Displaced G-tube - Revision history

Danbot: Add verified PubMed references (PMIDs 37614051)

2026-03-22T11:00:01Z

Add verified PubMed references (PMIDs 37614051)

← Older revision		Revision as of 11:00, 22 March 2026
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	==Background==		==Background==

	*The percutaneous gastrostomy tube (PEG) is commonly indicated in:		*The percutaneous gastrostomy tube (PEG) is commonly indicated in:<ref>Farrugia E, et al. Proportion of unplanned tube replacements and complications following gastrostomy: A systematic review and meta-analysis. Nutr Diet. 2024 Feb;81(1):63-78. PMID 37614051</ref>
	**Patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing		**Patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing
	**Oropharyngeal or esophageal obstruction		**Oropharyngeal or esophageal obstruction

Ostermayer: Prepared the page for translation

2026-01-04T22:48:25Z

Prepared the page for translation

← Older revision		Revision as of 22:48, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	*The percutaneous gastrostomy tube (PEG) is commonly indicated in:		*The percutaneous gastrostomy tube (PEG) is commonly indicated in:
	**Patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing		**Patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing
Line 8:		Line 12:
	*Most PEGs are 18F to 28F and may be used for 12-24mo		*Most PEGs are 18F to 28F and may be used for 12-24mo
	*Displacement is estimated to occur in 1.6-20% of patients with PEG tubes		*Displacement is estimated to occur in 1.6-20% of patients with PEG tubes


	===Anatomy===		===Anatomy===

	The G-tube creates a connection via a hollow tube, from the gastric lumen, through the gastric wall and peritoneum, and through the abdominal wall		The G-tube creates a connection via a hollow tube, from the gastric lumen, through the gastric wall and peritoneum, and through the abdominal wall


	==Clinical Features==		==Clinical Features==

	*G-tube fully removed or partially removed with deflated balloon exposed		*G-tube fully removed or partially removed with deflated balloon exposed


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{DDX G-tube}}		{{DDX G-tube}}
			<translate>


	==Evaluation==		==Evaluation==

	*Clinical diagnosis		*Clinical diagnosis


	==Management==		==Management==


	===Within 2-4 Weeks of Insertion===		===Within 2-4 Weeks of Insertion===

	*'''''Do not attempt to replace the tube'''''		*'''''Do not attempt to replace the tube'''''
	*May not represent sufficient time for full epithelialization of the percutaneous tract		*May not represent sufficient time for full epithelialization of the percutaneous tract
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	*Urgent general surgical, gastroenterology, or radiology consult is recommended		*Urgent general surgical, gastroenterology, or radiology consult is recommended
	*Admit for IV antibiotics and monitor for peritonitis		*Admit for IV antibiotics and monitor for peritonitis


	===More Than 2-4 Weeks===		===More Than 2-4 Weeks===

	*Reinsertion should be attempted as soon as possible		*Reinsertion should be attempted as soon as possible
	**Mature stomas close rapidly (within minutes to hours)		**Mature stomas close rapidly (within minutes to hours)
	*Replacement tubes should be of the same size as the initial tube		*Replacement tubes should be of the same size as the initial tube
	*If the original size is unknown, a 16 or 18 French G tube or a Foley catheter may generally be used		*If the original size is unknown, a 16 or 18 French G tube or a Foley catheter may generally be used

	===Replacing a G-Tube===		===Replacing a G-Tube===

	#Deflate the balloon		#Deflate the balloon
	#Lubricate the tube with lidocaine jelly		#Lubricate the tube with lidocaine jelly
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	#*Inject of 10cc NS through the tube under direct ultrasound visualization of the stomach		#*Inject of 10cc NS through the tube under direct ultrasound visualization of the stomach
	#*Check tube fluid: gastric fluid pH is normally <4		#*Check tube fluid: gastric fluid pH is normally <4


	==Disposition==		==Disposition==

	*Tubes in place less than 2-4 weeks need urgent surgical, gastroenterology, or radiology consult		*Tubes in place less than 2-4 weeks need urgent surgical, gastroenterology, or radiology consult
	*Otherwise, tubes may be reinserted as described above, with urgent surgical, gastroenterology, or radiology consult if the tube is not replaced easily		*Otherwise, tubes may be reinserted as described above, with urgent surgical, gastroenterology, or radiology consult if the tube is not replaced easily


	==External Links==		==External Links==

	*[https://www.youtube.com/watch?v=1Ue63A2ULUI YouTube - Gtube Replacement]		*[https://www.youtube.com/watch?v=1Ue63A2ULUI YouTube - Gtube Replacement]


