Changing or replacing an established G-tube procedure

Paediatric guidelines (in development)
NHS Lothian

This is only for G-tubes as they can be changed in the community. Monarch® gastrostomy tubes need to be changed in theatre so your healthcare professional will inform you when its due to be changed.

This procedure should be followed when performing a planned change of gastrostomy tube or when replacing a tube that has fallen out. An established gastrostomy is one where the stoma has been formed for longer than a 3-month period. A healthcare professional should demonstrate the procedure before undertaking independently.

At NO time should any implement be inserted into a gastrostomy tube to aid insertion as this will damage the stoma tract.

If the tube has fallen out and the tract has started to close over then simple replacement may not be possible. It is reasonable to attempt tube insertion as detailed below but if this cannot be accomplished the child/young person should be brought to A&E for gastrostomy tube replacement.

If the child/young person is on a medication that may affect the pH of the gastric aspirate, such as omeprazole of esomeprazole, it is advisable to delay medication administration until after the gastrostomy tube has been changed.

Items Required for the Procedure

  • 2 x 5ml luer slip syringes
  • 60ml enteral feeding syringe
  • Cooled boiled water
  • Water soluble lubricating agent
  • Appropriate size of gastrostomy tube
  • pH strips
  • Water or milk feed
  • Gauze swabs

Procedure

  1. Ensure everything you need has been collected and is near to hand.
  2. Inform the child/young person that you are going to change gastrostomy tube.
  3. Position the child/young person lying down.
  4. Wash and dry hands thoroughly.
  5. Remove the new gastrostomy tube from the packaging. Inflate balloon with prescribed amount of cooled boiled water. Ensure the balloon has no leaks and deflate by removing the water.
  6. Note measurement marker on the current gastrostomy tube above the external retention disk, if still visible.
  7. Lubricate tip of the new gastrostomy tube with water-soluble agent.
  8. Attach a 5ml luer slip syringe to the balloon port of the gastrostomy tube that is in the patient’s stomach. Pull back on the plunger until all the water is out of the balloon.
  9. Gently remove the gastrostomy tube from the child/young person’s stomach.
  10. Using a gauze swab wipe away any gastric secretions that may have leaked from the stoma tract.
  11. Holding the new gastrostomy tube at the tip of the shaft, gently guide the new gastrostomy tube into the stoma to the length noted on the removed tube. Do not insert the whole G-tube into the stomach.
  12. Hold the gastrostomy tube in place and using a 5ml luer slip syringe inflate the balloon with prescribed amount of cooled boiled water.
  13. Pull back on the gastrostomy tube until resistance is felt.
    Slide the external fixator down the gastrostomy tube to sit against the abdominal wallNB The position of the tube MUST be confirmed before using it.
  14. To confirm position, attach a 60ml enteral syringe to feeding port and withdraw a small amount of stomach contents. Test this on pH strip. A reading of 5.5 or less is required to confirm the gastrostomy tube position. Inability to aspirate fluid or aspiration of small volumes of fresh blood may suggest possible gastrostomy tube misplacement.NB If unable to obtain an aspirate or the pH is 6.0 or above, please contact a health care professional (contact details see Contact Points) for advice. The child/young person may need to be referred to Emergency Department where tube position should be confirmed by contrast injection under X-ray screening.

    The gastrostomy tube should NOT be flushed until its position has been confirmed.
  15. Open the feeding port and attach 60ml enteral syringe to it, ensure clamp is closed.
  16. Flush the gastrostomy tube by unclamping the gastrostomy tube and slowly pushing the plunger of the syringe to insert the water; only administer the recommended amount of cooled boiled water.
  17. Once the flush is complete close the clamp, detach the 60ml enteral syringe.
  18. Replace feeding port cover.NB If there is pain or distress with flushing or feeding or if feeds do not run in freely then again tube position should be checked. Please contact a healthcare professional for advice (Contact Points).
  19. Wash and store reusable syringe as per manufacturers instructions.
  20. Wash and dry hands thoroughly