• First change should be performed 6–8
weeks after initial gastrostomy tube placement.
• Dislodged gastrostomy tube or gastrostomy button.
• Replacing a gastrostomy button.
• Blocked gastrostomy tube or gastrostomy button.
• Coagulopathy (prothrombin time > 18 seconds).
• Thrombocytopenia (platelet count < 100,000/mcL).
• Recent intestinal tract surgery (< 1 month ago).
• Lubricant gel.
• Gastrostomy catheter.
• Normal saline.
• 10-mL syringe.
• Prepare new tube for insertion.
• Remove old tube.
• Insert new tube into stoma.
• Without moving the tube, inflate balloon fully.
• Tug on tube to check whether the balloon is inflated and then
secure (Figure 27–1).
• While firmly pulling tube upward, push fixation
bolster down to the skin so that any in-out movement of the tube is
• Small amount of slack (~2–5 mm) is advised for comfort and
to prevent pressure necrosis.
• Gastric contents will probably now be apparent in the tube.
• If not, and stoma is new, aspirate tube to check.
• If stoma is well established (> 3 months) and this is not the
first tube change, aspiration test is unnecessary.
Inserting and positioning gastrostomy tube.
• Balloons deflate over time (by osmosis), so contents should
be checked monthly (more often leads to increased risk of bursting).
• Withdraw the contents of balloon using a 10-mL syringe; hold
the tube in place carefully to avoid displacement.
• Observe amount withdrawn and top up to correct amount.
• Refill balloon with normal saline.
• Note: It is wise to push the tube
down into the stomach to avoid accidentally pulling it out. (If
this happens, simply push the tube back in.)
• You may feel resistance if you are inflating the balloon in
the tract. Stop and push in further. Deflate the balloon and reposition
• Pushing the tube in too far can place it through the pyloric sphincter
into the duodenum. If you ...
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