A.
Patient criteria for GJ tube placement:
1.
Patient must have a current gastrostomy tube that has been in place for at least EIGHT weeks
B.
All GJ tubes will be placed by PEDIATRIC RADIOLOGY under fluoroscopy
1.
All weekend or night requests will be deferred to the first available week day time
C.
Electronic radiology order is required for placement
1.
Inpatient: place order in CPOE
2.
Outpatient: place order in Practice Partner
A.
All GJ tube replacements will be completed by PEDIATRIC RADIOLOGY under fluoroscopy
1.
All weekend or night requests will be deferred to the first available week day time
2.
If patient presents over the weekend with GJ tube concern that requires replacement, patient may require admission to general pediatrics team for adequate nutrition and medication administration until replacement.
B.
Electronic radiology order is required for replacement
1.
Inpatient: place order in CPOE
2.
Outpatient: place order in Practice Partner
C.
Each patient should have scheduled replacement every THREE to FOUR months
1.
Electronic order for outpatient replacement should be placed in
Practice Partner and arranged with Radiology scheduling.

A.
Refer to gastrostomy tube care guidelines for GJ tube stoma care
1.
Clean peristomal skin daily with mild soap and water
2.
Keep peristomal skin dry
3.
Apply criticaid cream or moisture barrier product for skin irritation
4.
Call pediatric surgery with concern for stoma infection or abscess
A.
All jejunal feeds must be administered in a continuous manner
1.
DO NOT administer bolus feeds via the J tube
B.
FLUSH Gastric and Jejunal ports THREE times every day with 10-15cc of warm water
C.
FLUSH the Gastric and Jejunal ports with 10-15cc of warm water after every medication and formula administration
D.
Give all medications via the GASTRIC port unless otherwise directed by MD or PharmD
A.
PREVENTION is key. Emphasize the importance of flushing the tube THREE times a day and after every feed and medication administration
B.
If the tubing is clogged…
1.
Attempt to flush the tubing with a 3cc syringe of warm water. If two attempts are unsuccessful, move to step 2
2.
Attempt to flush the tubing with the CLOG ZAPPER product as directed.
(this product is stocked in central supply). If attempt is unsuccessful, move to step 3
3.
Contact PEDIATRIC RADIOLOGY to schedule for GJ tube replacement under fluoroscopy

a) All weekend and night requests will be deferred to the first available week day time b) Patient may require admission to general pediatrics team for nutrition, hydration, and medication management until the tube can be replaced.
A.
If the GJ tube becomes dislodged, attempt to re-insert the GJ tube or a temporary tube (i.e. red rubber catheter, foley catheter or MIC or MICKEY gastrostomy tube) as soon as possible.
1.
Following re-insertion, TAPE the GJ or temporary tube in place.
2.
DO NOT use the tube.
3.
Contact PEDIATRIC RADIOLOGY for replacement.
4.
Call PEDIATRIC SURGERY if you are not able to re-insert the GJ tube or temporary tube.
5.
DO NOT discard the dislodged GJ tube.