoneal cavity. This activity reviews what should be done If the tube needs to be replaced after the track is expected to be matured.
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Authors: Rushikesh Shah
Editors: Mili Shah
Chief Medical Reviewer: Sachit Anand
Nurse Planner/Reviewer/Editor: Lisa Haddad
Nurse Planner/Reviewer/Editor: Bernadette Makar
Nurse Planner/Reviewer/Editor: Dorothy Caputo
Pharmacy Planner/Reviewer/Editor: Mark Pellegrini
Physician Planner/Reviewer/Editor: Scott Dulebohn
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