THÔNG TIN TÀI LIỆU
and this may require placement of a smaller tube to keep the stoma patent The ED physician can then replace the tube with increasingly larger tubes until the original size is successfully inserted The physician must use caution when reinserting a G-tube because too much force can lead to tube insertion into the peritoneal cavity through a false tract If the ED provider is not able to easily withdraw gastric fluid after reinsertion, then the patient should have contrast injection imaging to confirm correct placement in the stomach prior to using the tube for feeding or medications A jejunal tube that has dislodged needs to be replaced by the subspecialist who placed it initially For example, a J-tube that was inserted via the gastrostomy should be replaced by the interventional radiologist under fluoroscopy A surgical J-tube requires replacement by a surgeon Clogging Clogging or obstruction of the lumen of the G-tube or J-tube can occur as a result of dried, solidified formula or twisting or kinking of the tube Tube obstruction is discovered when the caregivers cannot infuse fluids If formula is suspected as the cause, aspiration of the clot and gentle flushing of the lumen should be attempted Warm water is recommended as the most effective fluid Despite reports of the success of various carbonated drinks in this situation, their effectiveness is controversial When the G-tube becomes clogged, insertion of a stylet is not recommended because this technique may result in perforation of the tubing beneath the skin level Repositioning of the tube should be attempted next; if this procedure is not effective, removal and replacement are necessary If the gastrostomy is fresh (within month), the surgeon or gastroenterologist should be consulted before removal of the clogged tube Caregivers should be reminded of the need for proper flushing with each use If the patient has a button, the extension tubing should be removed from the button before flushing it
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