Can a Nurse Replace a Feeding Tube? Understanding Scope of Practice

October 22, 2025 •

5 min read

According to the Nevada State Board of Nursing, it is within the scope of practice for both a Registered Nurse (RN) and a Licensed Practical Nurse (LPN) to replace a gastrostomy (G) tube, provided the tract is well-established. However, whether a nurse can replace a feeding tube depends heavily on the type of tube, the maturity of the tract, and specific state and facility protocols.

Quick Summary

A nurse's ability to replace a feeding tube hinges on the tube type, maturity of the tract, and state regulations. Registered Nurses and Licensed Practical Nurses can replace established gastrostomy tubes, but complex cases like a dislodged PEG tube typically require a higher-level practitioner. Adherence to institutional policy and confirmed competency is essential for patient safety.

Key Points

RN and LPN Scope: Trained RNs and LPNs can replace gastrostomy (G) tubes, but only when the stoma tract is well-established and healed.
Maturity of Tract: The gastrocutaneous tract must be mature (typically 6-8 weeks old) for a nurse to safely perform a bedside replacement.
Specific Tube Types: The replacement procedure and who can perform it differ by tube type. A nurse can replace a standard G-tube but not a PEG tube with a non-collapsible bumper.
Placement Verification: After replacement, especially for NG tubes, confirmation of correct placement is mandatory, often using X-ray or aspirate pH testing, to prevent serious complications like aspiration.
Complex Cases: For newly inserted tubes, PEG tubes, or tubes with complications, a physician or specialist like an interventional radiologist should perform the replacement.
Training and Competency: All nurses involved in tube replacement must receive specific training and demonstrate ongoing competency for the procedure.

Understanding the Nursing Scope of Practice for Tube Replacement

Determining who can replace a feeding tube is a critical aspect of patient safety and nursing practice. The answer is not a simple 'yes' or 'no' but depends on several factors, including the type of tube, the condition of the stoma tract, and the nurse's training and licensure. Nurses are often on the front lines of patient care and may be the first to encounter a dislodged or malfunctioning tube, making their understanding of the proper protocol essential.

The Importance of a Mature Tract

One of the most significant factors is the maturity of the gastrocutaneous tract—the pathway from the skin to the stomach. For tubes inserted surgically or endoscopically, this tract takes time to heal and form. For newly placed gastrostomy (G) or jejunostomy (J) tubes, it can take 6 to 8 weeks for the tract to fully mature.

Mature Tract: A tract that has been established for several weeks and is well-healed. In these cases, a trained RN or LPN can often replace the tube without difficulty, as the risk of accidental misplacement into the abdominal cavity is minimal.
Immature Tract: For tubes that are newly placed (e.g., within the first 6-8 weeks), the risk of creating a 'false tract' by accidentally puncturing the stomach wall is high. In these instances, only a trained physician or surgeon should attempt replacement.

Can a Registered Nurse (RN) Replace a Feeding Tube?

A Registered Nurse's (RN) role in replacing a feeding tube is well-documented, but specific policies and training are paramount. A competent RN can replace most standard balloon-type gastrostomy tubes, especially after the initial tract has healed.

Procedure: The RN must first confirm the tract is mature and the patient is stable. The procedure involves deflating the old tube's balloon, removing it, lubricating the new tube, and inserting it into the stoma. After inflation, gastric placement is confirmed by checking aspirate and listening for air insufflation over the abdomen.
State-Specific Rules: Regulations vary by state, so RNs must always adhere to their state's Nurse Practice Act and their facility's specific policies.

What About Licensed Practical Nurses (LPNs)?

Licensed Practical Nurses (LPNs) can also play a role, particularly with routine gastrostomy tube replacements in established tracts. State regulations often grant LPNs this authority, provided they have received adequate training and supervision.

Limitations: An LPN should not replace a more complex tube, such as a Percutaneous Endoscopic Gastrostomy (PEG) tube with a non-collapsible bumper, or any tube where the tract is new or complications are suspected. In such situations, the LPN must escalate the issue to a higher-level practitioner, like an RN or physician.

Differentiating Between Feeding Tube Types

Different types of feeding tubes require different replacement procedures. Understanding the distinctions is crucial for patient safety.

Types of Feeding Tubes and Replacement Protocols


Tube Type	Insertion Method	Replacement by Nurse	Key Considerations
Nasogastric (NG) Tube	Inserted through the nose into the stomach.	Yes, by a trained RN. The procedure is common but requires careful verification of placement to avoid aspiration.	Placement requires confirming with an X-ray or pH testing of aspirate. High risk of misplacement if not careful.
Gastrostomy (G) Tube (Balloon-type)	Surgically placed with a balloon or bumper to hold it in place.	Yes, by a trained RN or LPN, especially once the stoma tract is mature.	Balloon deflation is required for removal and re-inflation upon insertion. Confirmation of placement is vital before feeding.
Percutaneous Endoscopic Gastrostomy (PEG) Tube	Inserted endoscopically, often with a non-collapsible bumper.	No, typically requires a physician or interventional radiologist.	The internal bumper cannot be removed easily at the bedside. Forcibly pulling it can cause serious injury, including bleeding or bowel obstruction.
Gastrojejunal (GJ) or Jejunostomy (J) Tube	Placed into the small intestine (jejunum).	No, requires an interventional radiologist or gastroenterologist.	These tubes extend past the stomach, making blind replacement dangerous due to the risk of intestinal perforation. Requires imaging guidance for placement.

