G/GJ tubes: Primary tube insertion by image guidanceGG/GJ tubes: Primary tube insertion by image guidanceG/GJ tubes: Primary tube insertion by image guidanceEnglishGastrointestinal;Other(diagnostic imaging, bloodwork, picc line, procedures�.)Child (0-12 years);Teen (13-18 years)Abdomen;Stomach;Small IntestineDigestive systemProceduresAdult (19+) CaregiversNA2019-07-30T04:00:00Z7.9000000000000063.3000000000000798.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Discover how a G tube is placed by image guidance, how to prepare you child for the procedure and what to expect once the procedure is over.</p><h2>What are G and GJ tubes?</h2><p>Gastrostomy tubes (G tubes) and gastrojejunostomy tubes (GJ tubes) are feeding devices. A G tube gives liquid nutrition, medication and other fluids directly into the stomach. A GJ tube gives liquid nutrition, medication and other fluids directly into the small intestine (the jejunum). </p><p>Most primary G or GJ tubes at SickKids are placed by an interventional radiologist using image guidance. The radiologist uses images produced by X-rays and ultrasounds to guide the placement of the tube in your child’s belly (abdomen). In some cases, the G or GJ tube will be inserted in the operating room by a general surgeon.</p><h2>Key points</h2><ul><li>At SickKids, most G or GJ tubes are placed by an interventional radiologist using image guidance.</li><li>All children are sedated during the tube insertion procedure. Your child will receive a general anaesthetic before the procedure. </li><li>Complications of G or GJ tube insertion include bleeding, stoma infection, blood infection, perforation, peritonitis and anaesthesia-related complications.</li><li>All families will have a consultation with a nurse practitioner or pediatrician prior to going ahead with G or GJ tube insertion. </li><li>If your child becomes ill within two days before the G or GJ tube insertion, or if they do not follow fasting guidelines for a general anaesthetic, the procedure may be cancelled.</li></ul><h2>How is a G or GJ tube inserted?</h2><p>All children are <a href="/Article?contentid=1260&language=English">sedated</a> during the procedure. Sedative medication makes your child sleepy or more comfortable during a hospital test or treatment. Most children receive a general <a href="/Article?contentid=1261&language=English">anaesthetic </a>to keep them asleep during the procedure and make sure they don’t feel any pain. The general anaesthesia will be given to your child by an anaesthesiologist, a doctor who manages the sedation.</p><p>Under general anaesthesia, your child may have a breathing tube put in the throat to help them breathe while asleep.</p><p>The procedure to insert a G or GJ tube is a short one. The radiologist and anaesthesiologist are always with your child during the procedure. </p><p>The interventional radiologist will create an opening in your child's abdomen called a stoma. The tunnel from the outside of the body into the stomach is called a tract.</p><p>A <a href="/Article?contentid=2536&language=English&hub=tubefeeding">Corflo PEG tube</a> is placed through the mouth, into the stomach and out through the stoma. A round bolster on the inside of the stomach helps prevent the tube from being pulled out. A fixation device on the outside of the stomach helps prevent the tube from moving too far into the stomach. The fixation device will be either a T-bar/crossbar or a white elbow fixation. The Corflo PEG tube ends in the stomach.</p><p>The primary G tube can be switched for a <a href="/Article?contentid=2908&language=English&hub=tubefeeding">low-profile G tube</a> three months after primary insertion. Low-profile feeding tubes are easier to manage than primary G tubes, so your health-care team may recommend you switch your child’s tube as soon as you are able.</p><h2>After the G or GJ tube insertion</h2><h3>Right after the procedure </h3><p>After the procedure, you can expect to see:</p><ul><li>A tube going inside the belly (this is the feeding tube).</li><li>An <a href="/Article?contentid=2451&language=English">intravenous (IV) line</a>, to ensure your child stays hydrated and to give strong pain medications. An IV line is a small tube that is put into a vein in your child's arm, neck or leg to give medications or fluids.</li><li>Possible oxygen: Your child was in a very deep sleep and may need oxygen until they are fully awake. They may be wearing an oxygen mask over their mouth and nose. The breathing tube will be gone.</li><li>A dressing on the site of the tube insertion.</li></ul><h3>Monitoring after the procedure</h3><p>Your child will spend several days in hospital. The interventional radiologist or the surgeon will visit your child daily for several days to monitor your child’s progress. The team will watch for the complications mentioned above. These complications are most common within the first two to three days after the tube is inserted.</p><h3>Pain management </h3><p>Inserting a G or GJ tube is a low-risk, mildly painful surgery. You can expect your child to be uncomfortable for several days after the insertion. To help with the pain, before the procedure, the doctors will:</p><ul><li>Give your child a large dose of <a href="/Article?contentid=62&language=English">acetaminophen</a> rectally (in the bum).