Planned Permanent Removal of a Surgically Placed Feeding Tube
Permanent removal of a gastrostomy type feeding tube may be considered when the child is clinically stable and able to consume adequate oral intake to grow appropriately and meet nutrition needs. The time frame for removing the tube is variable and needs to be decided on an individual basis. Consideration should be given to the child’s underlying condition, nutritional status, and possible future needs for nutrition support (Collins, Gaffney, Tan, Roberts, & Nyulasi, 2013). Removal of the tube should be considered permanent; a reversal of the decision to reinstate tube feeds following tube removal will require further surgical intervention.
A child who is stable and growing appropriately without the need for tube feeding for three to six months (depending on underlying medical condition) should be considered for tube removal. There is no urgency to remove a tube in less than three months if the child’s ability to tolerate an intercurrent infection and maintain nutrition and hydration is not assured. Equally there is an unnecessary cost to maintaining a tube that is not being used for longer than six months.
When considering permanent tube removal, the following questions should be considered (Collins, Gaffney, Tan, Roberts, & Nyulasi, 2013):
- is the child clinically stable?
- can the child eat and drink safely and adequately?
- can essential medications be taken orally?
- what are the child’s likely future healthcare needs that could impact their ability to meet nutritional requirements?
- does the child (as appropriate) and family understand the implications of tube removal and the process including risks of reinsertion if required?
In most cases, when a gastrostomy tube is no longer needed, it can simply be removed through the stoma following deflation of the balloon. PEG-type tubes will need to have the mushroom cut off or removed endoscopically at the direction of the surgeon. The site will usually close on its own over a period of about two to four weeks. Barrier cream and gauze can be used around the site to protect the skin from any leakage in the meantime. Spontaneous closure of the gastrostomy tube site is less likely to occur the longer the tube has been in place, although this is highly unpredictable and can vary from many months to years. Referral to a pediatric surgeon is recommended if the child has persistent issues with tube leakage after two to four weeks (Alshafei, Deacy, & Antao, 2017); (Khan, et al., 2015).