If your child has an Nasal Tube, it will get pulled out, even with the best taping job. Nasogastric (NG) tubes can be replaced at home. Your child’s doctor should teach you how to reinsert the tube and check for placement. If your doctor has not provided you with these instructions, he or she should instruct you on where to take your child for help, such as their office or the ER. Nasoduodenal (ND) and Nasojejunal (NJ) tubes typically must be replaced at the hospital. It’s good to have a plan ahead of time, especially if you need to go to the hospital for replacement.
Gastrostomy (G) Tubes
If your child has a balloon button or long tube, pull-outs are also very likely to happen. Either your child will pull it out, or you or another caregiver will. Extensions get caught when you are lifting your child out of a crib or car seat, or can just get tangled and catch on something. And balloons do sometimes break.
Talk with your doctor about what to do if your child’s G-tube is pulled out in the first few months after surgery. Your child may need an X-ray to confirm proper placement, as the stoma is still healing during that time. Stomas can close very quickly, so you want to have a plan in place ahead of time that will allow you to act quickly.
Once your child’s stoma is healed, children with balloon buttons can have their buttons changed at home. Your child’s doctor or nurse will teach you how to change the button yourself, and you should always have an emergency kit with water-based lubricant, an extra G-tube or Foley catheter, tape, and a 5ml slip tip syringe for deflating and filling a balloon button with water. It is very important to be well-trained on placement before attempting an emergency replacement yourself!
Depending on the situation, you can re-insert the button or tube that was pulled out. The stomach is not sterile, so a good rinse is all you need before putting it back in. Or you can use a new button/tube. But the stoma will start to close quickly, so you want to work fast to get something in. You can use a tube with a broken balloon taped into place, if necessary. If you do not have a spare, the button that came out is missing, or the stoma has closed too much already, another backup option is to insert a Foley catheter, if you happen to have one. Suction catheters and NG-tubes work too. Then you will likely need to visit the ER for help to get a new button in.
A tip for helping to get a button back in after the stoma has started to close is to stick a Q-tip (with the cotton removed) into the button before putting the button in. This makes the “stem” portion of the button more rigid and easier to replace. Use lots of lubricant!
Children with long tubes or buttons that do not have a balloon will need to get to the doctor’s office or the ER to have the tube/button replaced as soon as possible. Keep a spare Foley catheter around to hold the stoma open in the interim.
Gastro-jejunostomy (GJ) Tubes
If your child has a GJ and that comes out, you should have a spare G-button, tube, or Foley you can insert to keep the stoma open. Then you will need to contact your child’s doctor to get a new GJ placed. You will need to go to the hospital to have the GJ-tube replaced. Many hospitals only offer this service during business hours, unfortunately. If this is the case, your child may need to be admitted for IV fluids until the tube can be replaced.
Jejunal (J) Tubes
Children with separate J-tubes/buttons may or may not be able to replace these at home. Your doctor should let you know the protocol for your type of tube, which often depends on the type of surgery performed to place the tube.