Replacement of Dislodged Gastrostomy Tubes After Stoma Dilation in the Pediatric Emergency Department
Abstract
Introduction: A dislodged gastrostomy tube (GT) is a common complaint that requires evaluationin the pediatric emergency department (ED) and, on occasion, will require stoma dilation tosuccessfully replace the GT. The objective of this study was to describe the frequency that stomadilation is required, the success rate of replacement, complications encountered, and the techniquesused to confirm placement of the GT after dilation.
Methods: We conducted a retrospective medical record review of children 0-18 years whopresented to the pediatric ED from February 2013 through February 2015 with a dislodged GT thatrequired stoma dilation by pediatric emergency physicians with serially increasing Foley cathetersizes prior to successful placement of the GT.
Results: We reviewed a total of 302 encounters in 215 patients, with 97 (32%) of the encountersrequiring stoma dilation prior to replacing a GT. The median amount of dilation was 2 Frenchbetween the initial Foley catheter size and the final GT size. There was a single complication ofa mal-positioned balloon that was identified at the index visit. No delayed complications wereencountered. We performed confirmation of placement in all patients. The two most commonforms of confirmation were aspiration of gastric contents (56/97 [58%]) followed by contrastradiograph in 39 (40%).
Conclusion: The practice of serial dilation of a gastrostomy stoma site to allow successfulreplacement of a gastrostomy tube in pediatric patients who present to the ED with a dislodgedgastrostomy tube is generally successful and without increased complication. All patients received atleast one form of confirmation for appropriate GT placement with the most common being aspirationof gastric contents.