While G-tubes rarely migrate out of place, it can be a common problem for children with Nasal Tubes and especially GJ-Tubes. This page will help you identify when there is a problem and how to solve it.
Nasal tubes can sometimes come out of place. In fact, if a child vomits, the tube may come out of the stomach, up the esophagus, and come out of the mouth! It is important to check placement of the tube before using it each time. If your tube has numbers or other markings on it, make sure it is still at the same marking or number it was at when it was inserted into the nose. Then verify placement of the tube per your doctor’s recommendations. See more on how to check placement on our Nasal Tubes page.
Nasal tubes that extend into the intestines (ND and NJ tubes) may sometimes migrate into the stomach. If this happens, the tube will need to be replaced at the hospital by a doctor or nurse. The section below on GJ-Tube migration may also be helpful, as the migration process is the same.
The long part of a GJ-tube, which is placed into the small intestine, can sometimes migrate out of place. Typically, it curls up into the stomach, though in rare cases it can extend upward into the esophagus. When it moves out of place, feedings are no longer being delivered to the small intestine. Instead, they are being delivered to the stomach or esophagus.
Migration out of place is more likely to happen if a child has severe motility problems or frequent retching and vomiting. The easiest solution to this problem is to place a tube with a longer J-tube length, particularly the 45cm length. Some styles of tubes or buttons, such as the larger sized AMT G-Jet tubes, are specifically designed to prevent kinking and migration.
If the tube is migrating due to frequent vomiting, retching, or spasms, medication may be used to reduce the symptoms causing migration. Some hospitals are also experimenting with anchoring the J-portion of the tube using clips and other devices. This is not widely available currently.
If the tube continues to migrate out of place, it may be wise to consider placing a separate J-button directly into the small intestine.
Symptoms of GJ Out of Place
- Vomiting formula
- Feeding intolerance
- Abdominal pain
- Formula coming out the G-port
Checking GJ Placement
If you suspect your child’s GJ-tube may be out of place, the best way to determine if this is the case is to have the tube X-rayed using contrast or dye. You can also do an at-home study using food dye or Kool Aid. Simply insert about 15ml of dyed formula or Kool Aid into the J-port and allow the G-tube to drain into a diaper, basin, or bag. If the colored formula or Kool Aid immediately flows out of the G-port, the tube may be out of place. It is possible, however, for formula to back flow into the stomach due to severe dysmotility in some children, which may cause this at-home test to be invalid.