Gastrostomy tube-related complaints in the pediatric emergency department: identifying opportunities for improvement
OBJECTIVE: To describe the pediatric emergency medicine management of patients who present with gastrostomy tube (G-tube)-related complaints and identify opportunities for improving care and preventing G-tube complications.
METHODS: Retrospective cross-sectional descriptive study of patients (aged <18 years) who received care at an urban children's hospital (110 beds) emergency department (ED) for G-tube-related complaints.
RESULTS: Over a 23-month period, there were 181 ED patient visits by 77 patients for G-tube-related complaints. The mean number of visits per patient was 2.4. There were 159 (88%) G-tube and 22 (12%) gastrojejunostomy tube (GJ-tube) patient visits. The standard type of G-tube used at the study site ED was an adjustable-length tube. The most common complaint for G-tubes was dislodgement (99, 62%); and for GJ-tubes, malfunction (11, 50%). There were 119 patient visits (75%) needing G-tube replacement. Of these, 115 (97%) were successfully replaced in the ED, 85 (74%) by the pediatric emergency medicine attending physician, and 30 (26%) by the pediatric surgery service. The method of securing or documenting the intragastric depth of the adjustable-length tubes was documented in 15 (10%) of the 157 patients who had G-tubes or foley catheters at the time of ED disposition. The most common major G-tube complication was gastric outlet obstruction (3), and the most common major GJ-tube complication was aspiration pneumonia (3) secondary to gastric malposition (2) or dislodgement (1) of the GJ-tube. Only 9 patient visits (5%) resulted in hospitalization, and there were no deaths.
CONCLUSIONS: Patients with G-tubes had approximately 1.25 mean ED visits per year for G-tube complaints. The most common G-tube complaint was dislodgement. Most dislodged G-tubes were replaced by ED physicians without the assistance of surgeons, but documentation of management and methods of securing the tubes was often incomplete. There were few major complications or hospitalizations. Treatment guidelines are presented that emphasize documentation of confirming G-tube location at the time of disposition from the ED.