The accidental dislodgement of a feeding tube is a sudden and concerning event for any caregiver or patient. These tubes, placed through the nose, mouth, or abdomen, provide necessary nutrition or medication, and their removal creates an immediate medical situation. Focus on a calm, structured response rather than panicking. This guide outlines general protocols for handling a pulled feeding tube, but it is not a substitute for specific medical advice from a healthcare team.
Immediate Safety Steps and Patient Assessment
The first step is to ensure the patient’s immediate safety and prevent further injury. If the patient is confused or agitated and still pulling at the tube, gently secure their hands to stop the action. Immediately stop any active feeding or medication infusion running through the tube to prevent potential aspiration or leakage.
Once the immediate action stops, rapidly assess the patient’s condition. Look closely at the insertion site for signs of injury, such as bleeding, redness, or swelling. Check the patient for signs of distress, including persistent coughing, gagging, or new complaints of abdominal pain. These symptoms suggest the tube may have entered the airway or that gastric contents are leaking into the abdominal cavity, which is a serious complication.
After this initial assessment, focus on managing the open site where the tube exited the body. Gently wipe the area clean of any leaked formula or fluids, and then cover the opening with a clean, dry gauze dressing. Note the precise time the tube came out, as this detail is important for the healthcare team, especially with surgically placed tubes. Also, check the condition of the tube itself to see if it appears fully intact or if a piece may have broken off during removal.
Response Protocols for Different Tube Types
Subsequent actions depend entirely on the type of tube dislodged, as urgency varies between nasal and surgical placements. A nasogastric (NG) tube, which passes through the nose into the stomach, or a nasojejunal (NJ) tube, which extends into the small intestine, does not involve a surgical opening that closes quickly. These tubes are secured with tape or a fixation device, and their dislodgement is less time-sensitive than a surgical tube, though it still requires prompt attention.
If an NG or NJ tube is pulled out, the primary concern is safe reinsertion and confirmation of placement, which must be performed by a trained healthcare provider. Do not attempt to reinsert a nasal tube yourself, as there is a serious risk of misplacing it into the lungs. Keep the patient comfortable and contact the care team immediately for guidance on replacement.
Surgical Tubes (G-tube, PEG, J-tube)
Surgically placed tubes, such as a gastrostomy (G-tube), percutaneous endoscopic gastrostomy (PEG), or jejunostomy (J-tube), create a direct tract from the skin to the internal organ. This gastrocutaneous tract begins to close rapidly, often within a few hours, as the body naturally attempts to heal the opening. If the tract closes completely, the replacement procedure becomes more complex, potentially requiring endoscopy or surgery.
The goal is to maintain the patency of the stoma, which is the opening in the skin. If a trained caregiver has an emergency kit, a temporary measure may be to insert a replacement tube or a Foley catheter into the stoma. The replacement tube should be one size smaller than the tube that came out, and water-soluble lubricant should be used for insertion. The catheter should be inserted to the same length as the original tube. However, the balloon should only be inflated if specifically instructed by the medical team, and never if the tube was placed less than four weeks ago.
If the tube was placed within the last four to eight weeks, the tract is considered immature, meaning the stomach wall has not firmly adhered to the abdominal wall. Leakage of gastric contents into the abdominal cavity is a high risk, which can lead to peritonitis and sepsis. If the tube is from an immature site, or if the caregiver is not trained to replace it, the patient must be taken to an emergency department immediately to keep the tract open. Do not use a temporarily placed tube for feeding or medication until a healthcare professional confirms its correct placement, typically through an X-ray.
Essential Information for Healthcare Providers
Once the patient is stabilized and immediate safety measures are complete, contact the healthcare team. Having specific information ready will expedite the response and allow the provider to give accurate instructions. Relay the exact time the tube was pulled out, as the elapsed time is a major factor in the urgency of replacement for surgical tubes.
State the type and size of the tube dislodged, along with the date the tube was originally placed. This detail allows the provider to assess the maturity of the tract and the associated risk level. Describe the condition of the stoma site, noting any active bleeding, excessive leakage, or discharge.
Report any new patient symptoms, such as increased pain, fever, vomiting, or breathing difficulty. This information helps the provider determine if the patient can safely wait for an office replacement or if an immediate trip to the emergency department is necessary. The contact order should be the home health nurse or specialist, followed by the primary care physician, and finally 911 or the emergency department if the patient shows signs of distress or complication.
Post-Incident Site Care and Future Mitigation
After the tube is successfully replaced and placement is confirmed, pay careful attention to the insertion site to prevent complications. Monitor the stoma daily for signs of infection, including increasing redness, warmth, swelling, or the presence of thick, discolored drainage. Mild irritation is common, but these signs should prompt a call to the healthcare provider.
The site should be cleaned gently once a day using mild soap and water, ensuring the skin is completely dried afterward. A clean gauze dressing should be placed around the tube, changing it immediately if it becomes wet or soiled. Avoid using abdominal creams or powders near the site unless specifically recommended by the care team.
To reduce the chance of future dislodgement, evaluate the current tube securing method. Nasal tubes should be anchored with effective tape or a commercial fixation device that minimizes movement and tension. For surgical tubes, consider using abdominal binders or specialized tube belts to keep the external portion of the tube secure and prevent accidental pulling. Addressing underlying causes of patient agitation or confusion, often through distraction or behavioral strategies, can lower the risk of intentional removal.