Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; requiring revision of gastrostomy tract
CPT4 code
Name of the Procedure:
Replacement of Gastrostomy Tube, Percutaneous, Includes Removal, without Imaging or Endoscopic Guidance; Requiring Revision of Gastrostomy Tract
Common names: Gastrostomy tube replacement, G-tube change
Summary
Involves removing an old gastrostomy tube (G-tube) and inserting a new one through the abdominal wall into the stomach. This version doesn't use imaging or endoscopic guidance but requires revising the tract where the G-tube sits.
Purpose
Addresses issues like dislodged, clogged, or damaged G-tubes. The goal is to restore feeding access for patients who rely on G-tubes for nutrition.
Indications
- Dislodged or pulled-out G-tube
- Clogged or non-functioning G-tube
- Irritation or infection around the G-tube site
- Need for a different type or size of G-tube
Preparation
- Fasting for a few hours before the procedure
- Adjustment or discontinuation of certain medications (as directed by the healthcare provider)
- Pre-procedure assessment including blood tests if needed
Procedure Description
- The area around the old G-tube is cleaned and prepped.
- Local anesthesia is administered to numb the area.
- The old G-tube is carefully removed.
- The gastrostomy tract is assessed and revised if necessary to accommodate the new tube.
- A new G-tube is inserted through the stoma into the stomach.
- Ensuring proper positioning and securing the new tube.
Tools: G-tube, anesthesia, sterile equipment (gloves, drapes, disinfectant)
Duration
Typically, 30 minutes to an hour.
Setting
Performed in a hospital, outpatient clinic, or surgical center.
Personnel
- Physician (e.g., gastroenterologist or surgeon)
- Nurse or medical assistant
Risks and Complications
Common:
- Minor bleeding
- Infection at the insertion site Rare:
- Incorrect placement of the new tube
- Perforation of the stomach or abdominal wall
- Persistent pain at the site
Benefits
- Restores adequate nutrition and medication administration route
- Minimal downtime for patients who rely on G-tubes for sustenance
- Quick recovery time
Recovery
- Monitoring for a few hours post-procedure for complications
- Instructions on site care, cleaning, and signs of infection
- Typically, normal activities can be resumed in a day or two
- Follow-up appointment to ensure proper G-tube function
Alternatives
- Endoscopic or imaging-guided G-tube placement Pros: Higher accuracy in tricky cases Cons: More involved procedure, higher cost, possible need for sedation
Patient Experience
During:
- Minimal discomfort or pain due to local anesthesia After:
- Mild pain around the insertion site controlled with over-the-counter pain relievers
- Feeling of pressure or tightness around the new G-tube initially, which diminishes over a few days