</li><li>Give a stronger pain medicine through the IV line. </li><li>Use a local pain medication at the insertion site before they put the tube in.</li></ul><p>When your child is admitted on the inpatient unit after the surgery, your child will get pain medication as often as it is needed. Acetaminophen and <a href="/Article?contentid=153&language=English">ibuprofen</a> are usually enough to keep your child comfortable. This is given rectally (in the bum) initially.</p><p>Some children may need stronger medications, such as <a href="/Article?contentid=2999&language=English">morphine</a>. If you feel that your child is uncomfortable, ask your nurse about your child’s options.</p><p>By the time your child is discharged, acetaminophen and/or ibuprofen will likely be enough to manage their pain at home.</p><h2>How to prepare for a G or GJ tube insertion</h2><h3>Pre-procedure </h3><p>You will have a consultation with the G Tube Program nurse practitioner or pediatrician to help you and your family make the decision to insert a G or GJ tube. </p><p>You and your family will attend a one-on-one teaching session with a nurse to help you better understand how to care for your child's G or GJ tube. This is done after your child’s tube has been inserted, but before your child goes home.</p><p>For more information on what is done for patients and families at SickKids, see the At SickKids section below.</p><p>You will sign a consent form before the tube insertion can be done. </p><h3>Giving consent before a G or GJ tube insertion</h3><p>More details about the major complications of tube insertion and how the feeds will be given will be discussed with you before you give your consent to the tube insertion. A nurse practitioner will speak with you about all of this before you give consent. </p><p>Informed consent includes explaining:</p><ul><li>treatment, its risks and alternatives</li><li>risks and benefits of each alternative treatment</li><li>risks and benefits of non-treatment</li></ul><h3>How to prepare your child for a G or GJ tube insertion</h3><p>Depending on your child’s medical history, blood work or an abdominal ultrasound may be required before the G or GJ tube insertion. These recommendations will be made at the time of the G/GJ tube consultation. </p><p>It will also be very important to follow strict rules about eating and drinking before the procedure. Your child will need to follow strict fasting guidelines (called NPO guidelines) before the procedure so that they have an empty stomach at the time of the procedure.</p><table class="akh-table"><thead><tr><th>Time</th><th>What your child can eat and drink</th></tr></thead><tbody><tr><td>Midnight on the day of the procedure</td><td><p>Stop giving your child solid food, milk, candy and orange juice. Your child must eat nothing until they wake up from the anaesthesia.</p><p>Your child may drink clear fluids such as clear apple juice, water, ginger ale and rehydration solution.</p></td></tr><tr><td>6 hours before the procedure</td><td>Stop giving your baby formula.</td></tr><tr><td>4 hours before the procedure</td><td>Stop giving your baby breast milk.</td></tr><tr><td>3 hours before the procedure</td><td>Stop giving your child clear fluids. Your child must drink nothing until they wake up from the anaesthesia.</td></tr></tbody></table><p>If your child takes prescription medicine, ask your doctor or nurse practitioner when and how to give the medication. You may need to change your child’s usual medication schedule or the medication may need to be given by a different method (for example, by IV rather than by mouth). This is especially important for essential medications such as cardiac or seizure medications.</p><p>To ensure your child is safe during the tube insertion, these rules must be followed. If they are not, your child’s procedure may be cancelled.</p><h3>If your child becomes ill within two days before the G or GJ tube insertion</h3><p>If your child is sick at the time of the procedure, the tube insertion may need to be postponed because a general anaesthesia may be unsafe. Call your child’s doctor or G tube resource nurse if your child has:</p><ul><li>a cough or is wheezing</li><li>a <a href="/Article?contentid=30&language=English">fever</a></li><li>a runny nose</li><li>is vomiting</li><li>is generally feeling unwell</li></ul><h2>At SickKids</h2><p>If you are a SickKids patient with a tube, contact the G tube resource nurse at 416-813-7270, extension 4, with any questions or concerns. If your child does not have a tube yet, contact the nurse practitioner at 416-813-7274.</p>

 

 

 

 

