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G‐tubes may be replaced by a caregiver following the first tube change and at least four weeks from initial tube placement (Table 1.4). Typically, a gastrostomy tube is changed every three to four months. G‐tube replacement should be confirmed with the aspiration of gastric contents and/or pH testing. The gold standard for G‐tube confirmation is a fluoroscopic dye study whereby dye is injected through the G‐tube port and a radiograph is taken to verify dye positioning in the stomach. If there is any trauma to the G‐tube site or if the tube is considered an immature tube (<4 weeks from placement), aspiration of gastric contents and pH testing are inadequate, and the tube site should be verified with a fluoroscopic dye study.

Table 1.4 Gastrostomy‐tube replacement.

Supplies

G‐tube low profile button with extension tubingOrTraditional G‐tubeLuer slip tip syringe to inflate balloonLarger catheter tip syringe to prime and flush tubingOptional:G‐tube port stylet

Stepwise procedure

Deflate the G‐tube gastric balloon with a 10 ml syringe.Gently remove the G‐tube by holding the port site and steadily pulling it back.Keep stoma patent with a Foley catheter (do not exceed the G‐tube size).Remove the G‐tube from packaging and check balloon by filling it with tap water (do not fill with normal saline as this will degrade balloon and do not use air as it will not provide adequate tension on the balloon).Deflate balloon prior to tube insertion.Insert the G‐tube stylet, if one is provided.Lubricate the tube with sterile jelly (do not use petroleum jelly as it will degrade tubing).Direct the G‐tube into the stoma and apply steady pressure.Stop and reposition if you meet resistance.Once the G‐tube external base is resting on the skin surface, inflate the balloon.Confirm positioning by pulling gently on the port site.

GJ tube must be placed by interventional radiology under fluoroscopy to ensure proper placement for both the initial placement and any subsequent tube replacement. GJ tubes are replaced every six months.