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What is Gastrostomy Tube (G-Tube) and how is it Changed at the Bedside by a Physician? How do you Confirm the Placement of a new G-Tube Using Contrast?

Daniel Davidson, MD, MBA, DBA, PHD

Introduction:

A gastrostomy tube, often known as a G-tube, is a medical device that is placed through the abdominal wall into the stomach to give patients who are unable to swallow or absorb enough food or liquids nourishment, hydration, and medication. Individuals with illnesses including dysphagia, neurological abnormalities, or gastrointestinal diseases frequently receive this life-saving intervention. In order to provide adequate nutrition and hydration for patients who depend on enteral feeding, G-tube implantation and replacement procedures are essential. This article explains what a G-tube is, how a doctor changes it at the patient’s bedside, and how contrasts is used to verify the tube’s placement.

What is a Gastrostomy Tube (G-Tube)?

A flexible tube called a gastrostomy tube (G-tube) is placed into the stomach via a tiny abdominal wall incision during surgery or endoscopic procedures. Usually composed of silicone or polyurethane, the tube features an exterior section that stays outside the body for convenient access. G-tubes are available in a range of sizes and designs, such as balloon-retained tubes and low-profile buttons, to meet the needs and preferences of diverse patient populations.

Changing a G-Tube at the Bedside:

Preparation:


Assemble Supplies: The healthcare professional makes sure that all required materials are on hand, such as a fresh G-tube that is the right size and kind, sterile gloves, sterile drapes, antiseptic solution, a suture removal kit, and a securing device.

Patient Assessment:

A review of the patient’s current health, medical history, and any possible procedure contraindications is conducted. Vital indicators can be tracked in order to guarantee consistency.

Patient Get Ready:

Placement:

The patient is ideally placed in a semi-reclined position on the bed or examination table.

Anesthesia/Sedation:

Depending on the patient’s tolerance level and overall health, either local anesthetic or sedation may be used to reduce discomfort during the treatment.

Dismantling the Previous G-Tube:

Deflating the Balloon (if Applicable): If the previous G-tube was balloon-retained, the balloon is released from the stomach wall by deflating it using a syringe.

Withdrawal:

The medical professional gently takes out the previous G-tube from the stoma, which is the abdominal wall opening. Cut and remove any sutures holding the tube in place.

Inspection of the Stoma:

The stoma site is examined for indications of inflammation, infection, or granulation tissue.

The New G-Tube’s insertion:


Alignment and Positioning: The new G-tube is properly positioned inside the stomach by being placed into the stoma.

Inflating the Balloon (if Applicable):

In the event that the new G-tube is balloon-retained, sterile water is inflated inside the balloon to keep it firmly in the stomach.

Keeping the G-Tube Safe:

Stabilization:

After the new G-tube is positioned, the abdominal wall is fastened to it with the proper fastening tool, like a bolster or retention device.

Placement of Sutures:

To further support the tube and stop displacement, sutures may be positioned around the stoma site.

Validation and Record-Keeping:

Verification of Positioning:

The medical professional confirms that the new G-tube is positioned inside the stomach and permits sufficient drainage.

Documentation:

The patient’s medical record contains information about the specifics of the procedure, such as the new G-tube’s size and type, any difficulties that arose, and instructions for what to do afterward.

Confirming G-Tube Placement using Contrast:

Patient Preparation:

The patient is usually placed on an X-ray table or other examination surface prior to the contrast imaging treatment. To make imaging easier, the patient can be instructed to lie flat or adopt a particular position. Making ensuring the patient is relaxed and positioned correctly for the treatment is crucial.

Connecting the Contrast Agent:

An injection-ready radiopaque contrast agent, such as an iodinated contrast solution that dissolves in water, is made. A syringe filled with contrast agent is connected to the G-tube and firmly fastened to the tube’s feeding port or extension set.


Injecting the Contrast:

 A healthcare professional will guide the gentle injection of the contrast agent into the G-tube. Depending on the patient’s tolerance and the preferences of the healthcare professional, the injection rate may change. Extreme caution is exercised to prevent abrupt or strong injections, which may cause pain or other issues.

Monitoring the Contrast Flow:

 A real-time imaging technique, like fluoroscopy or X-ray, is utilized to monitor the flow of the contrast agent through the gastrointestinal tract as it is injected into the G-tube. With the continuous, dynamic imaging that fluoroscopy offers, a medical professional can see the movement of contrast in real time.

Visualizing G-Tube Placement:

Throughout the contrast imaging process, the medical professional keeps a close eye on how the contrast material moves through the digestive system. The objective is to monitor the contrast as it passes from the site of G-tube implantation into the esophagus and stomach. When the contract is seen entering the stomach without any indications of leakage or obstruction, the insertion of the G-tube is confirmed to be correct.

Examining for Complications:

During the contrast imaging process, the medical professional looks for any indications of potential problems, like aspiration or improper placement of the tube. Early detection of problems enables quick action to reduce risks and guarantee patient safety.


Recording the Findings:

The healthcare practitioner records the results in the patient’s medical file when the contrast imaging process is finished and the appropriate positioning of the G-tube is verified. The type and quantity of contrast utilized, the day and time of the procedure, and any pertinent observations or issues that arose throughout the imaging process are all included in this documentation.

Conclusion:


For patients who need assistance with enteral feeding, the insertion and replacement of a gastrostomy tube are crucial procedures. Healthcare professionals can guarantee the safe and efficient management of patients requiring enteral feeding by being aware of the procedures involved in changing a G-tube at the bedside and verifying its placement using contrast imaging. In order to improve patient outcomes and the quality of life for those who depend on G-tubes for their nutritional needs, several operations are essential.

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