Ver el código de «Displaced G-tube»

==Background==
*The percutaneous gastrostomy tube (PEG) is commonly indicated in:
**Patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing
**Oropharyngeal or esophageal obstruction
**Major facial trauma
**Passive gastric decompression
**Mechanical apposition of the stomach to the abdominal wall to prevent hiatal herniation
*Most PEGs are 18F to 28F and may be used for 12-24mo
*Displacement is estimated to occur in 1.6-20% of patients with PEG tubes

===Anatomy===
The G-tube creates a connection via a hollow tube, from the gastric lumen, through the gastric wall and peritoneum, and through the abdominal wall

==Clinical Features==
*G-tube fully removed or partially removed with deflated balloon exposed

==Differential Diagnosis==
{{DDX G-tube}}

==Evaluation==
*Clinical diagnosis

==Management==
===Within 2-4 Weeks of Insertion===
*'''''Do not attempt to replace the tube'''''
*May not represent sufficient time for full epithelialization of the percutaneous tract
*Efforts at replacement may result in intra-peritoneal tube
*Urgent general surgical, gastroenterology, or radiology consult is recommended
*Admit for IV antibiotics and monitor for peritonitis

===More Than 2-4 Weeks===
*Reinsertion should be attempted as soon as possible
**Mature stomas close rapidly (within minutes to hours)
*Replacement tubes should be of the same size as the initial tube
*If the original size is unknown, a 16 or 18 French G tube or a Foley catheter may generally be used
===Replacing a G-Tube===
#Deflate the balloon
#Lubricate the tube with lidocaine jelly
#Position the patient reclined in bed to decrease abdominal pressure and relax abdominal wall musculature
#Reinsert the tube along the tract
#*'''Never force the tube'''
#*Forcing the tube may separate the stomach from the abdominal wall and result in intraperitoneal placement of the G tube
#*If unable to replace g-tube, attempt one size smaller or a foley catheter
#Inflate the balloon with NS (amount written in milliliters on the port)
#Apply gentle traction to position the balloon against the gastric wall
#Adjust the external bolster against the skin with approximately 1cm of mobility and secure with tape and gauze
#Not recommended to place gauze between external bolster and skin
#Confirm positioning. Options include:
#*Inject 20-30mL of water-soluble contrast [Gastrografin], then obtain an upright abdominal XR
#*Inject of 10cc NS through the tube under direct ultrasound visualization of the stomach
#*Check tube fluid: gastric fluid pH is normally <4

==Disposition==
*Tubes in place less than 2-4 weeks need urgent surgical, gastroenterology, or radiology consult
*Otherwise, tubes may be reinserted as described above, with urgent surgical, gastroenterology, or radiology consult if the tube is not replaced easily

==External Links==
*[https://www.youtube.com/watch?v=1Ue63A2ULUI YouTube - Gtube Replacement]

==See Also==
*[[G-tube complications]]

==References==
<references/>

[[Category:GI]][[Category:Procedures]]
[[Category:Surgery]]