Gastrostomy Tubes

A gastrostomy feeding tube insertion is the placement of a feeding tube through the skin and the stomach wall, directly into the stomach.

How to care for a gastronomy tube (GT)

Site Care

  1. Gather and set up equipment:
    a. Warm tap water
    b. Mild soap (if needed)
    c. Cloth adhesive tape (unless patient's skin becomes red from the tape)
    d. Ear swabs

  2. Wash hands.

  3. Clean skin around GT area (twice a day, or as instructed).

  4. Remove old tape gently. Do not pull the tube away from the belly.

  5. Check the skin and tube for changes:
    a. Skin: Redness, drainage, tenderness, open areas, bleeding or skin temperature changes
    b. Tube: Cracks and leakage (be sure it is pulled against the stomach wall)
    c. Contact Neil Ead, CPNP at 401-350-1757 or contact the pediatric surgeon on call at 401-444-5611 (ask operator to call the pediatric surgical resident).

  6. Wash the site in a circular motion from the center of the tube toward the outside of the belly using the ear swabs.

  7. Tape the tube to keep it in place. Be sure it is fixed firmly to the skin and it is taped downward.

  8. Be sure the GT is hidden away from your child's hands and feet (for example, under clothes) so it is not accidentally pulled out .

Bathing

  • Your doctor will tell you when your child may begin to take baths.
  • Avoid overly warm water because this can irritate tender skin.
  • Use only mild soaps and soft washcloths.
  • While the GT is vented, do not let water get into the tube (the tube should not be clamped, even in the tub).
  • After the bath, perform site care.

What to do if the GT falls out

  • Cover the site with a 4"x4" gauze until a new GT is in.
  • Call your surgeon about coming to the doctor's office or emergency room.
  • The GT needs to be replaced within 2 hours.
  • Travel with a 14Fr. Foley Catheter, luberfax, paper towels or, better yet, make sure that you always carry a replacement tube (MICKey button) of the same size.

GT feeding

  • The child should be sitting or positioned on his/her right side with the head of bed elevated.
  • Set up tube feeding on feeding pump as per home care company.

Vented system

  • Allows the feeding back up into an empty syringe instead of vomiting.

Setup:

  1. Tie catheter tip syringe with string to keep it above stomach level.

  2. Be careful that the tube is not pulling on the belly.

  3. Flush the tube with tap water before and after feeding and every 4 hours. This helps to make sure that tube will not clog.

  4. Place the feeding tube inside the syringe and operate the tube.

  5. If the tube backs up, try to flush it with water. If this does not work, check the position of the tube, milk the tube and then flush it again.

This set-up is kept even if the feeding is done or when traveling. Be sure to pin strings higher than the stomach (e.g., to the shirt). The tubing is only clamped with the surgeon's instruction. This will be done slowly, when changing from vented to direct feeds.

Giving medications

Give 30 minutes before feeding or 1 hour after feeding.

  1. Draw up the medications in syringes. If pills must be used, crush them up and mix them with water before putting them in the syringe.
  2. Put medications into the large syringe.
  3. Flush with 15 cc (1 tablespoon) of water.

Formula that is too hot or too cold, or given too quickly, can cause vomiting, diarrhea or cramping.

Signs of feeding intolerance: Vomiting, diarrhea, discomfort, distention or continuous backup in the tube greater than one quarter of the feeding volume.