Changing from a Gtube to a GJ tube- Major Differences you should know about!

There are times when a G tube is not working for you or your child, and it has to be changed to a GJ tube.  Even though change can be scary, the change from a G tube to a GJ tube shouldn’t be!

A G tube and GJ tube have a lot of similarities in daily care, but there are some major differences in these feeding tubes.  The most obvious difference is that a G tube puts food into the stomach and the GJ puts food into the intestines (jejunum) or into the stomach.  The GJ has two connections that can be used separately or at the same time.  

Commons Reasons to switch from a Gtube to a GJ tube

Usually, you will start with a G tube and then be switched over to a GJ tube, if your care team feels that there are certain symptoms and issues that need to be resolved or managed differently.

Here is a list of common reasons to switch to a GJ tube:

• severe and chronic acid reflux
• vomiting that is not related to a food allergy
• not gaining weight
• volume sensitive to food
• a need for “gut rest” (allows the stomach to heal)
• an increased risk of aspiration (food going into the lungs)
• unable to tolerate feeds in the stomach
• constantly coughing up secretions (spit and mucous)

Sometimes it may be one of these issues or a combination of issues that will result in a GJ tube to be considered.  A GJ tube has a connection to the stomach and to the intestines, so you can start off with feeds into the jejunum (intestines) and eventually work on getting feeds back into the stomach without having to change back to a G Tube right away.

For my daughter, she started with a G tube and then was changed to a GJ tube.  Eventually over time, we were able to trial feeds into the G side, and then later switched back over to a G-tube.

Gtube and GJ Tube Daily Care & Washing

Overall, the daily care and washing of the site for a Gtube and a GJ tube are pretty much the same.  Once the site is healed, you can resume normal baths or showers and washing the site with soap and water is fine. For more information about water and feeding tubes, check out this article here.

Both types of feeding tubes can use split gauze or covers.  To find out more about split gauze, pads, and covers, check out this article here.

Natural and Forced Rotation of the Feeding Tube

Rotation is the first major difference between the care of a G tube and a GJ tube.  With a G tube you are encouraged to rotate the g tube so that it doesn’t always rest in one place.  This can help the g tube from causing an indent in the skin which can cause abnormal healing and leaking. For more information about feeding tube leaking, check out this article.

With a GJ tube, you do not want to force the site to rotate. You can move it slightly from side to side to clean around it, but you do not want it to rotate around.  If the GJ tube site rotates it can cause coiling or flipping, which is basically dislodging the inside part of the GJ tube.  This can cause the J portion of the tube to move up into the stomach and disrupt feeds going to the correct area.

As with any feeding tube, your body will move, and this can cause the site to naturally rotate or turn as you move.  To keep the site in place, it is usually recommended to tape the GJ extensions down and keep them secured even when feeds are not being given.

On my daughter, we found that taping the tubes down with paper tape in an upward arc not only kept her site secured but also minimalized her leaking around the site.

Replacing a Gtube vs GJ Tube

If you have had a g tube, you are probably used to getting a replacement gtube from your DME (durable medical equipment) & medical supply company. G tubes can usually be replaced every 3 months or so, at home by a parent with no issues.

Unfortunately, GJ tubes can only be replaced by a medical professional.  Typically, a GJ tube is replaced every 3-9 months as needed.  Most of the time, the GJ tube will be replaced in Interventional Radiology (IR) by a Radiologist that uses imaging to make sure that the placement is correct.

Depending on the situation, GJ tubes can also be replaced in the OR (operating room) by your surgeon.  If another procedure or surgery is due to take place near a replacement date, it is usually replaced at the same time to avoid having a separate appointment.

Now most IRs are located inside a hospital and require an appointment for outpatient procedures.  These appointments are typically only Monday through Friday.  On evenings and weekends, IR is usually only used for emergency services and inpatient procedures.

What happens if the GJ tube comes out?

If your GJ becomes dislodged at home, you will need to either place a backup g tube or catheter into the stoma (hole), so it does not start to close.  After that you will need to call your medical team. They will advise you to go to the Emergency Room or help you get an appointment with IR to get a new GJ tube placed.

Like I mentioned above, IR typically only does appointments during the week so if the GJ comes out on a Friday night, it may not get replaced until Monday.  This is very stressful for most patients and parents.

Thankfully my daughter only pulled her GJ tube out once when she was about a year old, and she did it while we were in the day surgery waiting room.  We were able to get it replaced during our already scheduled procedure, so there were no additional issues.

After that event, I was determined to not ever have to worry about her pulling her GJ tube out again, so that is when I created Padded Belly Bands.  These bands wrap around the stomach and help keep curious fingers away from the feeding tube site.  They also help if your child is very active and may get their site or tubes snagged or pulled on.  You can check out the different belly bands available here.

