Gastrostomy tubes and devices are an established means of providing long term (>4-6 weeks) enteral nutrition. A gastrostomy tube or device is inserted into the stomach through the abdominal wall, so that liquid nutrition, fluids and medication can be given.
In 2012, the NSW Agency for Clinical Innovation (ACI) was notified by the NSW Ombudsman about the death of a patient after the reinsertion of a gastrostomy tube and as a result guidelines were developed for Clinicians to improve the quality and safety of the care of patients with gastrostomy tubes.
Please refer to the full guidelines for detailed information on gastrostomy tubes including general information on methods of insertion, routine device care, and methods of safe medication administration and feeding principles.
Patients may present to the emergency department as a result of a complication from a gastrostomy tube which may be minor or potentially life threatening. Emergency management of some of the more frequency sources of patient presentation have been provided here for ease of access. It is important to consider that detection and treatment of complications need to be carefully thought through where the patient may have diminished capacity to recognise them.
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Tube Inadvertently Removed
If the time between insertion and inadvertent removal is greater than 6 weeks but less than 12 weeks, consider radiological intervention.
Before restarting feeds, device placement should be confirmed and advice obtained from the proceduralist.
Transfer of Care from ED
After a patient has been treated in the Emergency Department (ED) for a gastrostomy tube/device issue, it is important to provide information to the primary health care provider* about the ED presentation as follows:
- Reason/s for presentation
- Action taken
- Who attended the patient
- Ongoing care arrangements – the same as original instructions unless the type of tube or device has changed.
If the tube was replaced, both the primary health care provider and the patient/carer need the following information:
- The type and size of the tube or device inserted and the markings at skin level. For example:
- X brand” 16 French ballooned gastrostomy tube. Tube markings at skin level = X cm.
- If it is a temporary tube or device that needs to be replaced with a longer term tube or device.
*The primary health care provider should include the GP and the local gastrostomy service or relevant health professional (e.g. Nursing, Nutrition support team, Nutrition and Dietetics etc.).
Note: If the patient brought in their own spare tube and this has been used to replace the existing tube, it is important to check that the patient has another spare tube. If they don’t, it is important they know how to obtain another tube (e.g. from their local nursing or gastrostomy service, from EnableNSW or other provider) and is reminded to do so.