Name of the Procedure:

Change of Gastrostomy Tube, Percutaneous, Without Imaging or Endoscopic Guidance

Summary

This procedure involves the replacement of a gastrostomy tube (a tube inserted into the stomach for feeding) without using imaging technology or an endoscope. It is performed through the skin and is a relatively straightforward technique.

Purpose

The procedure addresses issues related to existing gastrostomy tubes that are malfunctioning, clogged, or causing discomfort. The goal is to ensure the patient can continue to receive necessary nutrition directly into the stomach without complications from the tube.

Indications

• Blockage or malfunction of the existing gastrostomy tube
• Tube dislodgement or accidental removal
• Persistent irritation or infection around the tube site
• Needing to upgrade or change the type of gastrostomy tube based on patient needs

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments, particularly blood thinners, may be required.
• A preliminary assessment of the gastrostomy site and overall patient health will be conducted.

Procedure Description

1. The area around the gastrostomy site is cleaned and sterilized.
2. The healthcare provider deflates the balloon (if present) that keeps the tube in place inside the stomach.
3. The old tube is gently removed.
4. A new gastrostomy tube is inserted through the existing stoma (opening).
5. The new tube’s balloon is inflated, or another securing mechanism is engaged.
6. The integrity of the new tube is checked by flushing it with water.

Tools used include a new gastrostomy tube, sterile gloves, saline solution, and a syringe. Local anesthesia may be applied to minimize discomfort.

Duration

The procedure typically takes about 15 to 30 minutes.

Setting

This procedure is usually performed in an outpatient clinic or a hospital setting.

Personnel

• A nurse or a physician skilled in managing gastrostomy tubes
• Possible support from an assistant nurse

Risks and Complications

• Discomfort or pain around the stoma site
• Infection at the insertion site
• Bleeding or leakage around the tube
• Accidental placement of the tube causing complications

Benefits

The procedure provides immediate restoration of nutritional support through a functional gastrostomy tube. Most patients will experience immediate improvements in their nutrition delivery once the new tube is in place.

Recovery

• Post-procedure care includes monitoring for any signs of infection.
• Patients might be advised on how to care for the new tube site.
• Normal activity can often be resumed shortly after the procedure, but strenuous activities should be avoided for a few days.
• Follow-up appointments may be scheduled to ensure the new tube is working well.

Alternatives

• Endoscopic or radiologic-guided gastrostomy tube replacement.
• Surgical replacement under more controlled settings.
• Cons are that these alternatives might require more resources, time, and have higher associated risks.

Patient Experience

The patient may feel some discomfort during the tube change and may be given pain medication or local anesthesia to help manage this. There might be mild soreness at the site for a few days, but this is generally mild and manageable with standard pain relief measures.