G/GJ tubes: Preparing for permanent tube removal

​​

There are several important things you must consider before your child’s G or GJ tube is permanently removed.

Has my child taken all of their nutrition (food or formula), fluids (water), and medications by mouth for at least three months? Has my child used their G tube in the last three months?

It is important that your child is no longer dependent upon their G tube or GJ tube. It is also important that your child can take all their nutrition, fluids, and medications by mouth, even when they are sick. Two to three months without using the G tube or GJ tube is generally enough time to know whether your child will continue to take everything by mouth in the future. However, this is only a general guideline and you should discuss your child’s personal history with their health care provider.

Many medications that have previously been given through the G tube or GJ tube are very bitter tasting. It is important to consider the taste of a medication and how well it will be tolerated by your child when switching to oral medications.

Is my child scheduled for a major surgery or procedure that may affect their ability to take nutrition, fluids, or medications by mouth?

If the answer to this question is “yes,” it may be better to leave your child’s G tube or GJ tube in until your child recovers from this procedure. Your child’s health care provider and the surgeon performing the procedure will be able to help you decide.

Getting ready for G tube or GJ tube removal

Your child will need to take an antacid medication such as omeprazole or lansoprazole​ by mouth for at least one week before the G tube or GJ tube is removed and for as long as the stoma (the opening in the stomach) is leaking after the tube is removed. Once the tube is removed, stomach contents will leak from the stoma and will continue to do so until the tract closes completely. Lowering the acid level of the stomach contents that leak out will help protect the skin around the stoma and promote better and faster healing.

G tube or GJ tube removal

If your child has a balloon-type tube, such as a Mic-Key low-profile G tube or GJ tube (a “button”), a Foley catheter, or a Mic-Gastrostomy tube in place, you may remove it at home. Your child must be taking the antacid medication for at least one week before the tube is removed. To learn how you can remove the tube yourself, read the page on removing a balloon type G tube or GJ tube.

If your child has a Cook Mac-Loc G tube or GJ tube, a Carey Alzate GJ tube, or a Corpak Corflo Max PEG G tube, your child’s doctor must send a referral for tube removal to your G tube specialist.

After the G tube or GJ tube is permanently removed

To learn how to take care of your child’s stoma after the tube has been removed, read the page on post G tube and GJ tube removal​.

Key points

  • Your child must be able to take all of their nutrition, fluids, and medications by mouth for at least two to three months before their G tube or GJ tube is removed.
  • If your child is scheduled for surgery or a procedure that may affect their ability to take nutrition, fluids, or medication by mouth, you should consider delaying the removal of the tube.
  • Make sure your child has been taking antacid medication for at least one week before the tube is removed.
  • Your child must continue taking antacid medication until the stoma stops leaking after tube removal.
​​
​​

Holly Norgrove, RN, BScN

9/7/2015

​​At Sick Kids

At SickKids, you may be referred to the G tube clinic in the Division of Gastroenterology, Hepatology and Nutrition for tube removal. A written physician’s order must be sent with the referral in order for the appointment to be made.

If you have any questions or concerns, you can contact the G tube resource nurse at 416-813-7270, extension 4.​

Notes: