Size Matters: Early Gastrostomy Tube Dislodgment in Children

Jeziorczak, Paul M.; Frenette, Riley S.; Lee, Joon; Coe, Sarah C.; Aprahamian, Charles J.

doi:10.1089/lap.2021.0352

Cited by 2 publications

(5 citation statements)

References 22 publications

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“…For example, some patients might need a larger diameter of the tube if they are going to receive mixed food instead of specialised formula, or if there is a risk for not completely dissolved medication to get stuck in the tube. Our recommendation is however debatable according to other authors who have reported an increased risk of dislodgement of 12 Fr gastrostomies compared to 14 Fr 14 . The findings in that study could not be confirmed in our material where the risk of dislodgement was lower, however not significantly, for patients with 12 Fr gastrostomies.…”

Section: Discussioncontrasting

confidence: 84%

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Complication rate after gastrostomy placement in children can be reduced by simple surgical steps

et al. 2023

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Aim To evaluate if the incidence of postoperative complications after gastrostomy placement is correlated to perioperative parameters or patient characteristics. Methods In this prospective observational study, children <18 years of age planned to receive a gastrostomy at partaking clinics between 2014 and 2019 were invited. Pre‐, peri‐ and postoperative variables were collected and followed up 3 months postoperatively. Results Five hundred and eighty‐two patients were included (median age: 26 months, median weight: 10.8 kg), mainly laparoscopic (52.0%) and push‐PEG (30.2%) technique used. The incidence of complications was lower in the group of patients receiving a gastrostomy tube that was 2 mm longer than the gastrostomy canal (p < 0.001–0.025), and a thickness of 12 Fr (p < 0.001–0.009). These findings were confirmed by multivariate analysis also including operative technique, age and weight. Patients with oncological disease had significantly higher incidence of pain and infection but the lowest incidence of granulomas (p < 0.001–0.01). Conclusion This study indicates that a 12 Fr gastrostomy tube that is 2 mm longer than the gastrostomy canal is correlated with the lowest incidence of postoperative complications the first 3 months after surgery. Oncological patients had the lowest incidence of granulomas which probably is related to chemotherapy.

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Section: Discussioncontrasting

confidence: 84%

“…Our recommendation is however debatable according to other authors who have reported an increased risk of dislodgement of 12 Fr gastrostomies compared to 14 Fr. 14 The findings in that study could not be confirmed in our material where the risk of dislodgement was lower, however not significantly, for patients with 12 Fr gastrostomies.…”

Section: Discussioncontrasting

confidence: 63%

Complication rate after gastrostomy placement in children can be reduced by simple surgical steps

et al. 2023

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“…In a study by Saavedra et al, 8 they determined that children with g-tubes visit the ED 1.5 times per year. The most common etiology for an ED evaluation was a dislodged g-tube and was estimated to be approximately 2.5% among children and adults up to age 28 years 8,9 . Although a parent or home nurse may replace a g-tube at home, it is surprising to note that among children presenting to our ED, it seems that only physicians or advanced practice providers (APP) are permitted to replace a g-tube 3,8,9 …”

Section: Discussionmentioning

confidence: 99%

“…The most common etiology for an ED evaluation was a dislodged g-tube and was estimated to be approximately 2.5% among children and adults up to age 28 years. 8,9 Although a parent or home nurse may replace a g-tube at home, it is surprising to note that among children presenting to our ED, it seems that only physicians or advanced practice providers (APP) are permitted to replace a g-tube. 3,8,9 Emergency department replacement of a dislodged g-tube is straightforward as long as a similar size and length is provided.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Although a parent or home nurse may replace a g-tube at home, it is surprising to note that among children presenting to our ED, it seems that only physicians or advanced practice providers (APP) are permitted to replace a g-tube. 3,8,9 Emergency department replacement of a dislodged g-tube is straightforward as long as a similar size and length is provided. On reinsertion, gastric aspiration is usually adequate to confirm placement.…”

Section: Discussionmentioning

confidence: 99%

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The Pediatric Emergency Department Nurse and Gastrostomy Tube Replacement

VanDerhoef,

Proudford,

Amoni

et al. 2023

Pediatr Emer Care

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AimTo review the outcomes of a nurse-only guideline for replacement of gastrostomy tubes (g-tubes) in a pediatric emergency department (ED) and compare rates of success, failure, length of stay (LOS), and return visits with that of ED physicians.DesignNursing g-tube guidelines, created by a nurse educator and nursing council, were instigated on January 31, 2018. Variables examined included LOS, age at visit, return visit within 72 hours, reason for replacement, and any postplacement complications.Review MethodsData of g-tube placement by nurses and physicians were compared using t test or χ2 analysis (IBM-SPSS version 20, New Orchard Road, Armonk, NY). The institutional review board determined the study to be exempt from human subjects. The STROBE checklist was used and completed accordingly.Data SourcesChart abstraction and data were collected from January 1, 2011 through April 13, 2020, and medical records were obtained using International Classification of Diseases, Tenth Revision (ICD-10) codes for g-tubes: Z93.1, K94.23.ResultsA total of 110 patients were included in our study. Fifty-eight underwent nursing-only replacements; 52 were replaced by physicians. Nurse replacement success rate was 98.3% with an average stay of 22 minutes. Physician success rate was 100% with an average stay of 86 minutes. The difference between nursing and physician LOS was 64.6 minutes. No patient in either group experienced postreplacement complications.ConclusionsThe initiation of nurse-only management of dislodged g-tubes was successful, safe, and had a shorter LOS when compared with physicians in the pediatric ED.ImpactOur study determined the implications of nurse-only replacement of g-tubes in a pediatric ED. We found that nurses replacing g-tubes was equally safe and effective as physician counterparts. In addition, we found that it significantly reduced the LOS for patients, which has consequences on patient satisfaction and billing.Patient/Public ContributionNursing staff were trained in g-tube replacement using guidelines created by a nurse educator and nursing council. Patients either had their dislodged g-tubes replaced by the trained nurse or a physician and comparisons on the outcomes were made. Patients were aware of the study and consented to have their medical records accessed to make the data comparisons.Relevance to Clinical PracticeWith more than 189,000 children in the United States relying on g-tubes, nursing staff will inevitably be involved in the care of patients with such a device. In addition, as pediatric EDs continue to develop longer and longer waiting times, we must learn how to better use our nursing staff for procedures within their scope and minimize LOS. Our research demonstrates the safety, feasibility, and general benefits of having the pediatric nursing staff replace g-tubes in the ED, and it is hoped that this will lead to beneficial policy changes.What does this article contribute to the wider global community? - Demonstrates the safety and effectiveness of nurse-only g-tube replacement- R...

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Size Matters: Early Gastrostomy Tube Dislodgment in Children

Cited by 2 publications

References 22 publications

Complication rate after gastrostomy placement in children can be reduced by simple surgical steps

Complication rate after gastrostomy placement in children can be reduced by simple surgical steps

The Pediatric Emergency Department Nurse and Gastrostomy Tube Replacement

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