If you’ve ever been the caretaker for a tubie (someone who has a gastrotomy, a.k.a. g-tube), you’ve wondered what happens if it falls out. In the back of your mind you fear that it’ll fall out and you won’t notice before the stoma (hole) closes. I know this is many of our worries, because it just happened to me and many people responded with, “that’s one of my biggest fears!”
Some days I wonder, “does this crap happen to me just to give me something to write about?”
That may be, but since it did happen and I learned a thing or two I wished I had known in advance, I thought I’d share so others can hopefully benefit and avoid a drive to the ER wondering if your child is going to need surgery. Note, I did not say you can avoid a trip to the ER. I’d still recommend going in, but you just may have a better idea on the surgery or no surgery question.
Owen has a Mic-Key button so this information best fits this button.
Regardless of the type of g-tube your child has, please review your emergency plan with your doctor. I’m sharing what was recommended as “rule of thumb” but every patient is different and has unique circumstances.
If the stoma is less than six weeks old, do not attempt to replace a g-tube. Cover the stoma and get to a doctor as quickly as possible.
This information assumes you have been trained to replace a g-tube by a medical professional. If you have not been trained to change g-tubes, cover the stoma and go to the doctor.
Emergency Kit: You will want to keep this emergency kit with you at all times. If at any time you try to replace a g-tube and can’t fit the tube into the stoma, this will be your back up plan.
- 1-2 sizes of foley catheters that are smaller than your child’s g-tube. (For example, Owen has a 12 French g-tube. My kit has a 6 french and an 8 french foley catheter. French measurement is the diameter of catheter. Each unit is 1/3 mm). To the right is an example of a Foley catheter. You should be able to get catheters from the same provider who supplies your g-tube replacements.
- 5 ml syringe (use one from an old g-tube kit)
- Lubricant (KY Jelly or similar)
- A small diaper (newborn works best, but any size will do)
- Tape that will stick to skin
- Hand sanitizer (in case you’re not near a sink).
How to use your emergency kit when the g-tube won’t fit in the stoma: The process is very similar to replacing a g-tube, however, you’ll instead use the foley as place holder to keep the stoma open until you can get to the doctor.
- With the syringe draw up the amount of water that your child’s g-tube calls for. (3-5 ml are most common)
- Take catheter and dip the deflated balloon (balloon looks just like a g-tube balloon, note picture above) end in lubricant.
- Attempt to insert the catheter into the stoma so the balloon is fully inserted. You may need to try the smaller size if the first one does not work.
- If neither size comfortable slides in, cover the stoma and go to the doctor. Do not force it.
- If one fits, move on to step four.
- Fill the balloon with the syringe of water using med port.
- Wrap the open end of the catheter in the diaper to avoid stomach contents draining out and tape it closed.
- Tape the catheter onto the stomach to secure it from moving around or getting pulled.
Now, you can take your child to the doctor knowing that the stoma is still open. The stoma should open a little wider than the size of the catheter so once you get to the doctor, they can try the next size up and then they will keep moving up the scale until the stoma is large enough to place the correct g-tube. The process works well and shouldn’t cause much, if any discomfort, to the patient. Owen did cry when they placed the g-tube but I think that it was more related to medical anxiety than actual pain.
Again, this is the general recommendation from the ER, however, please check with your doctor to make sure there is not a better plan for your child. I really wish I would have known to have an emergency back up kit. It would have lessened my fears and made for a much shorter ER visit.
For a tube replacement refresher, here is a great description with diagrams from BC Children’s in Canada.