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Types of Tubes
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GJ feeding tubes

What to do if the GJ tube falls out
If the GJ tube becomes blocked

A GJ tube is a radiologically inserted tube that is placed through the already established gastrostomy stoma and threaded into the jejunum in the x-ray department.

GJ tubes are used for children who cannot tolerate feeding into the stomach, usually due to gastroeshophageal reflux (GERD).

To change a GJ tube in radiology:
  • a requisition must be sent to the x-ray department for every tube change
  • the requisition must be signed by a doctor with admitting privileges at Children’s
  • the GJ feeding tubes are routinely replaced on Thursdays

Important things to know about a GJ tube

  • feeding will now need to be continuous - the small bowel can not handle bolus feeds like the stomach can - you will no longer be able to bolus feed with this type of feeding tube
  • the length of feeding time will increase if you have been bolus feeding
  • the GJ tube may not be as secure as the GT, it can fall out if it is not taped and secured well (if a Cook catheter is used)
  • the GJ tube tends to block easier that the GT (flush tube well before and after medications)

Preventing the tube from falling out


If a Cook catheter is being used - you need to keep the GJ tube well secured - there is no balloon or disc that keeps the tube in the small bowel. 
  • keep tube well secured to the abdomen with waterproof tape
  • you may find that a piece of duoderm on the skin helps to protect the skin from the tape needs to be changed frequently
  • remember to always carry a replacement tube with you
  • you will need to place the replacement tube into the stoma to stop the stoma from closing
  • you can purchase an emergency kit at the outpatient pharmacy at in the Ambulatory Care Building

If the tube falls out


If the GJ tube falls out, a replacement tube needs to be placed into the stoma as soon as possible so that the hole does not close over. You can use a Foley catheter to keep the stoma open until the GJ tube can be replaced.

  • if your child can tolerate medications and fluids via the gastrostomy – you can use this route until the tube can be replaced
  • if your child can NOT tolerate any fluid via the gastrostomy you will need to take your child to a hospital for intravenous fluid until an appointment can be arranged to replace the GJ feeding tube
Do not panic

If the stoma is new (the gastrostomy tube itself was less than six weeks):
  • cover the stoma with a clean gauze or cloth
  • you need to see a doctor to put the tube back in as soon as possible (within two hours)
  • the stoma will close pretty quickly (within four to six hours)

If the stoma is more than six weeks old:

  • you need to place a feeding tube into the stoma as soon as possible
    • gather equipment:
      -feeding tube (Foley catheter or skin level tube)
      -wash cloth
      -tape
      -5ml syringe – to inflate the balloon
      -5ml water – to inflate the balloon
      -water-soluble lubricant (like KY jelly)
    • draw up 5ml of water into the syringe
    • check the balloon on the new tube before putting it into the stoma by inflating the balloon with 5ml of water
    • deflate the balloon by pulling the water back into the syringe
    • moisten the end of the tube with water or water-soluble lubricant (to make the tube go in easier)
    • insert the new tube about 2 inches into the stoma - inflate balloon with the 5 ml of water in the syringe – remove the empty syringe from the tube
    • gently pull back on the tube – to feel it (the balloon) snug against the stomach wall
    • you will need to arrange to have the GJ tube replaced
      • your doctor will have to arrange to have the tube changed
      • if your child can not have medications and/or fluids via the gastrostomy route – you will need to go to the hospital for intravenous fluid until an appointment can be booked to have your tube changed

 

If the GJ tube becomes blocked


First try using warm water and use a firm push/pull action with a 60ml syringe to unblock the tube. If this is not successful a mixture of cotazyme and sodium bicarbonate can be used to unblock the tube. Your doctor will need to supply you with a prescription for the cotazyme capsules.

Supplies

  • doctor must prescribe a cotazyme capsule (pancreatic enzyme)
  • cotazyme capsules are available at a pharmacy
  • sodium bicarbonate 1 tablet (325mg) or ½ teaspoon of baking soda
  • warm water
  • syringe (60ml)
  • small cup
Method
  1. Try to unblock tube with warm water using a firm push/pull action.
  2. Pull out as much of the contents of the tube as you can.
  3. Place contents of cotazyme capsule (just the powder) and crush sodium bicarb tablet (baking soda) into cup.
  4. Add 10-15ml of warm water to the powders and mix very well
  5. Draw up this solution into the syringe (60ml).
  6. Put the solution into the blocked tube and let it sit for 15-30 min.
  7. You can “milk” the tubing to move the solution through the tube.
  8. Flush the tube with warm water using the push/pull action .
  9. If tube is still blocked, repeat above. You may leave the solution in place for one (1) hour.
  10. If two (2) attempts to unclog the tube do not work – contact your doctor or remove the tube and use as a gastrostomy until the GJ tube can be replaced.