Digestive
Considerations:
● Verify with student’s health care provider whether the student’s PRIMARY tube should be replaced in the school setting.
o The PRIMARY tube/button is the initial tube placed by General Surgery, Gastroenterology or Interventional radiology.
▪ The primary tube/button change date is dependent on the type of tube/button.
▪ The first change date can be 6 weeks to 3 months after surgical placement.
● Whether the student’s G-tube has been changed before should be verified through review of the student’s medical information from the health care provider.
● If G-tube cannot be replaced but a catheter has been provided, place the catheter into the G-Tube tract and tape this into place, then call the parents/guardian.
● If G-tube cannot be replaced and a catheter is not available, cover the opening with a clean dressing and tape and then call parents/guardian.
● Provide the student with as much privacy as possible given the urgency of the situation.
Supplies:
● Gastrostomy tube replacement “kit”:
o Replacement gastrostomy tube
o 6-mL luer slip syringe
o Medical tape
o Water-based lubricant
● Clamp or plug, if used
● Stabilizing device, if used
● 2 clean cloths
● Distilled or sterile water
● Non-sterile gloves
● Student’s Individualized Health Care Plan (IHCP) and Health care provider’s order
● Parent/Guardian authorization form
Procedure for a G-tube/Button that has been in place for MORE THAN 2 MONTHS:
- Review the student’s IHCP and/or health care provider’s order
- Ensure proper documentation of parent/guardian authorization to perform this procedure
- Explain the procedure to student at their level of understanding
- Gather supplies and place on clean surface
- Wash hands
- Put on clean gloves
- For Long G-tube, place a mark on the tube at ordered length with a permanent marking pen
a. This step is not needed with a skin-level or “button” device - Make sure replacement gastrostomy tube is the same size (French and centimeters) as the previous tube
a. Look at sizing information located on device - Check the new gastrostomy tube by filling the balloon with manufacturer’s recommended mL of distilled or sterile water
a. Be sure it does not leak and that the balloon is not misshapen - Remove the water from the balloon
- Wet the tip of the G-tube with lubricant
- Insert the tip of the G-tube into the stoma
a. Insert the G-tube to ordered length or until the button is at skin level - Fill the balloon with the indicated amount of distilled or sterile water
- Gently pull tube to position the balloon against the wall of stomach
a. For Long G-tube: gently slide the external retention disc to its original centimeter marking
b. Pulling the tube too tightly will cause the opening to enlarge and formula may leak out around the tube - Clamp or plug the tube
- Apply stabilizing device, if used
- Check the tube for correct placement
a. For Long G-tube:
i. Remove plug from G-tube
ii. Attach 60-mL ENFit/enteral syringe with plunger to the G-tube
iii. Aspirate stomach contents to verify placement - Gastric contents are normally yellow or clear
iv. Return stomach contents
v. Remove the ENFit/enteral syringe
vi. Insert plug into G-tube
b. For Button/Skin Level Device:
i. Attach 60-mL ENFit/enteral syringe with plunger to the end extension tubing
ii. Remove plug from button
iii. Attach extension tubing to button
iv. Aspirate stomach contents to verify placement - Gastric contents are normally yellow or clear
v. Return stomach contents
vi. Remove extension tubing
vii. Insert plug into button - DO NOT administer feeding or medications via the G-tube unless correct placement has been verified
a. If correct placement cannot be verified, contact parents/guardians and health care provider, if needed - Remove gloves
- Wash hands
- Document assessment, interventions, and outcomes in student’s health care record
- Follow up with parents/guardian and health care provider
Procedure for a G-tube/Button that has been in place for LESS THAN 2 MONTHS:
- Review the student’s IHCP and/or health care provider’s order
- Ensure proper documentation of parent/guardian authorization to perform this procedure
- Explain the procedure to student at their level of understanding
- Have another staff person contact the parent/guardian to inform them that the student’s G-tube has come out and advise them that the student needs to be seen immediately by health care provider
- Gather supplies and place on clean surface
- Wash hands
- Put on clean gloves
- For a Long G-Tube: Put a mark at the same level with a permanent marking pen
a. This step is not needed with a skin-level or “button” device - Make sure replacement gastrostomy tube is the same size (French and centimeters) as previous tube
a. Look at sizing information located on device - Lubricate the tip of the tube with water-soluble lubricant
- Put the tip of the G-tube into the stoma
- Gently push into the stomach until the button is at skin level
- DO NOT inflate the balloon
- Tape the tube to the student’s abdomen
- DO NOT feed, give fluids, or medications to the student through their G-tube or through their mouth
- The student must be seen immediately by their health care provider, if possible, or receive care at the nearest emergency department
- Remove gloves
- Wash hands
- Document assessment, interventions, and outcomes in student’s health care record
- Follow up with parents/guardian and health care provider
References:
Avanos Medical, Inc. (2020). MIC* G replacing a tube. Retrieved June 22, 2023, from https://tubefed.com/troubleshooting/
Children’s Hospital St. Louis. (2015, May). Gastrostomy tubes home care manual (corpak, foley catheter, genie, malecot, mic-G). Retrieved June 22, from https://www.stlouischildrens.org/sites/legacy/files/Gastrostomy%20Tubes%20Home%20Care%20Manual.pdf
Children’s Mercy Kansas City. (2022, December 2). Gastronomy tube (g-tubes): Training for school nurses.. Retrieved June 21, 2023, from https://www.youtube.com/watch?v=_Gif-699CmM
Cleveland Clinic. (2019, November 1). Home tube feeding – Checking residuals. . Retrieved August 22, 2023, from https://www.youtube.com/watch?v=59tusCo2wAI
DeLegge, M.H. (2022, November 11). Gastrostomy tubes: Complications and their management. In Saltzman, J.R., and Seres, D. (Eds.) UpToDate, Retrieved June 20, 2023, from https://www.uptodate.com/contents/gastrostomy-tubes-complications-and-their-management
National Association of Pediatric Nurse Practitioners. (2018). Gastrostomy tube (G-tube) fact sheet. Retrieved June 22, 2023, from https://www.childrensmercy.org/siteassets/media/in-the-community/school-health-support/g-tube-fact-sheet.pdf
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Acknowledgment of Reviewers:
Angie Bulmahn, MSN, RN, NCSN
School Nurse Specialist
Missouri Department of Health and Senior Services
Marjorie Cole, MSN, RN, FASHA
State School Nurse Consultant
Missouri Department of Health and Senior Services
Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog
Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing
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Page last reviewed: October 4, 2021
Page last updated: October 4, 2021; video December 22, 2023; February 15, 2024
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The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same. The information is not intended to substitute for, supplement or replace clinical judgment. If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider. The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.
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