Who should perform the first replacement of a gastrostomy or PEG tube, and who may perform subsequent replacements?

• A. First by the physician who inserted the tube, then by trained nurses
• B. First by a physician assistant, then by the physician
• C. First by a nurse, then by a physician
• D. First by a surgeon, then by a dietitian

Answer: (A)

Safe tube replacement hinges on who performs it and the maturity of the stoma tract. The first replacement should be done by the physician who placed the tube because they know the exact tract, select the appropriate tube, and can assess for immediate issues such as misplacement, bleeding, or injury to the stoma. After the tract has matured and stabilized, routine exchanges can be performed by trained nurses following a standardized protocol, which allows safe, efficient care while reserving physician involvement for complications or problem cases. If any signs of trouble occur—dislodgement, blockage, infection, or abdominal pain—seek medical evaluation promptly.