CardioVascular and Interventional Radiology

, Volume 42, Issue 1, pp 116–120 | Cite as

Which G-Tube to Use in Pullers: Assessment of Pull Pressures on Skin Models to Determine Optimal Catheter Choice in Patients with Recurrent Pulled Gastrostomy Tubes

  • R. Nasirzadeh
  • S. F. StellaEmail author
  • O. Mironov
  • A. Jaberi
  • J. R. Kachura
  • M. E. Simons
  • J. R. Beecroft
  • G. Annamalai
  • K. T. Tan
Laboratory Investigation



Pulled or dislodged gastrostomy catheters represent a common complication associated with percutaneous gastrostomy and are a common cause of recurrent visits in patients with altered mental status. We intended to perform an experiment to compare the pull forces required to dislodge different commonly used gastrostomy catheters.

Materials and Methods

We used a digital force gauge device to measure the pull forces required to dislodge three types of 20 French gastrostomy catheters in double-layer skin models. These included the Flow 20 Pull Method (Cook Medical, Bloomington, IN, USA), Entuit Gastrostomy BR Balloon Retention feeding tube (Cook Medical, Bloomington, IN, USA), and Ponsky Non-Balloon Replacement Gastrostomy Tube (CR Bard Inc, Salt Lake City, Utah, USA). The catheters were inserted into the skin model using the same technique as would be utilized in a patient.


The mean forces measured to dislodge the per-oral Flow 20 Pull Method, Entuit Thrive Balloon Retention, and button-type retention Ponsky replacement catheters were 35.6, 22.8, and 20.6 Newtons, respectively. The pull method per-oral gastrostomy catheter required significantly more pull force to dislodge than both the Ponsky button-type retention catheter and the Entuit balloon retention catheters. There was no significant difference in the pull force required to dislodge the Ponsky replacement catheter and the Entuit balloon retention catheter.


Per-oral image-guided gastrostomy with pull-method button-type retention catheters may be the ideal choice in patients at high risk of tube dislodgment.


Gastrostomy Percutaneous Pull force 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Laasch HU, Wilbraham L, Bullen K, Marriott A, Lawrance JAL, Johnson RJ, et al. Gastrostomy insertion: comparing the options—PEG, RIG or PIG? Clin Radiol. 2003;58(5):398–405.CrossRefGoogle Scholar
  2. 2.
    Stroud M. Guidelines for enteral feeding in adult hospital patients. Gut. 2003;52(Suppl 7):vii1–12.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Issaka RB, Shapiro DM, Parikh ND, Mulcahy MF, Komanduri S, Martin JA, Keswani RN. Palliative venting percutaneous endoscopic gastrostomy tube is safe and effective in patients with malignant obstruction. Surg Endosc. 2014;28(5):1668–73.CrossRefGoogle Scholar
  4. 4.
    Shaw C, Bassett RL, Fox PS, Schmeler KM, Overman MJ, Wallace MJ, et al. Palliative venting gastrostomy in patients with malignant bowel obstruction and ascites. Ann Surg Oncol. 2013;20(2):497–505.CrossRefGoogle Scholar
  5. 5.
    Itkin M, Delegge MH, Fang JC, McClave SA, Kundu S, Janne B, et al. Multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, with endorsement by Canadian Intervention. J Vasc Interv Radiol. 2011;22(8):1089–106.CrossRefGoogle Scholar
  6. 6.
    Sutcliffe J, Wigham A, Mceniff N, Dvorak P, Crocetti L, Ubertoi R. CIRSE standards of practice guidelines on gastrostomy. Cardiovasc Intervent Radiol. 2016;39(7):973–87.CrossRefGoogle Scholar
  7. 7.
    Covarrubias DA, O’Connor OJ, McDermott S, Arellano RS. Radiologic percutaneous gastrostomy: review of potential complications and approach to managing the unexpected outcome. Am J Roentgenol. 2013;200(4):921–31.CrossRefGoogle Scholar
  8. 8.
    Collares FB, Faintuch S, Kim SK, Rabkin DJ. Reinsertion of accidentally dislodged catheters through the original track: what is the likelihood of success? J Vasc Interv Radiol. 2010;21(6):861–4.CrossRefGoogle Scholar
  9. 9.
    Funaki B, Peirce R, Lorenz J, Menocci PB, Rosenblum JD, Straus C, et al. Comparison of balloon- and mushroom-retained large bore gastrostomy catheters. AJR Am J Roentgenol. 2001;177(2):359–62.CrossRefGoogle Scholar
  10. 10.
    Funaki B, Zaleski GX, Lorenz J, et al. Radiologic gastrostomy placement: mushroom versus pigtail catheters. AJR. 2000;175:375–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Division of Vascular and Interventional RadiologyToronto General Hospital-University Health Network/University of TorontoTorontoCanada

Personalised recommendations