Administering Medications in a Gtube and GJ Tube

Most people with feeding tubes have feeds and medications administered by tube and not by mouth.  Your medical team will tell you if your medications need to put into the G side or the J side of your GJ tube.  Some people will always put medications on the G side, but others are advised to put them in the J side. Typically, medications for acid reflux and vitamins go into the G side, but sometimes due to gut rest they will be put in the J side.

If you are ever in doubt of which side the medications should be given and can’t get ahold of your medical team, try calling your pharmacy.  The pharmacist should be able to help you determine which side would be best.

Whenever we were prescribed a new or temporary medication like steroids or antibiotics, I would always double check with the pharmacist about where they should be placed. 

Most pharmacies will also make notes on your account that these medications are used in a feeding tube so that they are aware for future prescriptions and any possible drug interactions.  My pharmacy actually will double check with doctors beforehand and have them specify which side of the GJ the medication should be given so that everyone is on the same page.

Venting a Gtube and GJ Tube

Venting a feeding tube is typically done for 2 reasons: acid reflux or for gas.  Venting should only be done if your medical team advises you to vent. If you vent a feeding tube without being advised and taught how to do it correctly, you can actually cause more harm than good. 

Improper venting can lead to an electrolyte imbalance and can teach the body to not try to get rid of gas on its own by burping or passing gas (farting).  We have to remember that the body is prepared to get rid of excess gas by burping and farting.  If we constantly step in to help the body do this, it will actually train the body to stop trying to get rid of gas.  This creates a cycle, where if you are constantly venting the body, the body will start to rely on you to do the venting.

When you are venting to remove excess acid reflux, you are actually trying to get rid of the excess and this is typically not put back into the body.

When you are venting to relieve gas, some fluids like bile and stomach acid can come out with the gas, and these fluids are typically put back into the body.

When venting a GJ tube, only the G side should be vented.   The G side can even be vented while the J side is giving a feed!

The J side should never be vented.  This will interfere with the intestines breaking down food and creating stool.  This can lead to an imbalance of electrolytes and can cause too much moisture to be removed making stool very hard and compact.

Venting can be done with a Ferrel Bag, an open syringe, or into a diaper.  Ferrel Bags and the syringe method are typically used for releasing gas because it collects any fluids, and you are able to let the fluid go back into the body using those same supplies.  Venting into a diaper is more typical for relieving excess acid because then the diaper is removed and thrown away.

In this picture, you can see my daughter has a diaper hanging out from under her padded belly band.  This diaper is collecting excess acid reflux from her stomach because her body creates way too much acid.  Every few hours the diaper is removed and thrown away.  We typically tuck the diaper underneath the belly band so it can’t be pulled or tugged on, but I couldn’t find another picture where you could see it.

Bolus Feeds and Continuous Feeds

Gtubes can be fed using a bolus method or a continuous method.  A bolus feed is given for a small amount of time and given multiple times a day.  A continuous feed is given at a slower rate and is delivered over a long stretch of time like 12, 18 or 20 hours.

GJ tubes that are fed through the J side are always done in a continuous method.  This is because the intestines (jejunum) do not expand like the stomach does. If you were to give a bolus feed into the J side, it will usually cause discomfort and pain because it is too much volume all at once.

The G side of the GJ tube can be fed in a bolus method, but this is usually done when you are weaning from the J side to the G side.

G Tube and GJ Tube Extensions

The most obvious difference between a G tube and GJ tube is that the G tube has one extension and the GJ tube has two extensions.

The two major manufacturers of G tubes the Mini AMT and the Mic-Key also make GJ tubes.  That means that some extensions from G tubes will work with GJ tubes.

For example, a Mini Amt G tube extension will fit the J side of a Mini AMT GJ tube.  Totally confusing right?!?!?!

The super fun part is that at first glance all the extensions will look compatible, but they won’t actually fit into the port. 

An extension should never have to be forced to connect to the feeding tube site.  It should slide in and turn to lock very smoothly.  If you have to force it, that probably means it is not supposed to fit.  By forcing extensions on, it can damage the valve and cause the extension not to lock in, which could mean you will need a full GJ replacement. 

If you need more information about extensions and how to care for them, check out this article.

Conclusion

Switching from a G tube to a GJ tube is fairly simple.  There are a few differences to be aware of, but in general the upkeep and maintenance is very similar.

Most people see a pretty huge improvement in symptoms and issues when they switch from a G tube to a GJ tube. 

We saw a pretty significant change in acid reflux after we made the switch.  Once we were able to correct and better manage the acid reflux, we were then able to switch back to the G tube, and then later fully wean off of a feeding tube completely! 

If you would like to see our weaning journey, you can start that series here.