G/GJ tubes: What to do if your child’s feeding tube moves

Gastrostomy tubes (G tubes) and gastrojujenostomy tubes (GJ tubes) are feeding devices. A G tube gives liquid nutrition, medication and other fluids directly into the stomach. A GJ tube gives liquid nutrition, medication and other fluids directly into the small intestine (the jejunum). Both G tubes and GJ tubes are placed in a surgical opening in your child's tummy (abdomen) called the stoma. The tunnel from the outside into the stomach is called the tract.

Corflo PEG tubes and MacLoc G tubes are types of feeding tubes placed by an interventional radiologist using image guidance. Low-profile balloon type G tubes are placed by a G tube specialist (at SickKids this is the G Tube Resource Nurse). If your child’s G tube looks longer or shorter than normal, it may have moved out of position. Depending on the type of G tube your child has, the instructions for moving the tube back into place may be different.

Corflo PEG tube

A Corflo PEG tube has a round bolster inside the stomach that helps prevent the tube from being pulled out. There is a crossbar or white elbow fixation device at the stoma that helps prevent the tube from moving into the stomach. If the crossbar or elbow fixation device is not sitting at your child’s stoma, the tube may have moved out of position.

If the Corflo PEG tube has moved farther into the stomach your child may experience the following signs and symptoms.

• Vomiting
• Discomfort or pain
• Diarrhea
• Bloated stomach

If any of these signs occur, contact your G tube team.

Preventing your child’s Corflo PEG tube from moving

To prevent your child’s Corflo PEG tube from moving:

• Always secure the tube
• A crossbar or elbow fixation device is used to prevent the tube moving from in and out of the stoma
• Ensure proper fit of the crossbar or elbow fixation device at the stoma

For the first two weeks after tube insertion, do not adjust the crossbar or elbow fixation device. Contact your G tube team if you have concerns about the placement of the cross bar or elbow fixation device.

Two weeks after the initial insertion of the Corflo PEG tube, you may adjust the crossbar or elbow fixation device to sit at the stoma.

How to re-position your child’s Corflo PEG tube:

1. Wash your hands with soap and water.
2. Remove any tape used to secure the tube to abdomen.
3. Pull the tube back gently until resistance felt. This means the bolster is at the end of stoma tract.
4. Stop pulling when resistance felt, then adjust the crossbar or elbow fixation device to sit at the stoma.
5. Re-tape the tube to the skin if preferred and secure the tube well.

What to do if the Corflo PEG tube is partially pulled out

Although it is very unlikely, your child's Corflo PEG tube may be pulled out part way, which can cause the bolster on the end of the tube to become stuck in the tract. If this has happened, you may notice the following.

• Significant pain in the G tube area
• A visible hard plastic bulge (the bolster) that does not go away when you move the tube
• You may be able to feel a hard bulge (the bolster) in the tract or stoma
• Formula leaking from the stoma
• If you are concerned that the tube has been partially pulled out and the bolster is stuck, call your G tube specialist right away. On the weekend/after hours, go to the Emergency Department

Low-profile balloon type G tube

If your child has a low-profile balloon type G tube, it will not move farther into the stomach. This is a skin level tube that extends through the stoma. There is a balloon filled with water at the end of the tube that is in the stomach. This balloon holds the tube in place. Check the amount of water in the balloon at least once a week; if there is less water in the balloon, the tube may be able to move slightly in the tract. Use sterile or distilled water to refill the balloon.

MacLoc G tube

If your child has a MacLoc type G tube that looks longer or shorter than normal, it may have moved out of position.

If the MacLoc type G tube has moved farther into the stomach, your child may experience the following signs and symptoms:

• Vomiting
• Discomfort or pain
• Diarrhea
• Bloated stomach.

If any of these signs occur, contact your child's G tube team.

Preventing your child’s MacLoc G tube from moving

To prevent your child’s MacLoc type G tube from moving:

• Always secure the tube in place with tape
• Mark the outside part of your child’s feeding tube where it meets the stoma.

How to mark your child's MacLoc G tube:

1. Wash your hands with soap and water
2. Remove the tape securing the tube to the skin
3. Pull back on the tube gently
4. When you feel resistance, stop pulling. Push the tube into the stomach 1–2 cm.
5. Re-tape the tube to the skin and mark the tube where it meets the stoma. Use a permanent marker so it will not wash off with your daily soap and water cleaning.

You may also measure the length of the outside part of the feeding tube, from stoma to adaptor. Make sure to mark this number down somewhere you will remember.

Foley catheter

A foley catheter may be used as a G tube, J tube, or emergency tube. It has a balloon that sits inside the stomach or jejunum that prevents the tube from being pulled out. A piece of tape used to secure it on the outside and prevent the tube from moving into the stomach or jejunum. If the Foley catheter appears longer or shorter than normal, the tube may have migrated out of place.

If the Foley catheter migrates inwards, your child may experience the following signs and symptoms:

• vomiting
• abdominal discomfort or pain
• bloated abdomen
• diarrhea

If the tube has moved inwards, follow these steps:

1. Using a slip tip syringe, check the volume of water in the balloon. Re-inflate with appropriate volume (as directed by the health-care team).
2. Pull back on the tube until you feel resistance from the balloon.
3. Tape the tube down onto the abdomen to prevent it from falling out later.

If these symptoms do not improve, please contact your G Tube specialist during business hours or go to the emergency department for assistance, after hours.

Preventing your child’s Foley catheter from moving

To prevent a Foley catheter from moving:

• Always secure the catheter with tape to the abdomen.
• Check the water volume in the balloon at least once a week. Use sterile or distilled water to refill the balloon.
• Mark the position of the catheter where it meets your child’s stoma. You can use a permanent marker to prevent it washing off with daily cleaning.
• Measure the length of the outside part of the catheter, from stoma to adaptor. This will be a reminder of how long the external length is.

To mark the catheter:

1. Wash your hands with soap and water.
2. Remove the tape securing the catheter to the skin.
3. Pull the tube gently. When you feel resistance, sop. This is the balloon on the inner side of the tract.
4. Re-tape the tube to the skin and mark the tube where it meets the stoma.

At SickKids

If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.

G Tube Resource Nurse contact info:

Phone 416-813-7177

g.tubenurse@sickkids.ca

On weekends/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.