Trick of the Trade: Deflate an Undeflatable Gastrostomy Tube

A 54-year-old female with a past medical history of throat cancer presents for gastrostomy tube (G-tube) replacement. The initial G-tube was placed 3 years ago. Most recently, the patient had the G-tube changed 7 months ago. She presents to the Emergency Department because the G-tube is leaking from the tubing that is external to the skin. When you attempt to deflate the cuff, you are unsuccessful.

Trick of the Trade

Accessing the inflation channel using an IV catheter

This is a de novo technique to deflate G-tube cuffs that will not deflate via the typical method of using a syringe at the G-tube cuff port. It is also less traumatic than pulling the G-tube out with an inflated cuff.

Equipment

• 22-gauge IV catheter
• 10-cc syringe

Technique

1. Identify the port from where the cuff is usually deflated, and visually follow this down the length of the tube as close to the patient’s skin that is safe. You should see a difference in the coloration which represents the tubing channel that is connected to the balloon cuff.
2. Insert a 22-gauge IV catheter, then remove the needle.
3. Attach a syringe to the end of the catheter and withdraw the fluid to deflate the balloon cuff.
4. Proceed with G-tube removal and replacement as you normally would.

Patient Selection

This technique can be attempted in any patient with a G-tube that has a cuff that cannot be deflated by conventional means.

Caution

Try to bend the G-tube so that you are introducing the catheter parallel to the patient’s skin and then place a barrier between the tubing and the patient as to reduce the risk of sticking the patient with the needle.

Feedback

What are your thoughts regarding this trick of the trade? What techniques have you used when unable to deflate G-tube cuffs?

Reference

1. Saavedra H, Losek JD, Shanley L, Titus MO. Gastrostomy tube-related complaints in the pediatric emergency department: identifying opportunities for improvement. Pediatr Emerg Care. 2009 Nov;25(11):728-32. PMID: 19864965.
2. Schrag SP, Sharma R, Jaik NP, et al. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis. 2007 Dec;16(4):407-18. PMID: 18193123.
3. O’Keefe KP, Dula DJ, Varano V. Duodenal obstruction by a nondeflating Foley catheter gastrostomy tube. Ann Emerg Med. 1990 Dec;19(12):1454-7. PMID: 2122777.

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