What is the procedure for replacing a G (gastrostomy) tube?

G-Tube Replacement Procedure

Replace G-tubes only when indicated by breakage, occlusion, dislodgement, or degradation—not at routine intervals—and use bedside balloon-type replacement through the mature tract for tubes placed more than 4 weeks ago, with endoscopic or radiologic replacement reserved for immature tracts or high-risk patients. 1

Indications for Replacement

G-tubes require replacement only when complications arise, not at scheduled intervals 1:

• Tube breakage or mechanical failure 1
• Occlusion that cannot be cleared 1
• Dislodgement or inadvertent removal 1
• Material degradation (fungal colonization, structural compromise) 1
• Balloon deflation in balloon-type tubes 1

Most transorally placed bumper-type tubes can be maintained for many years with careful handling 1. Balloon-type tubes typically require replacement every 3-4 months due to balloon degradation 1.

Timing-Based Replacement Strategy

Tubes Placed >4 Weeks Ago (Mature Tract)

Direct bedside replacement is safe and appropriate 1:

• The gastrocutaneous tract is mature and adherent to the abdominal wall 1
• Use balloon-type replacement tubes for blind replacement through the same tract 1
• Replace expeditiously to prevent tract closure 1
• If no commercial tube is available, temporarily use a same-size Foley catheter to maintain tract patency 1

Tubes Placed 2-4 Weeks Ago (Maturing Tract)

Proceed with caution—consider endoscopic or radiologic replacement 1:

• Blind replacement may be attempted by experienced clinicians 1
• Mandatory confirmation of position with water-soluble contrast study before use 1
• Tract maturation typically occurs in 7-14 days but may be delayed in high-risk patients 1

Tubes Placed <2 Weeks Ago (Immature Tract)

This is an emergency—do not attempt blind replacement 1, 2:

• Replacement must be done endoscopically or radiologically through the same site 1
• Risk of free perforation from stomach-abdominal wall separation 2
• Delayed maturation occurs in patients with malnutrition, ascites, or corticosteroid use 1, 2

Replacement Technique for Mature Tracts

Bumper-Type Tube Removal

For bumper-type tubes requiring replacement 1:

1. Cut the tube at skin level 1
2. Push the internal bumper into the intestinal lumen ("cut and push" technique) 1
3. Migration is usually uneventful, even with large-caliber tubes 1

Exception: Retrieve bumper endoscopically in patients with previous bowel surgery or risk of strictures/ileus 1

Balloon-Type Tube Insertion

Standard bedside replacement procedure 1:

1. Insert balloon-type replacement tube through the existing tract 1
2. Inflate balloon with sterile water (not saline)—typically 5-10 mL 1
3. Use minimal insertion force to avoid tract disruption 3
4. Maintain good control of the tube along the well-formed tract 3

Post-Replacement Confirmation

Confirm intragastric position before feeding 1, 3:

• pH testing: Gastric aspirate pH ≤5 1
• Irrigation test: Flush with 3-50 mL sterile water without resistance or leakage 1
• External length assessment: Compare to documented baseline 1
• Tube manipulation: Rotate and move in-out to assess mobility 1
• Water-soluble contrast study: If any doubt about position 1, 3

Never use the tube if position is uncertain—intraperitoneal placement causes chemical peritonitis and death 3.

Alternative Replacement Methods

When bedside replacement is not appropriate 1:

• Endoscopic replacement: For immature tracts, difficult anatomy, or failed blind attempts 1
• Radiologic replacement: When endoscopy unavailable or contraindicated 1
• Surgical replacement: Reserved for complications or failed percutaneous attempts 1

Balloon Maintenance

Weekly balloon volume checks prevent spontaneous deflation 1:

• Check water volume weekly 1
• Maintain manufacturer-recommended volume 1
• Replace tube if balloon fails to hold volume 1

Critical Pitfalls to Avoid

Never replace a tube from an immature tract without imaging guidance—this risks free perforation from stomach-abdominal wall separation 2, 3:

• Assume delayed maturation in malnourished patients, those with ascites, or on corticosteroids (may require up to 4 weeks) 1, 2
• Do not use excessive force during insertion—this disrupts the tract 3
• Never feed through a newly replaced tube without confirming position 3
• If abdominal pain or peritoneal signs develop after replacement, assume intraperitoneal placement until proven otherwise 3

Post-Replacement Management

Immediate assessment 2:

• Inspect stoma site for erythema, drainage, or bleeding 2
• Assess for pain or peritoneal signs 2
• Confirm hemostasis 2

Patient instructions 2:

• Keep area clean and dry 2
• Report fever, increasing abdominal pain, purulent drainage, or persistent leakage 2
• Apply simple gauze dressing changed daily if needed 2