	==See Also==		==See Also==
	*[[G-tube complications]]
			*[[Special:MyLanguage/G-tube complications\|G-tube complications]]


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]][[Category:Procedures]]		[[Category:GI]][[Category:Procedures]]
	[[Category:Surgery]]		[[Category:Surgery]]
			</translate>

Cmb23: /* Within 2-4 Weeks of Insertion */

2023-10-26T03:42:54Z

Within 2-4 Weeks of Insertion

← Older revision		Revision as of 03:42, 26 October 2023
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	*Efforts at replacement may result in intra-peritoneal tube		*Efforts at replacement may result in intra-peritoneal tube
	*Urgent general surgical, gastroenterology, or radiology consult is recommended		*Urgent general surgical, gastroenterology, or radiology consult is recommended
	*~~Patients with early removal should be admitted~~ for IV antibiotics and ~~monitoring~~ for peritonitis.		*Admit for IV antibiotics and monitor for peritonitis

	===More Than 2-4 Weeks===		===More Than 2-4 Weeks===

Chris.carpenter.538: /* Within 2-4 Weeks of Insertion */

2020-08-02T20:51:24Z

Within 2-4 Weeks of Insertion

← Older revision		Revision as of 20:51, 2 August 2020
Line 27:		Line 27:
	*Efforts at replacement may result in intra-peritoneal tube		*Efforts at replacement may result in intra-peritoneal tube
	*Urgent general surgical, gastroenterology, or radiology consult is recommended		*Urgent general surgical, gastroenterology, or radiology consult is recommended
			*Patients with early removal should be admitted for IV antibiotics and monitoring for peritonitis.

	===More Than 2-4 Weeks===		===More Than 2-4 Weeks===

ClaireLewis: /* References */

2019-09-29T20:22:30Z

References

← Older revision		Revision as of 20:22, 29 September 2019
Line 64:		Line 64:

	[[Category:GI]][[Category:Procedures]]		[[Category:GI]][[Category:Procedures]]
			[[Category:Surgery]]

Kxl328 at 13:19, 8 September 2016

2016-09-08T13:19:33Z

← Older revision		Revision as of 13:19, 8 September 2016
Line 23:		Line 23:
	==Management==		==Management==
	===Within 2-4 Weeks of Insertion===		===Within 2-4 Weeks of Insertion===
	*Do not attempt to replace the tube		*'''''Do not attempt to replace the tube'''''
	*~~This many~~ not represent sufficient time for full epithelialization of the percutaneous tract		*May not represent sufficient time for full epithelialization of the percutaneous tract
			*Efforts at replacement may result in intra-peritoneal tube
	*Urgent general surgical, gastroenterology, or radiology consult is recommended		*Urgent general surgical, gastroenterology, or radiology consult is recommended

	===More Than 2-4 Weeks===		===More Than 2-4 Weeks===
	*Reinsertion should be attempted as soon as possible		*Reinsertion should be attempted as soon as possible

Neil.m.young at 11:55, 11 August 2016

2016-08-11T11:55:34Z

← Older revision		Revision as of 11:55, 11 August 2016
Line 53:		Line 53:

	==External Links==		==External Links==
			*[https://www.youtube.com/watch?v=1Ue63A2ULUI YouTube - Gtube Replacement]

	==See Also==		==See Also==

Neil.m.young: format

2016-08-11T11:53:39Z

format

Neil.m.young: I'm not sure if "or" is needed

2016-08-11T11:52:08Z

I'm not sure if "or" is needed

← Older revision		Revision as of 11:52, 11 August 2016
Line 1:		Line 1:
	==Background==		==Background==
	*The percutaneous gastrostomy tube (PEG) or is commonly indicated in:		*The percutaneous gastrostomy tube (PEG) is commonly indicated in:
	**~~patients~~ with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing		**Patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing
	**~~oropharyngeal~~ or esophageal obstruction		**Oropharyngeal or esophageal obstruction
	**~~major~~ facial trauma		**Major facial trauma
	**~~passive~~ gastric decompression		**Passive gastric decompression
	**~~mechanical~~ apposition of the stomach to the abdominal wall to prevent hiatal herniation.		**Mechanical apposition of the stomach to the abdominal wall to prevent hiatal herniation
	*Most PEGs are 18F to 28F and may be used for 12-24mo		*Most PEGs are 18F to 28F and may be used for 12-24mo
	*Displacement is estimated to occur in 1.6-20% of patients with PEG tubes		*Displacement is estimated to occur in 1.6-20% of patients with PEG tubes

