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Chapter 7: References
GJ-tube plan of care
In the other chapters in this notebook, there are important things about GJ-tubes. Please review this in detail if needed. Below are the important things to remember when taking care of the GJ-tube. Also, visit our G-tube video page.
Reminders on care of the GJ-tube:
- Do not spin the tube.
- Know which port is used for stomach (G) and which is used for the jejunum (J).
- Feedings into the jejunum should be a given slowly using a feeding pump.
- Know which port should be used to give your child's medicines.
- Flush the GJ-tube often. Use 2 to 5 mLs of water every 4 hours.
- Know if the G-port will be clamped or vented or drained to a bag.
- GJ-tubes should be replaced in Interventional Radiology every 3 to 4 months.
What problems can happen with a GJ-tube?
- The tubing might clog
- The tubing in the J-port might move out of place
- The whole GJ-tube might fall out
What do I do if these problems happen?
It may seem scary, but it is not an emergency if the GJ-tube has a problem. Do not come to the Emergency Room unless needed. It is best to call Interventional Radiology first. If you come to the Emergency Room in the evening or overnight, your child's GJ-tube will not be replaced until the next day.
- Some children can handle slow feedings or Pedialyte in their stomach.
- Some children may not handle anything in their stomach but can wait to have the GJ-tube exchanged.
- Most children can go without feedings or liquids for 12 hours without any harm.
- Some children may need IV fluids.
- Your child may need to be admitted to the hospital while the GJ-tube is not working. It will depend on your child's age and special medical needs. Your child's doctor or nurse should talk to you about your child's emergent feeding plan.
Who do I call if these problems happen?
It is best to call Interventional Radiology (IR) if you do not know what to do.
If any problems happen that would need your child's GJ-tube exchanged, call one of the numbers below. If the problem happens during regular scheduling hours, call right away. If the problem happens after hours or on weekends, call IR the next morning to have GJ-tube exchanged.
- Monday thru Friday, 8:00 a.m. - 4:00 p.m at (414) 266 - 3152
- Weekdays, after hours and weekends at (414) 266 - 3116
What if the GJ-tube is clogged?
Try flushing the port with warm water or fizzy or seltzer water. Use a 3 mL syringe and push and pull on the plunger to help unclog the tubing. It is helpful to let the water sit in the tube for 20 minutes and to try again. Do not use soda or juices to unclog the tube.
If the J-port still will not flush after trying these things, contact your child’s doctor or Interventional Radiology. Some children may be able to handle food through their G-port into the stomach.
What if the GJ-tube is not in the right place?
Sometimes the tubing of the J-port becomes loose and starts to get pulled out. Sometimes the tubing of the J-port may twist and move into the stomach rather than the intestines. If this happens, you may see:
- Discomfort during feedings
- Throwing up formula
- Formula from the G-port
If you see any of these problems, contact your child's doctor or Interventional Radiology.
What do I do if the GJ-tube falls out?
If this is your child's very first tube and it has never been changed before, do not try to place anything into the tract. Cover the stoma. Call Interventional Radiology if this happens during the weekday. If this happens on weekends or evenings, bring your child to the Emergency Room.
If your child's GJ-tube falls out of the tract and you have a spare G-tube, you may replace if you were told to do so. If you placed the G-tube successfully and if you were told that your child may handle slow feedings or Pedialyte in the stomach, you could try this. If you don't have a spare G-tube, you could try to put the tip of the GJ-tube into the tract 2 inches and tape into place. This will keep the tract from closing.
If you are not able to put anything into the tract, contact Interventional Radiology or your child's doctor for more instructions.
This is used for long tubes without a bar or disc to hold it secure. Bolsters help keep the tube propped straight up. This helps the stoma heal correctly. Bolsters are most often used for Pezzer tubes or catheter type of tubes.
To learn more about bolsters:
You do not have to remove the bolster to clean the site. If you are changing the bolster, then it would be best to clean the site at this time.
Change a bolster:
- When it is dirty
- If the tube is not secure
- If it has been in the same spot on the belly for 3 days
How to make a bolster
- Get supplies ready:
– Gauze that is 3 inches by 3 inches
– Half inch wide tape (4 pieces that are about 3 to 4 inches long)
- Wash your hands with soap and water.
- Make bolster. You can make several of them up ahead to save time. Put them in a plastic baggie.
– Stack 2 pieces of gauze and fold in thirds.
– Roll it tightly and tape it so it won't unroll.
- Take off the old bolster dressing.
- Clean the skin site if needed.
- Gently spin the tube in the tract. This helps the stop the tube from sticking to the skin.
- Gently pull back on the tube until the mushroom or water balloon is snug against the stomach wall.
- Put the bolster on the skin next to the tube. Do not put bolster in the same spot on the belly.
- While holding the tube straight up, lay the tube over the bolster and begin to secure.
– Put 3 pieces of tape over the tube and bolster dressing. Lay them in the same direction overlapping each piece a little bit. The tape should not criss-cross.
- Put one extra strip about 1 to 2 inches away from the bolster. This is called a tension loop.
– Fold it around until the tape meets.
– Put the ends of the tape onto the skin.
– This strip adds security to the tube and bolster.