Gastrostomy tube care, replacement, and removal: Expanding the registered dietitian nutritionist scope of practice to...

The prevalence of community-dwelling individuals dependent on home enteral nutrition (HEN), commonly delivered via gastrostomy tube (G-tube), continues to rise. Fragmented healthcare approaches often lead to limited follow-up support, inadequate education, and insufficient routine G-tube maintenance. This can lead to preventable complications, such as infection, tube dysfunction, dislodgement, and avoidable emergency department visits. The Registered Dietitian Nutritionist (RDN), already central to HEN management, is uniquely positioned to provide comprehensive G-tube assessment and care. International models demonstrate that RDNs trained in advanced practice roles to deliver G-tube care, including balloon G-tube (BGT) replacement, can improve access, enhance patient satisfaction, and reduce healthcare utilization and costs. Expanding the RDN scope of practice to include G-tube management represents an opportunity to improve continuity of care for HEN consumers while addressing gaps in healthcare access and reducing health care system burden. This narrative review describes current practices for routine BGT care and exchanges and explores the benefits of RDN-led G-tube management. Three U.S.-based institutional approaches to credentialing RDNs in G-tube care and replacement are described. In addition, key implementation components, such as stakeholder engagement, policy development, competency-based training, and interdisciplinary collaboration, are highlighted. Standardized training pathways, broader support, and further research on outcomes are needed to support wider implementation of this advanced practice role.