Oak: GJ tube management

GJ tube Standard of Practice at UCSF

How often to exchange? every 6 months minimum per manufacturer. Can last annually.

  • GI should place standing order “Fluoro Replace gastrojejunostomy tube” with manual release every 3 months. 
  • Families need to call Radiology (510) 428-3410 to schedule every 6 months

How often is too often? Less than every 4-5 months. 

  • IR will try trial different tube lengths for at least 1 year. 
  • GI RN to speak with family to ensure family is using correct extension with correct port

Malfunctioning tubes – who to reach out to?

  1. Determine if EMERGENT or URGENT
    1. EMERGENT if tube is dysfunctional and needs tube for hydration, come to ER
      1. ER needs to place order “Fluoro Replace gastrojejunostomy tube”
    2. NOT URGENT if tube still functional, schedule for outpatient exchange
      1. To schedule for outpatient exchange: MD or NP to place an order “Fluoro Replace gastrojejunostomy tube” and list as ASAP and email : [email protected] (write pt name, tube size, tube issue)
  2. What is the issue?
  • Clogging?
    • Step 1: GI can try to troubleshoot- warm water flushes with smaller syringes (5ml), can try carbonated water/Coke prior to replacement
    • Step 2: if not unclogging, determine if urgent vs. non-urgent (see above)
  • Broken balloon? Broken ports?
    • Step 1: GI to let family know to tape down G-tube or tape down extension
    • Step 2: make MD/NP aware to place “Fluoro Replace gastrojejunostomy tube” order
  • J-tube flipped into stomach (if family can aspirate formula from G-portion)? 
    • Step 1: Tell patient to come to ER
    • Step 2: ER needs to place order “Fluoro Replace gastrojejunostomy tube”
  • Leaking? 
    • Step 1: Tell patient to send photo
    • Step 2: RN to set up visit to check G-tube balloon if family hasn’t
    • Step 3: make MD/NP aware to place “Fluoro Replace gastrojejunostomy tube” order

NOTE: If sending to MB, order should be “Ambulatory Referral to Pediatric IR”

 

How to message GI RNs: P EB Ped Gastro Clinical Pool

How to message GI NPs: Voalte Erin Murphy

How to message IR team: [email protected] (if Oakland patient), [email protected] (if MB patient)

 

 

 

Keywords: gastrostomy, GJ, IR, occlusion, replacement, tube