Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract
CPT4 code
Name of the Procedure:
Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract.
Summary
This procedure involves replacing a gastrostomy tube (feeding tube) through the skin (percutaneously) without the need for imaging or endoscopic guidance. The old tube is removed, and a new one is inserted into the existing gastrostomy tract without needing to revise or change the tract.
Purpose
This procedure is done to replace an old, damaged, or blocked gastrostomy tube that is used for nutritional support when one cannot eat by mouth. The goal is to ensure continued adequate nutrition and hydration.
Indications
- Blocked or clogged gastrostomy tube
- Damaged or leaking gastrostomy tube
- Routine scheduled replacement of gastrostomy tube
- Significant weight gain or loss requiring a different tube size
Preparation
- Patients may be required to fast for a few hours before the procedure.
- Medication adjustments may be necessary, especially anticoagulants.
- Pre-procedure assessment of the gastrostomy tract might be conducted to ensure it is suitable for tube replacement.
Procedure Description
- The patient is positioned comfortably, and the gastrostomy site is cleaned.
- Local anesthesia is applied to numb the site.
- The old gastrostomy tube is gently removed.
- A new gastrostomy tube is inserted into the existing tract.
- The tube is secured and tested to ensure proper placement and function.
- The site is cleaned and dressed.
Duration
The procedure typically takes about 15-30 minutes.
Setting
This procedure is usually performed in an outpatient clinic or a hospital setting.
Personnel
- Registered Nurse
- Gastroenterologist or trained healthcare provider
Risks and Complications
- Infection at the insertion site
- Bleeding
- Tube dislodgement or migration
- Pain or discomfort at the site
- Peritonitis (rare but serious)
Benefits
- Maintains adequate nutritional support
- Minimally invasive with relatively quick recovery
- Immediate improvement in enteral feeding function
Recovery
- Patients can usually go home the same day.
- The site should be kept clean and dry.
- Follow-up care includes checking the site regularly for signs of infection and ensuring the tube functions properly.
- Most patients can resume normal activities within a day or two.
Alternatives
- Surgical replacement of the gastrostomy tube
- Endoscopic gastrostomy tube replacement
- Nasogastric or nasojejunal tube placement (temporary options)
- Each alternative has its own risks and benefits which should be discussed with the healthcare provider.
Patient Experience
- Patients might feel mild discomfort or pressure during the procedure.
- Pain management includes local anesthesia at the site.
- Post-procedure, slight soreness may persist for a few days, but severe pain should be reported to a healthcare provider immediately.