G/GJ tubes: Primary tube insertion by image guidance3818.00000000000G/GJ tubes: Primary tube insertion by image guidanceG/GJ tubes: Primary tube insertion by image guidanceGEnglishGastrointestinal;Other(diagnostic imaging, bloodwork, picc line, procedures�.)Child (0-12 years);Teen (13-18 years)Abdomen;Stomach;Small IntestineDigestive systemProceduresAdult (19+) CaregiversNA2019-07-30T04:00:00Z7.9000000000000063.3000000000000798.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Discover how a G tube is placed by image guidance, how to prepare you child for the procedure and what to expect once the procedure is over.</p><h2>What are G and GJ tubes?</h2><p>Gastrostomy tubes (G tubes) and gastrojejunostomy tubes (GJ tubes) are feeding devices. A G tube gives liquid nutrition, medication and other fluids directly into the stomach. A GJ tube gives liquid nutrition, medication and other fluids directly into the small intestine (the jejunum). </p><p>Most primary G or GJ tubes at SickKids are placed by an interventional radiologist using image guidance. The radiologist uses images produced by X-rays and ultrasounds to guide the placement of the tube in your child’s belly (abdomen). In some cases, the G or GJ tube will be inserted in the operating room by a general surgeon.</p><h2>Key points</h2><ul><li>At SickKids, most G or GJ tubes are placed by an interventional radiologist using image guidance.</li><li>All children are sedated during the tube insertion procedure. Your child will receive a general anaesthetic before the procedure. </li><li>Complications of G or GJ tube insertion include bleeding, stoma infection, blood infection, perforation, peritonitis and anaesthesia-related complications.</li><li>All families will have a consultation with a nurse practitioner or pediatrician prior to going ahead with G or GJ tube insertion. </li><li>If your child becomes ill within two days before the G or GJ tube insertion, or if they do not follow fasting guidelines for a general anaesthetic, the procedure may be cancelled.</li></ul><h2>Going home</h2><p>While your child is still in the hospital, get involved in your child’s care. This way, you will learn and become comfortable with caring for your child’s tube. </p><p>Before your child is discharged from the inpatient unit, you will learn to:</p><ul><li>Give feeds and medications through the tube, either by pump or gravity.</li><li>Use and care for the equipment.</li><li>Identify, monitor and manage complications and challenges at home.</li><li>Protect the tube and the <a href="/Article?contentid=2906&language=English&hub=tubefeeding">skin around the tube</a>.</li></ul><h2>How is a G or GJ tube inserted?</h2><p>All children are <a href="/Article?contentid=1260&language=English">sedated</a> during the procedure. Sedative medication makes your child sleepy or more comfortable during a hospital test or treatment. Most children receive a general <a href="/Article?contentid=1261&language=English">anaesthetic </a>to keep them asleep during the procedure and make sure they don’t feel any pain. The general anaesthesia will be given to your child by an anaesthesiologist, a doctor who manages the sedation.</p><p>Under general anaesthesia, your child may have a breathing tube put in the throat to help them breathe while asleep.</p><p>The procedure to insert a G or GJ tube is a short one. The radiologist and anaesthesiologist are always with your child during the procedure. </p><p>The interventional radiologist will create an opening in your child's abdomen called a stoma. The tunnel from the outside of the body into the stomach is called a tract.</p><p>A <a href="/Article?contentid=2536&language=English&hub=tubefeeding">Corflo PEG tube</a> is placed through the mouth, into the stomach and out through the stoma. A round bolster on the inside of the stomach helps prevent the tube from being pulled out. A fixation device on the outside of the stomach helps prevent the tube from moving too far into the stomach. The fixation device will be either a T-bar/crossbar or a white elbow fixation. The Corflo PEG tube ends in the stomach.</p><p>The primary G tube can be switched for a <a href="/Article?contentid=2908&language=English&hub=tubefeeding">low-profile G tube</a> three months after primary insertion. Low-profile feeding tubes are easier to manage than primary G tubes, so your health-care team may recommend you switch your child’s tube as soon as you are able.</p><h2>After the G or GJ tube insertion</h2><h3>Right after the procedure </h3><p>After the procedure, you can expect to see:</p><ul><li>A tube going inside the belly (this is the feeding tube).</li><li>An <a href="/Article?contentid=2451&language=English">intravenous (IV) line</a>, to ensure your child stays hydrated and to give strong pain medications. An IV line is a small tube that is put into a vein in your child's arm, neck or leg to give medications or fluids.</li><li>Possible oxygen: Your child was in a very deep sleep and may need oxygen until they are fully awake. They may be wearing an oxygen mask over their mouth and nose. The breathing tube will be gone.</li><li>A dressing on the site of the tube insertion.</li></ul><h3>Monitoring after the procedure</h3><p>Your child will spend several days in hospital. The interventional radiologist or the surgeon will visit your child daily for several days to monitor your child’s progress. The team will watch for the complications mentioned above. These complications are most common within the first two to three days after the tube is inserted.</p><h3>Pain management </h3><p>Inserting a G or GJ tube is a low-risk, mildly painful surgery. You can expect your child to be uncomfortable for several days after the insertion. To help with the pain, before the procedure, the doctors will:</p><ul><li>Give your child a large dose of <a href="/Article?contentid=62&language=English">acetaminophen</a> rectally (in the bum).</li><li>Give a stronger pain medicine through the IV line. </li><li>Use a local pain medication at the insertion site before they put the tube in.