The Critical Role of Proper Training and Competency

Beyond licensure, formal training and ongoing competency assessment are non-negotiable for any nurse involved in feeding tube replacement. A nurse's training should include:

Anatomy and Physiology: A thorough understanding of the gastrointestinal tract and the unique aspects of the patient's anatomy.
Procedure Technique: Step-by-step training on how to safely remove and insert the specific tube type.
Placement Verification: The ability to verify correct tube placement using appropriate methods, including aspirate pH testing and auscultation. For surgically placed tubes, aspiration of bile or gastric contents is a key indicator.
Complication Management: Recognizing and responding to potential complications, such as peritonitis, aspiration pneumonia, or tube blockage.

The Decision-Making Process for Replacing a Feeding Tube

Assess the Situation: The nurse must first assess the patient's condition and the reason for the replacement. Is the tube clogged, damaged, or dislodged? Is the patient showing signs of distress or complications?
Verify Tube Type: Confirm the specific type of feeding tube. A G-tube is not the same as a PEG tube, and the replacement procedure differs significantly.
Check Tract Maturity: For surgically placed tubes, confirm the age of the tract. If it's less than 6-8 weeks old, do not attempt a bedside replacement.
Confirm Nurse Competency: Ensure the nurse has the necessary training and has been deemed competent by the facility to perform the specific replacement procedure.
Follow Protocol: Adhere strictly to the institution's policies and the physician's orders. If there is any doubt or complication, consult with a higher-level provider or interventional service.

Conclusion

While a nurse can replace a feeding tube under the right circumstances, it's not a universal rule. Registered Nurses and Licensed Practical Nurses can safely replace gastrostomy tubes with mature tracts after receiving specific training and following facility policy. However, complex procedures, like replacing a newly placed tube or a PEG tube with a non-collapsible bumper, fall outside the standard nursing scope and require a physician or specialist. Patient safety is the guiding principle, and any uncertainty should result in escalation to the appropriate medical professional. Proper training, vigilance, and adherence to established protocols are essential for a safe and successful outcome.

Key Safety Considerations

Correct Placement: Always verify the correct placement of any replaced tube before use, especially nasogastric tubes, to prevent pulmonary misplacement and aspiration.
Mature Tract: A nurse should never attempt to replace a gastrostomy tube if the tract is less than 6-8 weeks old. Referral to a specialist is required.
Specialized Tubes: Replacement of jejunostomy or percutaneous endoscopic gastrostomy (PEG) tubes with non-collapsible bumpers must be done by a physician or radiologist.
Emergency Situations: A Foley catheter can be temporarily used to maintain the patency of a mature gastrostomy tract if a replacement tube is not immediately available, but only for a short period.
Institutional Policy: Always consult and follow your specific healthcare facility's policies and protocols regarding feeding tube replacement.
Patient Status: Assess the patient's overall health and stability before and after the procedure. If complications arise, act immediately.

Ethical Considerations in Tube Replacement

Beyond the practicalities, ethical considerations are also part of the process, particularly regarding patient consent and quality of life. In cases where a patient's wishes regarding life-sustaining treatment are unclear, replacing a feeding tube can have significant ethical and legal implications, necessitating discussions between the medical team, family, and ethics committee. However, in most routine replacement scenarios for stable patients, the process is primarily a matter of safe and competent technical execution.

Frequently Asked Questions

No, a trained Registered Nurse (RN) should not typically replace a Percutaneous Endoscopic Gastrostomy (PEG) tube with a non-collapsible bumper. This procedure is usually reserved for a physician or interventional radiologist due to the risk of internal injury.

Yes, an LPN can replace a standard balloon-type gastrostomy (G) tube if the tract is mature, and they have received proper training and are following facility policy. They should not replace complex tubes like PEG or J-tubes.

For nasogastric (NG) tubes, nurses can confirm placement by X-ray or aspirate pH testing. For gastrostomy (G) tubes, confirmation often involves checking for gastric aspirate, though auscultation can also be used.

If a feeding tube with a new tract falls out, the nurse should not attempt to replace it blindly. The tract can close quickly, and forceful re-insertion could create a false tract. The nurse should notify a physician or surgeon immediately.

The primary difference is the placement method. A G-tube is a general term for a gastrostomy tube, while a PEG tube refers specifically to a tube placed endoscopically. Many PEG tubes have a non-collapsible internal bumper, which prevents bedside replacement by a nurse.

In an emergency, a Foley catheter of a similar size can be used temporarily to maintain the patency of a mature gastrostomy tract until a proper replacement tube is available. This should be done carefully and is not a long-term solution.

Improper replacement can lead to serious complications, including aspiration pneumonia, peritonitis from accidental placement into the abdominal cavity, bleeding, and infection.

No, the replacement of a jejunostomy (J) tube, which is placed in the small intestine, is a more complex procedure than a G-tube replacement and typically requires image guidance by a radiologist.