Mackeym2 at 17:09, 10 August 2016

2016-08-10T17:09:03Z

← Older revision		Revision as of 17:09, 10 August 2016
Line 1:		Line 1:
	==Background==		==Background==
	*The percutaneous gastrostomy tube (PEG) is commonly indicated in:		*The percutaneous gastrostomy tube (PEG) or is commonly indicated in:
	**patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing		**patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing
	**oropharyngeal or esophageal obstruction		**oropharyngeal or esophageal obstruction
Line 34:		Line 34:
	#Deflate the balloon		#Deflate the balloon
	#Lubricate the tube with lidocaine jelly		#Lubricate the tube with lidocaine jelly
			#Position the patient reclined in bed to decrease abdominal pressure and relax abdominal wall musculature
	#Reinsert the tube along the tract. '''Never force the tube'''. Forcing the tube may separate the stomach from the abdominal wall and result in intraperitoneal placement of the G tube.		#Reinsert the tube along the tract. '''Never force the tube'''. Forcing the tube may separate the stomach from the abdominal wall and result in intraperitoneal placement of the G tube.
	#*If unable to replace g-tube, attempt one size smaller or a foley catheter		#*If unable to replace g-tube, attempt one size smaller or a foley catheter
	#Inflate the balloon with NS (amount written in milliliters on the port)		#Inflate the balloon with NS (amount written in milliliters on the port)
	#Apply gentle traction to position the balloon against the gastric wall		#Apply gentle traction to position the balloon against the gastric wall
	#~~Secure tube~~ with tape and gauze. ~~Never~~ place gauze between external ~~cuff~~ and skin.		#Adjust the external bolster against the skin with approximately 1cm of mobility and secure with tape and gauze. Not recommended to place gauze between external bolster and skin.
	#Confirm positioning. Options include:		#Confirm positioning. Options include:
	#*Inject 20-30mL of water-soluble contrast [Gastrografin], then obtain an upright abdominal XR.		#*Inject 20-30mL of water-soluble contrast [Gastrografin], then obtain an upright abdominal XR.

← Older revision		Revision as of 11:53, 11 August 2016
Line 24:		Line 24:
	===Within 2-4 Weeks of Insertion===		===Within 2-4 Weeks of Insertion===
	*Do not attempt to replace the tube		*Do not attempt to replace the tube
	**This many not represent sufficient time for full epithelialization of the percutaneous tract		*This many not represent sufficient time for full epithelialization of the percutaneous tract
	*Urgent general surgical, gastroenterology, or radiology consult is recommended		*Urgent general surgical, gastroenterology, or radiology consult is recommended
	===More Than 2-4 Weeks===		===More Than 2-4 Weeks===
Line 35:		Line 35:
	#Lubricate the tube with lidocaine jelly		#Lubricate the tube with lidocaine jelly
	#Position the patient reclined in bed to decrease abdominal pressure and relax abdominal wall musculature		#Position the patient reclined in bed to decrease abdominal pressure and relax abdominal wall musculature
	#Reinsert the tube along the tract. '''Never force the tube'''. Forcing the tube may separate the stomach from the abdominal wall and result in intraperitoneal placement of the G tube.		#Reinsert the tube along the tract
			#*'''Never force the tube'''
			#*Forcing the tube may separate the stomach from the abdominal wall and result in intraperitoneal placement of the G tube
	#*If unable to replace g-tube, attempt one size smaller or a foley catheter		#*If unable to replace g-tube, attempt one size smaller or a foley catheter
	#Inflate the balloon with NS (amount written in milliliters on the port)		#Inflate the balloon with NS (amount written in milliliters on the port)
	#Apply gentle traction to position the balloon against the gastric wall		#Apply gentle traction to position the balloon against the gastric wall
	#Adjust the external bolster against the skin with approximately 1cm of mobility and secure with tape and gauze. Not recommended to place gauze between external bolster and skin.		#Adjust the external bolster against the skin with approximately 1cm of mobility and secure with tape and gauze
			#Not recommended to place gauze between external bolster and skin
	#Confirm positioning. Options include:		#Confirm positioning. Options include:
	#*Inject 20-30mL of water-soluble contrast [Gastrografin], then obtain an upright abdominal XR.		#*Inject 20-30mL of water-soluble contrast [Gastrografin], then obtain an upright abdominal XR
	#*Inject of 10cc NS through the tube under direct ultrasound visualization of the stomach.		#*Inject of 10cc NS through the tube under direct ultrasound visualization of the stomach
	#*Check tube fluid: gastric fluid pH is normally <4.		#*Check tube fluid: gastric fluid pH is normally <4

	==Disposition==		==Disposition==