Dr. Paul Chang, Senior Medical and Practice Advisor for the Home Center Care Institute. Today, I will be demonstrating how to change a gastrostomy tube. Please note that I am not wearing PPE for the video to make it easier for you to hear the instructions. However, you should follow infection control guidelines and use appropriate personal protective equipment during the visit. This, of course, applies to the current COVID-19 pandemic. You can consider training caregivers and family members to perform the procedure in case of an emergency. This can help avoid costly and unnecessary visits to the emergency room. Please adhere to your own practice guideline if you do so. You will want to first gather the equipment and supplies for the procedure. I will now walk you through the procedure step-by-step. This is the point where you put on gloves, surgical mask, and eye protection. Again, please follow the guidelines and follow the instructions. I will now walk you through the procedure step-by-step. This is the point where you put on gloves, surgical mask, and eye protection. Again, please follow the guidelines and eye protection. Again, I am not wearing it for the purposes of the video. Examine the new gastrostomy tube for any defects and test the balloon for leakage by instilling 5 to 10 mLs of sterile or distilled water. Deflate the balloon after testing and put it aside. Apply a small amount of lubricant to the end of the replacement gastrostomy tube. Make sure the external bumper slides up the tube for placement. Move the external bumper three to four centimeters above the previously noted distancing markings on the old tube. Note, this does not apply to low-profile gastrostomy tubes. Set the replacement tube on a clean surface, usually back inside of the sterile package of the replacement tube. Place a paper towel or a cloth towel around the gastrostomy tube area to absorb any leakage of tube feeding or gastric secretions. The providers stand on either the right side or the left side of the patient. Before removal, review and identify the brand, type, size of the tube, and the external centimeter marking on the current gastrostomy tube so the replacement tube is placed in the correct position. A bumper bolster type gastrostomy tube can be changed or removed at home using traction removal without local anesthesia. Although some patients and specialists prefer changing this type of tube endoscopically, consider checking with the specialist who placed this type of gastrostomy tube for additional input. Remove the bumper or bolster type gastrostomy tube by placing the non-dominant hand flat against the abdomen for counterpressure with the gastrostomy tube fitting in the web between the thumb and the index finger. Wrap the gastrostomy tube around the fingers of the dominant hand until the hand is within a few centimeters of the abdominal wall and pull firmly on the gastrostomy tube to remove. Remove balloon type gastrostomy tube by first deflating the balloon in the old tube using a syringe. If no fluid can be aspirated from the balloon and there's concern that the valve may be malfunctioning, the valve can be cut off to allow any fluid in the balloon to escape. The valve can be cut off right here. Place the non-dominant hand against the abdomen for counterpressure. Gently pull out the old tube using the dominant hand. Discard the old tube. Insert the new gastrostomy tube into the stoma with gentle pressure beyond the previously noted distance marking on the gastrostomy tube. Inflate the balloon with appropriate amount, usually seven to 10 mLs of sterile or distilled water. Gently pull back on the gastrostomy tube until resistance is met. This ensures the retention balloon is secured against the stomach wall. Wipe any secretions off the tubing. Move the external bumper bolster down the gastrostomy tube until a snug fit is achieved, making sure that the external bumper is not too tight to the gastrostomy tube. It should not compress the abdominal wall, which can lead to pressure ulcer. And the tube can be freely rotated. Note, a low profile gastrostomy tube does not have an external bumper or bolster. Verify the gastrostomy tube position by using a syringe to flush air or water into the stomach and listening with a stethoscope or by aspirating gastric content through the feeding port. Replace the gastrostomy tube dressing with a new gastrostomy tube. Wash hands post-procedure and document the procedure, including the brand and the type of the tube, the external centimeter marking of the bumper on the gastrostomy tube, and the lot and expiration date. Here are some additional considerations. If the gastrostomy tube surgically within the last two weeks becomes dislodged, the provider should contact a specialist who performed a procedure to reinsert as endoscopic or fluoroscopic replacement may be necessary. Order a replacement gastrostomy tube through the tube feeding supplier after the replacement so there will be a replacement tube Balloon-type gastrostomy tubes can be changed every three to four months, although there is currently no consensus recommendations on the frequency of the gastrostomy tube change. I hope this video and practicing this procedure will help you gain confidence on how to safely change a gastrostomy tube at home.

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