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  • • 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.

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Absolute

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  • • Unstable airway.

    • Hemodynamically unstable patient.

    • Intestinal perforation.

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Relative

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  • • Coagulopathy (prothrombin time > 18 seconds).

    • Thrombocytopenia (platelet count < 100,000/mcL).

    • Recent intestinal tract surgery (< 1 month ago).

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  • • Lubricant gel.

    • Gastrostomy catheter.

    • Button.

    • Normal saline.

    • 10-mL syringe.

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  • • Bleeding.

    • Perforation.

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  • • Explain indication and risks to the patient and parents.

    • Inform the patient of the intention of the procedure.

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  • • Supine.

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  • • The gastrostomy opening is usually located in the left upper quadrant of the abdomen with the bulb located in the body of the stomach.

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  • • Prepare new tube for insertion.

    • • Remove from package.

      • Check balloon integrity by inflating.

      • Deflate and lubricate end with gel.

      • Put stopper in place.

    • Remove old tube.

    • • Deflate balloon fully with syringe and pull out firmly.

      • There is usually some resistance caused by the tube cuff.

    • Insert new tube into stoma.

    • • If patient is obese, may need to go further.

      • Check old tube shaft measurements before removing.

    • Without moving the tube, inflate balloon fully.

    • Tug on tube to check whether the balloon is inflated and then secure (Figure 27–1).

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  • • While firmly pulling tube upward, push fixation bolster down to the skin so that any in-out movement of the tube is prevented.

    • 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.

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Figure 27–1.
Graphic Jump Location

Inserting and positioning gastrostomy tube.

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Checking the Balloon

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  • • 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.)

    Caution:

    • • You may feel resistance if you are inflating the balloon in the tract. Stop and push in further. Deflate the balloon and reposition the tube.

      • Pushing the tube in too far can place it through the pyloric sphincter into the duodenum. If you ...

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