A low-profile GJ tube is a type of feeding tube that provides fluids, nutrition and medications directly to the small intestine (jejunum). It is called "low-profile" because it sits close to the skin and is very discreet. Low-profile GJ tubes are placed by an interventional radiologist using image guidance.
A Mic-Key low-profile GJ tube is not used for primary tube insertion, instead it is a transition tube. This means that your child will have had a different type of feeding tube before transitioning to the low-profile GJ tube.
The low-profile GJ tube is placed through an opening in your child's abdomen called a stoma. The tunnel from the outside through the stoma is called the tract.
| The SickKids G-Tube Feeding Program has developed a one page guide to help you quickly troubleshoot any issues with your child's feeding tube: G-Tube Feeding Program Family One Pager |
Low-profile GJ tubes are different than surgically inserted J tubes. While both are inserted into the small intestine, the low-profile GJ tube enters through your child's stomach, passes through into the first part of the small intestine and ends in the jejunum. Surgical J tubes are inserted directly into the jejunum by a surgeon in an operating room.
The G tube team provides support related to both low-profile GJ tubes and surgical J tubes after insertion.
Giving feeds, liquids and medication through the low-profile GJ tube
Your child's tube feeds are to remain the same as with previous GJ tube exchanges.
A Mic-Key low-profile GJ tube extension set needs to be attached to the feeding port to administer feeds and medications. A slip-tip syringe can be attached directly to the feeding port; however, this is not recommended as the one-way valve can break with frequent access. The one-way valve is built inside the GJ tube and prevents the stomach contents from flowing back out through the tube.
For more information on connecting and removing the extension set, please see the article “How to use a feeding extension set for a low-profile balloon G tube”.
Caring for your child's low-profile GJ tube
The balloon port of your child's low-profile GJ tube helps to keep the tube from accidentally being pulled out. The balloon of a 14 French (FR)-size low-profile GJ tube can safely hold 5 to 10 mL of sterile or distilled water.
Here are some things to remember when caring for your child's low-profile GJ tube:
- Do not feed your child through the balloon port.
- Do not fill the balloon with saline or air.
- Filling the balloon with more or less water can affect the position of the tube.
- Less water makes the tube stick out and more water brings the tube closer to the skin.
The doctor who inserts the tube may fill the balloon with less than the recommended balloon volume. If this is the case, you will need guidance from your health-care team before you increase the balloon volume.
Filling the balloon with too much or too little water can affect the fit of the tube to the skin. Not enough water in the balloon makes the tube sit looser and stick out from the skin. Too much water in the balloon makes the tube sit tighter and closer to the skin. If the tube is so tight you can see an indent in your child’s skin, you can decrease the amount of water in the balloon. If the tube sticks out too much and is dangling from the stoma, you can increase the amount of water in the balloon. If adjusting the balloon volume does not help with the fit of your child’s tube, you may need to have the tract re-measured by your child’s G tube specialist.
For more information on checking the volume of water in the balloon, please see the article “Checking the ballon on a feeding tube”.
Skin care
Keep the stoma and surrounding skin as dry and clean as possible. Dressings and tape are not needed with a low-profile GJ tube.
Despite your best effort to keep your child's skin around the stoma healthy, some common skin problems may occur including:
What to do if your child's tube is accidentally pulled out, becomes blocked or migrates into the stomach
If the tube is accidentally pulled out
Although it is very unlikely, your child's low-profile Mic-Key GJ tube may be accidentally pulled out. It is important to insert a Foley type tube into the tract as soon as possible to prevent the stoma and tract from closing. The sooner you insert the Foley catheter, the easier it will be to insert. You will need to carry the Foley catheter and emergency supplies with you at all times in case the tube is accidentally pulled out.
Most children with a GJ tube cannot feed into their stomach. However, some can. Speak to your child’s medical provider to discuss whether this is safe for your child.
For full instructions on what to do if your child's tube is accidentally pulled out, please see the article "What to do if your child's feeding tube is pulled out".
What to do if your child’s tube becomes blocked
To learn what to do if your child’s GJ tube becomes blocked, please see the article "What to do if your child’s feeding tube is blocked".
If the tube has moved into the stomach
If the Mic-Key low-profile GJ tube has moved out of the small intestine and into the stomach, your child may experience:
- increased vomiting
- vomiting formula
- gagging and retching
- abdominal discomfort or pain
- bloated stomach
- diarrhea
- leaking of formula from the stoma
The position of the tip of the GJ tube will need to be confirmed by an interventional radiologist using image guidance. Do not use the tube for feeding until the tube position is confirmed.
For more information on what to do if the tube has moved, please see the article “What to do if your child’s feeding tube moves”.
Intussusception
Intussusception may occur around the tube. Intussusception refers to when one part of the small bowel slides into the next part. This may lead to a bowel obstruction at the tip of the GJ tube. Large GJ tubes and/or normal movements of the bowels may cause intussusception.
A child with intussusception will experience:
- discomfort and feeding intolerance (vomiting when fed)
- vomiting bile (green fluid)
- diarrhea or blood in the stool
If your child’s tube has intussuscepted, contact their G tube specialist during business hours. After hours, on weekends or on holidays, take your child to the Emergency Department.
Replacing the low-profile GJ tube
GJ tubes are typically changed every four to six months. You will need to keep track of how long your child has had their tube and contact the G tube specialist to make an appointment for the tube exchange.
When to seek medical attention
Contact the G tube specialist if you notice any of the following signs and symptoms:
- Your child's stoma site appears infected with redness, swelling and odorous discharge.
- There is hypergranulation tissue, which is pink to bright red, bloody, raw, moist, oozing yellow sticky discharge and/or painful.
- The stoma site is leaking intestinal or stomach contents and /or formula.
- The tube appears to be damaged, broken, or dislodged, but you can still use the tube.
Go to the nearest Emergency Department if you notice any of the following signs and symptoms:
- Your child experiences abdominal pain, distension, discomfort, vomiting and/or other signs of feeding intolerance.
- Your child has signs of respiratory distress (i.e., higher breathing rate or difficulty breathing).
- The tube appears to be damaged, broken, or dislodged and you cannot use the tube.
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.