Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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. +++ Absolute + • Unstable airway.• Hemodynamically unstable patient.• Intestinal perforation. +++ Relative + • Coagulopathy (prothrombin time > 18 seconds).• Thrombocytopenia (platelet count < 100,000/mcL).• Recent intestinal tract surgery (< 1 month ago). + • Lubricant gel.• Gastrostomy catheter.• Button.• Normal saline.• 10-mL syringe. + • Bleeding.• Perforation. + • Explain indication and risks to the patient and parents.• Inform the patient of the intention of the procedure. + • Supine. + • The gastrostomy opening is usually located in the left upper quadrant of the abdomen with the bulb located in the body of the stomach. + • 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). + • 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. ++Figure 27–1.Graphic Jump LocationView Full Size||Download Slide (.ppt)Inserting and positioning gastrostomy tube. +++ Checking the Balloon + • 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the contents of balloon using a 10-mL syringe; hold the tube in place carefully to avoid displacement.• Observe amount withdrawn and top up to correct amount.• Refill balloon with normal saline.• Note: It is wise to push the tube down into the stomach to avoid accidentally pulling it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 ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.