From the Guidelines
The percutaneous gastrostomy tube is properly placed when contrast opacifies the external portion of the tube and the gastric antrum and duodenal bulb, as this confirms correct positioning within the gastric lumen and functioning of the tube. This is based on the most recent and highest quality study available, which emphasizes the importance of radiographic confirmation of tube placement to ensure safe administration of enteral nutrition and medications 1.
Key Points to Consider
- The use of contrast material to verify tube position is a common and effective technique, as it allows for visualization of the tube's placement and patency 1.
- Proper tube placement is essential to minimize risks of complications such as peritonitis or aspiration, and to ensure that nutrition or medications delivered through the tube will properly enter the gastrointestinal tract rather than being misplaced in the peritoneal cavity or other structures.
- The location of the tube in the right upper quadrant is consistent with normal gastrostomy tube placement, and the opacification of the gastric antrum and duodenal bulb confirms that the tube is correctly positioned within the gastric lumen.
Clinical Implications
- Radiographic confirmation of tube placement should be performed for all blind enteric placements and if there is concern about misplacement after guided placement 1.
- The technique of using contrast material to verify tube position is a valuable tool in ensuring the safe and effective use of percutaneous gastrostomy tubes.
- Clinicians should prioritize the use of radiographic confirmation to verify tube placement, rather than relying solely on bedside auscultation or other methods, which may be misleading 2.
From the Research
Proper Placement of Percutaneous Gastrostomy (G) Tube
- The proper placement of a percutaneous gastrostomy (G) tube is crucial to ensure effective enteral access for nutrition, decompression, and medication administration 3.
- To confirm the proper placement of the G-tube, contrast opulates the external portion of the tube and the gastric antrum (GA) and duodenal bulb, which can be visualized using radiographic procedures such as fluoroscopy or radiograph-only exams 4.
Verification of G-Tube Placement
- Verification of G-tube placement is essential to prevent complications such as gastric outlet obstruction (GOO), which can occur due to malposition of the tube 5.
- Radiologic-guided tube placement relies on image guidance for safe placement of the tube, and a thorough knowledge of the immediate and delayed hazards is essential to recognize, avoid, or get out of trouble 6.
- Ultrasound can also be used to guide gastrostomy tube replacement and confirm proper tube placement at the bedside, providing a safe and quick adjunct to traditional methods 7.
Complications of G-Tube Placement
- Complications of G-tube placement can include tube malposition, leakage around the tube, and gastric outlet obstruction (GOO) 4, 5.
- Fluoroscopy exams have been shown to have a sensitivity of 100% and a specificity of 100% for detecting G-tube malposition, while radiograph-only exams have a sensitivity of 75% and a specificity of 100% 4.