</li></ul><p>When your child is admitted on the inpatient unit after the surgery, your child will get pain medication as often as it is needed. Acetaminophen and <a href="/Article?contentid=153&language=English">ibuprofen</a> are usually enough to keep your child comfortable. This is given rectally (in the bum) initially.</p><p>Some children may need stronger medications, such as <a href="/Article?contentid=2999&language=English">morphine</a>. If you feel that your child is uncomfortable, ask your nurse about your child’s options.</p><p>By the time your child is discharged, acetaminophen and/or ibuprofen will likely be enough to manage their pain at home.</p><h2>How to prepare for a G or GJ tube insertion</h2><h3>Pre-procedure </h3><p>You will have a consultation with the G Tube Program nurse practitioner or pediatrician to help you and your family make the decision to insert a G or GJ tube. </p><p>You and your family will attend a one-on-one teaching session with a nurse to help you better understand how to care for your child's G or GJ tube. This is done after your child’s tube has been inserted, but before your child goes home.</p><p>For more information on what is done for patients and families at SickKids, see the At SickKids section below.</p><p>You will sign a consent form before the tube insertion can be done. </p><h3>Giving consent before a G or GJ tube insertion</h3><p>More details about the major complications of tube insertion and how the feeds will be given will be discussed with you before you give your consent to the tube insertion. A nurse practitioner will speak with you about all of this before you give consent. </p><p>Informed consent includes explaining:</p><ul><li>treatment, its risks and alternatives</li><li>risks and benefits of each alternative treatment</li><li>risks and benefits of non-treatment</li></ul><h3>How to prepare your child for a G or GJ tube insertion</h3><p>Depending on your child’s medical history, blood work or an abdominal ultrasound may be required before the G or GJ tube insertion. These recommendations will be made at the time of the G/GJ tube consultation. </p><p>It will also be very important to follow strict rules about eating and drinking before the procedure. Your child will need to follow strict fasting guidelines (called NPO guidelines) before the procedure so that they have an empty stomach at the time of the procedure.</p><table class="akh-table"><thead><tr><th>Time</th><th>What your child can eat and drink</th></tr></thead><tbody><tr><td>Midnight on the day of the procedure</td><td><p>Stop giving your child solid food, milk, candy and orange juice. Your child must eat nothing until they wake up from the anaesthesia.</p><p>Your child may drink clear fluids such as clear apple juice, water, ginger ale and rehydration solution.</p></td></tr><tr><td>6 hours before the procedure</td><td>Stop giving your baby formula.</td></tr><tr><td>4 hours before the procedure</td><td>Stop giving your baby breast milk.</td></tr><tr><td>3 hours before the procedure</td><td>Stop giving your child clear fluids. Your child must drink nothing until they wake up from the anaesthesia.</td></tr></tbody></table><p>If your child takes prescription medicine, ask your doctor or nurse practitioner when and how to give the medication. You may need to change your child’s usual medication schedule or the medication may need to be given by a different method (for example, by IV rather than by mouth). This is especially important for essential medications such as cardiac or seizure medications.</p><p>To ensure your child is safe during the tube insertion, these rules must be followed. If they are not, your child’s procedure may be cancelled.</p><h3>If your child becomes ill within two days before the G or GJ tube insertion</h3><p>If your child is sick at the time of the procedure, the tube insertion may need to be postponed because a general anaesthesia may be unsafe. Call your child’s doctor or G tube resource nurse if your child has:</p><ul><li>a cough or is wheezing</li><li>a <a href="/Article?contentid=30&language=English">fever</a></li><li>a runny nose</li><li>is vomiting</li><li>is generally feeling unwell</li></ul><h2>What are the risks of a G or GJ tube insertion?</h2><p>The G or GJ tube insertion is done under a general anaesthetic and is considered a low risk procedure. However, it does come with some risks and potential complications. Your child will be very closely monitored for these complications during their hospital stay after the tube is inserted.</p><p>Some complications related to the procedure include:</p><ul><li>bleeding</li><li><a href="/Article?contentid=2906&language=English&hub=tubefeeding">infection</a> of the stoma</li><li>infection in the blood (systemic) </li><li>perforation (puncture of other organs in the abdomen such as the colon or liver)</li><li><a href="/Article?contentid=3398&language=English&hub=tubefeeding">peritonitis</a> (inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the organs in the abdomen)</li><li><a href="/Article?contentid=1261&language=English">anaesthesia related</a></li></ul><h2>At SickKids</h2><p>If you are a SickKids patient with a tube, contact the G tube resource nurse at 416-813-7270, extension 4, with any questions or concerns. If your child does not have a tube yet, contact the nurse practitioner at 416-813-7274.</p>G/GJ tubes: Primary tube insertion by image guidanceFalse