Percutaneous feeding tube replacement in the ED—are confirmatory x-rays necessary?

Incisions for vascular clamps in minimal access aortic surgery

“…This technique is suitable for obese patients with a thick abdominal wall and saves on confirmatory radiology or endoscopy. 3 Additionally, the loop and lock make tube dislodgement, usually a common problem, unlikely. The author has used it in five adult patients.…”

Assessment of the effect of colored beverage on gastric returns after gastric tube replacement to enhance placement verification

“…Factors that may delay tract maturity and increase risk for tract disruption include age, gender, nutrition status, prior exposure to corticosteroids, underlying diagnoses, chemotherapy, or radiation therapy, 18 immunocompromised status, and ascites 17 . Trauma to the tract during insertion such as by using an obturator for device insertion, especially for initial tube exchange contributes to tract dehiscence or disruption 15,18,20 …”

“…Full or partial separation can result in fluid, medication, and/or feeding being delivered into the subcutaneous tissue or peritoneal cavity. Two issues recognized as contributing to complications associated with G tube replacement are trauma to the tract during insertion and tract immaturity 15 . Various factors influence the maturity of the tract itself, mandating the need for consideration for safe timing when it may not be safe to attempt percutaneous replacement.…”

“…17 Trauma to the tract during insertion such as by using an obturator for device insertion, especially for initial tube exchange contributes to tract dehiscence or disruption. 15,18,20 Risk for tract separation may also be associated with initial placement technique. Some procedures allow for gastric fixation to the abdominal wall or gastropexy, such as with T-fasteners or suturing, allowing the stomach to fixate to the abdominal wall during the maturation process.…”

“…Two issues recognized as contributing to complications associated with G tube replacement are trauma to the tract during insertion and tract immaturity. 15 Various factors influence the maturity of the tract itself, mandating the need for consideration for safe timing when it may not be safe to attempt percutaneous replacement. Timing since initial tube placement may help determine risk for gastric separation.…”