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 following the reinsertion of a gastrostomy tube. As a result, guidelines were developed to improve the quality and safety of the care provided by clinicians to patients with gastrostomy tubes.
For detailed information on gastrostomy tubes, refer to guidelines and key principles. These guidelines cover general information on methods of insertion, routine device care, and safe methods for medication administration and feeding principles.
A patient may present to the emergency department due to a complication from a gastrostomy tube. It may be a minor or potentially life-threatening case. We have provided emergency management for common patient presentations here for easy access. Detection and treatment of complications must be carefully thought through as the patient may have diminished capacity to recognise them.
Guideline
Guideline: A Clinician’s Guide: Caring for people with gastrostomy tubes and devices (PDF 1.7 MB)
Extracts from the guideline:
- Quick guide to gastrostomy feeding tubes and devices (PDF 2.1 MB)
- Gastric fluid leak (PDF 263.7 KB)
- Possible symptoms and potential complications (PDF 60.4 KB)
- Skin / site complications (PDF 744.0 KB)
- Tube or device dysfunction (PDF 5.0 MB)
- Hypergranulation (PDF 694.4 KB)
- Gastrointestinal complications (PDF 101.9 KB)
Tube inadvertently removed
Immature tract <6 weeks:
- If the time between insertion and inadvertent removal is greater than 6 weeks but less than 12 weeks, consider radiological intervention.
Mature tract >12 weeks:
- Before restarting feeds, device placement should be confirmed and advice obtained from the proceduralist.
Extracts from the guideline:
Transfer of care from ED
After a patient has been treated in the ED for a gastrostomy tube or other device issue, it is important to inform their primary health care providers. Primary health care providers include general practitioner, local gastrostomy service or relevant health professional (e.g. nursing, nutrition support team, nutrition and dietetics etc.).
Information will include:
- reason the patient presented at the ED
- action taken
- who attended the patient
- ongoing care arrangements. These will be the same as the original instructions unless the type of tube or device has changed.
If the tube was replaced, both the primary health care providers and the patient and/or their 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.
Note: If the patient brought in their own spare tube and this has been used to replace the existing tube, check that they have another spare tube. If they don’t, explain to the patient and/or their carer how they can get another tube. For example, from their local nursing or gastrostomy service, from EnableNSW or other provider. It is important that this is followed up.
Accessed from the Emergency Care Institute website at https://aci.health.nsw.gov.au/networks/eci/clinical/tools/gastrostomy-tubes