If you take it out before then there is a chance the stomach will fall away leaving a hole in the stomach draining into the abdomen.
In my experience, it tends to be the patient who takes it out.... (no, not the post-laryngectomy crowd, more the MMS<20 candidates)
Another helpful tip is determining who put in the tube (GI or IR) is that generally there is a bumper on the GI version and not one on the IR version
The IR version has a bumper, except that the bumper is a 20cc balloon filled with dilute contrast. The problem with that is that this gives the underpaid and often underqualified staff in 'skilled' nursing facilities another connector to play with. Attemps to 'flush' this port will often lead to deflation or rupture of the balloon and as a result a dislodgement of the percutaneous G-tube. Btw. the IR version would typically NOT be sown in beyond the immediate 10 day post placement period (what looks like a suture is actually something called a 'T-fastener', a little dohicky we use to pin the stomach against the anterior abdominal wall similar to what the surgeon does with his gastropexy during an open G-tube. Before you cut any of the 'sutures', make sure to talk to whoever put the tube in beforehand....).
The most common etiology for the demise of an IR placed tube is however 'operator error'. In addition to the stunt of deflating the balloon port, an alltime favourite is putting 'crushed pills' into the G or G-J. Only liquid med formulations or meds finely ground by pharmacy using a mortar and pestle should ever be put into G-tubes (or even more importantly surgically placed sutured direct red-rubber J-tubes). The 'crushed pills' invariably aggregate to a impenetrable concrete like substance that neither 'warm tea' nor 'coca cola' will dissolve (and no, I can't 'just wire it' if it is clogged up).
The GI version has a fixed plastic bumper and is actually placed by pulling the tube backwards through the patient over a wire. The upside of that is that the bumper can't deflate and that if necessary you can lift the patient off the table on a GI placed G-tube (the real PEG). The downside is that if you need to exchange the PEG (bc someone f-ed up the outside portion with some sharp instruments), it typically requires another endoscopic procedure (the IR placed version can be changed over a wire under fluoroscopy with the patient awake, just like a central line).
A final helpful tip is if someone pulls one out in the middle of the night, you can place a foley of the same size in the tract and keep the tract open.
PLEASE do this if you get called by nursing in the middle of the night. Just drop in a foley with some KY and carefully inflate the balloon (bench test it beforehand so you know how it feels when it inflates freely in the stomach as opposed to within the tract). Just make sure that nobody feeds the patient through the foley (suture the opening shut, put a big 'remove before flight' flag on it), bc sometimes the tip might not actually be in the stomach and your first bottle of 'ensure' ends up in the peritoneum. Deal with it the next day and call whoever 'owns' the tube (GI, IR or general surg) and ask them for help with the tube dislodgement.
Also if you have someone that is aspirating on regular feeds then a J tube may help. Finally GJ tubes are nice since you can decompress the stomach while feeding the distal gut.
If you have a G-tube, it can typically be converted into a G-J under fluoroscopy (try this: walk up to a first-year radiology resident and graciously offer to send him a 'G-J conversion'. He'll be your fast friend from this day forward
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