What are the key elements to include in a note when documenting the removal of a Gastrostomy (G) tube without complications?

Documentation for Uncomplicated G-Tube Removal

Document the procedure as a straightforward removal with confirmation of tract maturity, method of removal, immediate post-removal site assessment, and patient instructions for stoma closure monitoring.

Pre-Removal Assessment

• Confirm tract maturation status (typically mature after 7-10 days, but may take up to 4 weeks in patients with malnutrition, ascites, or corticosteroid use) 1
• Document the indication for removal (e.g., no longer needed for nutrition, patient able to tolerate oral intake, or tube replacement) 2
• Note tube type and size (e.g., 20-F balloon gastrostomy, PEG with internal bumper) to guide removal method 1

Removal Method Documentation

• For balloon-type tubes: Document deflation of balloon with syringe, volume of water removed, and gentle traction removal 2
• For PEG tubes with internal bumper: Consider documenting use of "cut and push" method if tract is mature—cut tube at skin level and allow internal bumper to pass spontaneously through GI tract (safe in 97.3% of cases, eliminates need for endoscopy) 3, 4
• Document if endoscopic removal was required (typically reserved for immature tracts, concern for bumper impaction, or patient-specific factors) 3

Immediate Post-Removal Assessment

• Inspect and document stoma site appearance: Note absence of erythema, purulent drainage, bleeding, or signs of infection 1
• Assess for immediate complications: Document absence of pain, peritoneal signs, or excessive drainage 1
• Confirm hemostasis at site with brief observation period 1

Patient Instructions and Follow-Up Plan

• Document instructions given regarding stoma closure: Typically closes spontaneously within days to weeks; patient should keep area clean and dry 1
• Provide warning signs to report: Fever, increasing abdominal pain, purulent drainage, persistent leakage of gastric contents, or signs of peritonitis 1
• For "cut and push" method: Instruct patient that internal bumper will pass in stool (typically within days); document instruction to report abdominal pain, vomiting, or inability to pass stool 3, 4
• Document dressing application: Simple gauze dressing changed daily until stoma closes 1

Key Documentation Elements

• Procedure date and time
• Indication for removal
• Tube type, size, and duration in place
• Method of removal (traction vs. cut-and-push)
• Immediate post-procedure site assessment
• Patient tolerance of procedure
• Complications: None (explicitly state this)
• Patient education provided and understanding confirmed
• Follow-up plan if needed

Common Pitfalls to Avoid

• Never remove a tube from an immature tract (<7-10 days) without endoscopic or radiologic guidance, as this risks free perforation from separation of stomach and abdominal wall 1
• Do not assume tract maturity in high-risk patients (malnourished, ascites, steroids)—these may require up to 4 weeks for tract maturation 1
• Avoid removing tubes endoscopically when simple traction or cut-and-push is safe—this wastes resources and exposes frail patients to unnecessary procedures 3, 4