Procedure: Replace G-tube
Indication: Loss of G tube for feeding
Date: [Â ]
Operators: Â John Doe, MD (Attending)/Jane Doe, MD (Fellow) Â Â Â
Medications: Lidocaine 2% local Â
Fluoroscopy time:Â 1 minutes
Catheter: Â Balloon 20 F
Complications:Â None immediate.
Procedure:
The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. Written informed consent was obtained. A time out/call to order was performed prior to procedure initiation.
The anterior abdominal wall was prepped and draped in sterile fashion. A scout radiograph was obtained.
Contrast was injected through the skin opening and followed into the stomach. A Kumpe catheter was used to follow this into the stomach. A wire was advanced through the Kumpe catheter into the stomach under fluoroscopic control. The tract leading from skin to gastric lumen was dilated with a 8 x 4 conquest balloon.
The balloon was retracted; a 20 French gastrostomy tube was loaded over the balloon. This was advanced over the wire and position in the skin tract. The balloon was partially inflated and the gastrostomy tube and balloon catheter were advanced into the stomach under fluoroscopic control. Contrast was injected into the balloon of the feeding tube which was then retracted to the anterior abdominal wall. The wire and catheter were removed and contrast was instilled through the feeding tube to verify adequate location within the gastric lumen.Â
Successful placement of the PEG tube was confirmed. Sterile dressings were placed and the patient discharged from Angio-Seal suite in good condition.
Findings:Â
- Near occlusion of gastrostomy tract post inadvertent loss of gastrostomy feeding tube outside the hospital. Â
- Successful balloon dilation of gastrostomy tract and placement of a 20 F Balloon Gastrostomy tube. Â
Impression:
Successful replacement of the gastrostomy tube after inadvertent loss of feeding tube.
Frequently Asked Questions
What is a gastrostomy tube and why is it used?
A gastrostomy tube, or G-tube, is a device inserted through the abdomen that delivers nutrition directly to the stomach. It's often used for patients who cannot eat by mouth due to conditions affecting swallowing or digestion, ensuring they receive the necessary nutrients.
How is a gastrostomy tube replaced?
Replacing a gastrostomy tube involves several steps. The procedure is performed using fluoroscopy to guide the placement. A catheter and wire are inserted through the existing tract, followed by balloon dilation. A new tube is then positioned and secured, ensuring it sits correctly within the stomach.
What are the risks of replacing a gastrostomy tube?
The risks of replacing a gastrostomy tube include infection, bleeding, and injury to the stomach or surrounding organs. However, these are rare when the procedure is done correctly. The benefits of maintaining proper nutrition often outweigh these risks.
What is fluoroscopy and why is it used in G-tube replacement?
Fluoroscopy is an imaging technique that uses X-rays to obtain real-time moving images of the interior of the body. During G-tube replacement, it helps ensure the tube is accurately placed within the stomach by providing visual guidance to the medical team.
Why might a gastrostomy tube need to be replaced?
A gastrostomy tube may need replacement if it becomes dislodged, damaged, or blocked. Regular maintenance and monitoring can help identify when a replacement is necessary to continue effective nutritional support.
What is a Kumpe catheter and how is it used in this procedure?
A Kumpe catheter is a flexible tube used to navigate through body channels. In gastrostomy tube replacement, it helps guide the wire into the stomach under fluoroscopic control, ensuring accurate placement of the new tube.
How long does a gastrostomy tube replacement procedure take?
The replacement of a gastrostomy tube is typically a quick procedure, often completed within 30 minutes to an hour. The use of fluoroscopy shortens the duration by providing precise guidance, minimizing the time needed for accurate placement.
What should a patient expect after a gastrostomy tube replacement?
After a gastrostomy tube replacement, patients can expect some mild discomfort at the site, which usually resolves quickly. Care instructions will be provided, including how to clean the area and manage the tube to prevent complications like infection.
Immediate complications are uncommon but can include minor bleeding or discomfort at the replacement site. The procedure is generally safe when performed by experienced medical professionals, and patients are monitored for any adverse reactions before discharge.