ALERT: What is best practice for managing dislodged balloon G, GJ and G/GJ tubes?

Connected Care Quick Hits are up to date and evidence based recommendations for the care of children with medical complexity & technology dependence, from hospital to home.

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ALERT: What is best practice for managing dislodged balloon G, GJ and G/GJ tubes?

SITUATION: 

This Quick Hit was informed by recently updated best practice guidelines for managing dislodged balloon G, GJ or G/GJ tube.

BACKGROUND:

Many children with medical complexity rely on enteral tubes to support nutrition and/or medication administration. Balloon G, GJ and G/GJ tubes are types of feeding tubes that have a balloon on the end which sits inside the stomach to keep the tube in place and prevent it from being pulled out. 

Balloon G, GJ and G/GJ tubes can become dislodged if the balloon is broken or does not have enough water in it. Typically, balloon G tubes are changed at home. A coordinated hospital appointment is required to replace a GJ or G/GJ tube as they must be changed using image guidance. 

New evidence informs a change in practice for management of dislodged balloon G, GJ and G/GJ tubes pending replacement of the new tube

ASSESSMENT:

When caring for a child with a balloon G, GJ or G/GJ tube, partner with family caregivers to review the type and size of the tube, date of insertion, and who inserted the tube (Imaged Guided Therapy or General Surgery). Knowing this information about the enteral tube will help you determine what to do if it becomes dislodged. The following Quick Hit outlines different types of enteral tubes. 

At the start of each shift and before travelling outside of the home, review that the child has an emergency G/GJ tube dislodgement kit. The following QuickHit outlines the appropriate supplies required for the emergency kit.  

This image outlines the contents of a G/GJ tube emergency kit

RECOMMENDATION:

Connected Care recommends following the most up-to-date best practice for managing dislodged balloon G, GJ and G/GJ tubes that are in a mature tract. 

This includes the following considerations: 

1. Check if the balloon G, GJ or G/GJ tube was inserted at least 8 weeks ago.

   • If yes and it is a G tube, attempt to replace the tube if it is intact or if you have a new one on-hand. If the G tube cannot be replaced, insert a temporary Foley catheter that is the same French size as the dislodged tube

   • If yes and it is a GJ or G/GJ tube, insert a temporary Foley catheter that is the same French size as the dislodged tube.

2. If you are not able to insert the same size Foley catheter, attempt to insert a Foley catheter that is one French size smaller.

3. Once the Foley catheter is in place, arrange to have the child’s original G, GJ or G/GJ tube replaced.

4. Contact a G tube specialist or go to the nearest emergency department if:

   • You cannot insert a Foley catheter after a tube has been accidentally dislodged

   • You cannot verify the Foley catheter is in the stomach for a G tube

   • The child has pain, bleeding or feeding intolerance after the insertion of a Foley catheter

   • If the child had a GJ or G/GJ tube and requires image guidance to replace the tube

5. Review this AboutKidsHealth article that outlines how to manage dislodged G, GJ or G/GJ tubes.

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