Name of the Procedure:

Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation, and report.

Summary

In this procedure, a gastrostomy or cecostomy tube, which is used for feeding or draining, is replaced through the skin using imaging techniques for precise placement. Fluoroscopy, a type of real-time X-ray, is used along with contrast injection to ensure proper tube positioning.

Purpose

The primary purpose is to replace a malfunctioning, damaged, or blocked gastrostomy or cecostomy tube. The goal is to ensure the new tube is correctly positioned for optimal function, preventing complications like leakage, infection, or incorrect nutrient delivery.

Indications

• Blocked or dislodged gastrostomy or cecostomy tube
• Infection or irritation around the tube site
• Tube malfunction affecting feeding or drainage
• Routine tube replacement as recommended by a healthcare provider

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments, especially blood thinners, may be necessary.
• Pre-procedure imaging or fluoroscopy might be required to assess the current tube placement.

Procedure Description

1. The patient is positioned appropriately, and local anesthesia is administered to numb the insertion site.
2. An initial scan using fluoroscopy is performed to visualize the existing tube.
3. A contrast agent is injected to highlight the pathway and ensure correct positioning.
4. The existing tube is carefully removed.
5. A new tube is introduced through the same pathway, guided by fluoroscopy.
6. Contrast is injected again to confirm the tube's correct placement.
7. Final images are taken for documentation, and the new tube is secured.

Duration

The procedure typically takes around 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital's radiology department or an outpatient surgical center equipped with fluoroscopic imaging technology.

Personnel

• Interventional radiologist or gastroenterologist
• Radiologic technologist
• Nurses
• Anesthesiologist or nurse anesthetist (if sedation or general anesthesia is used)

Risks and Complications

• Infection at the insertion site
• Bleeding or leakage around the tube
• Allergic reaction to contrast material
• Inaccurate tube placement
• Injury to surrounding organs

Benefits

• Restores proper function of the feeding or drainage tube
• Minimizes discomfort and complications associated with a malfunctioning tube
• Quick recovery allowing resumption of feeding or drainage soon after the procedure

Recovery

• Patients are monitored for a short period post-procedure.
• Instructions for site care and any restrictions on activity are provided.
• Pain management guidelines are given if necessary.
• Follow-up appointments may be necessary to monitor tube function and site health.

Alternatives

• Surgical replacement of the tube
• Endoscopic tube replacement
• Non-surgical management, such as adjusting the existing tube or using medications

Patient Experience

During the procedure, the patient may feel mild discomfort or pressure at the insertion site. Post-procedure, there may be some soreness and the need to avoid strenuous activities until fully healed. Pain management will be provided, and most patients can resume normal activities within a few days.