Is a gastrostomy (G) tube in place?

From the Guidelines

To determine if a gastrostomy tube (G-tube) is in place, you should first check for external markers or indicators on the tube that show proper positioning, and then confirm placement through radiographic confirmation, which is the gold standard, especially after initial placement or if there's any concern about tube migration or dislodgement. When checking for proper placement, confirm that the external bumper or disc is sitting approximately 1-2 cm from the skin surface. Next, aspirate contents from the tube using a syringe and check the pH of the aspirate - gastric contents typically have a pH of 1-4 1. You can also inject 5-10 mL of air while listening with a stethoscope over the stomach for a gurgling sound. For more definitive confirmation, you can instill a small amount (5-10 mL) of water-soluble contrast material through the tube and obtain an X-ray. Never administer medications or feedings until proper placement is confirmed, as misplaced tubes can lead to serious complications including peritonitis or respiratory complications if feeding enters the peritoneal cavity or lungs 1. Some key considerations for gastrostomy tube placement include the patient's underlying condition, respiratory function, and gastrointestinal function, as well as the potential risks and benefits of the procedure, including the risk of peristomal infection, which can occur in up to 30% of cases 1. The decision to place a gastrostomy tube should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances, and should be guided by the most recent and highest-quality evidence available 1. In general, gastrostomy tubes are indicated for patients who require long-term enteral nutrition, and the choice of tube placement method should be based on the patient's individual needs and circumstances, including their respiratory function and overall clinical condition 1. Some of the key factors to consider when selecting a method of gastrostomy include the status of the patient's respiratory function, their clinical condition, and any anatomical issues that may contraindicate the use of a particular method 1. Ultimately, the goal of gastrostomy tube placement is to provide safe and effective enteral nutrition, while minimizing the risks of complications and promoting the best possible outcomes for the patient, in terms of morbidity, mortality, and quality of life.

From the Research

Gastrostomy Tube Placement

• The placement of a gastrostomy (G) tube is a common procedure for providing enteral nutritional support in patients with dysphagia 2, 3.
• Percutaneous endoscopic gastrostomy (PEG) is the preferred method for providing enteral nutritional support in patients with dysphagia 2, 3.
• Gastrostomy, gastrojejunostomy, and jejunostomy tubes can be placed using endoscopic, radiologic, or surgical techniques 3, 4.

Confirmation of Gastrostomy Tube Placement

• Ultrasonography can be used to confirm the placement of a gastric tube, especially in settings where X-ray facilities are unavailable or difficult to access 5, 6.
• Ultrasound guidance can accurately guide gastrostomy tube replacement and confirm proper tube placement at the bedside 6.
• The use of color Doppler over the G-tube tip during catheter oscillation can enhance visualization and confirmation of placement 6.

Complications and Considerations

• Complications with feeding tubes are not uncommon and should be promptly recognized and treated 4.
• The improper replacement of a G-tube can lead to devastating consequences, and verifying appropriate placement is crucial 6.
• Esophageal hiatus hernia seems to be a major risk factor for gastroesophageal reflux (GER) complications after PEG tube placement 2.