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G-J Tube

What is a G-J tube?

A G-J tube is just like a G-tube (see “Percutaneous Gastrostomy Tube) except that it contains an extra portion of tubing that extends from the stomach to the intestine. An extra side port allows feeding and medication delivery directly in to the intestine through extension tubing. Your family will receive significant education on the skin care surrounding the tube site as well as on the proper usage and maintenance of the tube and extension material prior to the procedure.

About this Treatment Pre and Post Operative Care Departments

About this Treatment

How do we perform a G-J tube insertion?

Often G-J tubes can be easily replaced (exchanged) over an existing G-tube but if they are placed first, we begin planning our approach by doing an ultrasound study of your child’s abdomen, which will help us identify the track to the stomach and the location of vital structures to be avoided during the procedure. Contrast dye will be injected into the colon to delineate is borders so that it can be avoided, as well. Then, we will start by filling the stomach with air via a tube from the nose. This will make the stomach an easier, more visible target for puncture with a needle from the skin. Before this puncture, the skin will be numbed. After the needle has accessed the stomach, the G-J tube will be inserted over a guide wire all the way to the intestine and contrast will be injected during x-rays to ensure proper locations. Finally, the doctor will fill the stomach balloon with water to hold it in place.

Will my child be awake during the procedure?

Children often require no sedating medication for a simple G to G-J tube exchange.

Will my child be in any pain?

Your child will not feel pain during the procedure but some patients may feel discomfort around the tube insertion site for a few days following the procedure.

How long does the procedure take?

A typical G-J tube exchange takes about a half an hour but may take longer. Some children may need to arrive many hours before the procedure to have certain lab tests performed, which will be clearly communicated to you.

What risks are associated with this procedure?

G-J tube placements are considered low-risk procedures. However, potential complications include:

Tenderness or soreness at the site where the tube is placed
Bleeding
Infection
Injury to the other organs, such as the liver, spleen, and colon
Peritonitis, a serious condition in which the lining of the abdominal cavity becomes inflamed
Loss of access to the stoma (stomach opening).

Pre and Post Operative Care

How do my child and I prepare for the procedure?

We encourage good communication between you and your child, including the necessity and overview of the procedure as well as ensuring them that you are close by the whole time. Holding them or their hands until they leave for the procedure is a great way to provide support.

You will be given specific instructions along the way but you may need to arrive a few hours before the scheduled procedure to have some blood tests done. When you arrive at the hospital, a doctor will review the procedure and associated risks, after which you will sign a consent form. When we are ready to get started with the procedure, a nurse will place an intravenous line to deliver sedating medications and you will be allowed to accompany your child in the operating room until they are asleep, after which you will be escorted to a waiting room.

What happens after the procedure?

Nurses will monitor your child in the recovery area for a couple hours for successful recovery from any sedating medications, if any, and any immediate complications. The doctor may decide to have your child admitted to the hospital for an overnight stay. As mentioned, there may be some discomfort around the tube insertion site for some days following the procedure, which is easily relieved by over-the-counter medications. If there are no complications, feeding through the tube can begin about 8 hours after the procedure. It is important to keep the bandage surrounding the tube clean and dry.

When can my child bathe?

You can allow your child to sponge bathe for the first 48 hours after the procedure. It is important to avoid full submersion in water for two weeks after the procedure to allow for healing around the tube insertion site.

Are there any activity restrictions?

Though your child can resume normal school-going or daycare attendance, physical activity that can result in pulling of the tube should be limited, particularly contact sports and rough playing.

How long will the tube stay in place?

The total duration of tube placement will be determined by the physician caring for your child’s underlying disease but the primary tube will be exchanged about every three months at scheduled follow-ups. Specific concerns regarding clogging of the tube or the tube falling out will be addressed in your training prior to the procedure. These are not emergencies and can most often be handled by simple water flushing of the tube through a syringe or slightly pushing the tube back into place and securing it with tape while not feeding through it. It is important to call our department soon after these occurrences.

CONTACT CNMC IMMEDIATELY IF YOUR CHILD EXPERIENCES ANY OF THE FOLLOWING:

• Redness, pain, swelling, or bruising at the needle insertion site.

• Fever higher than 101^o Fahrenheit or 38^o Celsius.

The department of Interventional Radiology can be reached at: 202-476-3791, Monday through Friday, between 8 a.m. and 5 p.m.

At all other times please call 202-259-8643, which is the on-call pager. Follow the instructions and wait for a call back.

Departments

Interventional Radiology

Children’s National interventional radiologists perform a full range of minimally invasive, image-guided procedures to both diagnose and treat disease in infants, children, and adolescents.

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