Gastrostomy tubes
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What is a gastrostomy tube?
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“Gastro” is a word used to describe the stomach. A gastrostomy tube, sometimes called a G-Tube, GT or PEG tube, is a surgically placed tube that gives direct access to your child's stomach for supplemental feeding, hydration or medication.
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How is a G-tube placed?
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A G-tube is placed through the belly opening and into the stomach. G-tubes are placed surgically in the operating room. The surgeon will make one or more small incisions in the belly area, then make an opening into the stomach called a stoma.
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Preparing for G-tube surgery
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You and your child will meet with one of the general surgeons at CHEO for an appointment before the G-tube surgery. At this appointment, we will explain the details of the procedure and you’ll have a chance to ask questions and address any concerns. Then we will schedule the procedure for a later date.
Right after surgery, all children and youth are admitted to CHEO for a few days to safely begin feedings. During this admission, we will help the parents learn how to care for the G-tube, administer feedings, clean and care for the stoma and apply a gauze dressing.
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Follow-up after G-tube surgery
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Your child will be seen for an appointment with a surgery team member about four to six weeks after being discharged from CHEO. Often, we will change the G-tube at this appointment. If needed, we will schedule additional follow-ups.
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Types of G-tubes
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There are many different types of gastrostomy tubes that can be used to help your child. The type of tube selected depends on each child or youth’s unique medical condition. Their doctor will determine the best type of G-tube for them and explain this in detail at the time of the evaluation. Here are some of the most common types of G-tubes to help you understand what to expect.
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Percutaneous feeding tube
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The word “percutaneous” means “to go through the skin.” A percutaneous feeding tube is placed through the abdominal wall into the stomach to allow feeding directly into the stomach or intestines.
There are two different types of percutaneous feeding tubes - one that goes into the stomach (called a gastrostomy tube or G-tube) or one that goes into the intestines (called a gastrojejunostomy tube,or GJ-tube)
The first tube your child will have is called a Dawson Cook Pigtail Catheter.
After 6 weeks the primary tube will be removed and changed to a low-profile button, which sits 1 to 2 centimeters off the skin. These tubes are inserted and removed more easily than the original one. They will be changed approximately every 3-6 months and changing them does not require sedation.
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Low profile tubes
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One of the most common types of G-tubes is a low-profile tube sometimes called a “button.” This type of tube lays on top of the abdominal wall and is kept in place in the stomach by a water-filled balloon. A special extension tube is attached when administering medications or feedings. During your child’s CHEO admission, you will learn how to use, clean and care for the G-tube.
The low profile button is a small skin level gastrostomy device made of silicone. It is non-latex. The side port has a valve to inflate a balloon, which anchors the device inside the stomach. The feeding port on the top has an external base to allow for the feeding of formula or water.
The low profile device replaces the original gastrostomy tube. Once your child’s stoma is healed, we can replace it with a low profile device (either a MIC-Key or ATM MiniOne). You will come to CHEO for an appointment, where your child’s stoma will be measured so we can properly size the low profile device for you.
Want to learn more? Find detailed instructions for taking care of gastrostomy tubes here.
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Venting the G-tube
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Gas may build up in your child’s stomach. Usual signs of gas in the stomach are bloating, crying or restlessness, especially after feeding. You can let gas pass out of the stomach through the gastrostomy tube. This is called “venting” the tube. Your child’s doctor may recommend that you vent the tube before, in between and after each feed. Venting is important especially if your child has had a fundoplication (anti reflux surgery).
For detailed instructions and steps, check out our guide to taking care of gastrostomy tubes.
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Flushing the G-tube
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Flushing the gastrostomy tube is an important step to keeping it clean and preventing blockages in the tube. You should clean it often by flushing water through it. If the gastrostomy tube is not flushed, formula sticks in it and blocks the tube. Flushing also gives extra fluid that your child needs. Always make sure to use sterile water for babies less than four months of age and check the flush amounts for young babies and children with fluid restrictions very carefully.
You should flush the tube:
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Before and after each feed.
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After venting the tube.
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Every 4 hours during continuous feeding.
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Before and after giving your child medicine through the gastrostomy tube.
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Once a day if tube not used.
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Site care
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When caring for your child or youth’s tube, it’s important to:
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Wash your hands first
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Gently wash the stoma and surrounding skin with mild non-lanolin based soap and water (e.g. Dove unscented), using a soft hand cloth. To clean directly around the tube, gently use a q-tip or non-sterile gauze.
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Rinse well with clear water and pat dry.
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Check the stoma and surrounding skin area for any irritation, redness, swelling, leaks, tissue growth or bleeding.
The type of dressing needed type of tube and the amount of drainage at the stoma site.
You will also need to:
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Change your child’s dressing when it gets wet.
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Make sure your child’s feeding tube is always taped securely to the skin to prevent it from moving or falling out.
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Change the place where you tape the gastrostomy tube to your child’s skin once a day.
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Keep an extra feeding tube with you at all times.
You may notice a small amount of yellow-green liquid drainage at the site. This is normal.
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Feeding instructions
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Formula
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Your dietician will recommend the right formula for your child and will give you a schedule for feeding. Formulas may be ready to use, or you may need to prepare them from a powder or a liquid concentrate.
You may need to order the formulas from your drug store ahead of time. At least two days before going home, make sure your drug store has your formula in stock. Sometimes insurance can cover formula costs. Your dietician will help you make these arrangements before you leave CHEO.
For detailed instructions on storing and preparing formulas, check out our gastrostomy tube guide.
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Feeding instructions
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| Types of feedings
There are two different ways to feed through a gastrostomy tube: continuous and intermittent/ bolus. The dietician will discuss your child’s feeding program and work with you to develop a feeding plan. The plan can be adjusted if your child’s nutritional needs change over time.
Continuous feedings: are given at a constant, steady rate throughout the day (16 to 24 hours). The feed is administered into the stomach using a feeding pump to deliver a given amount of feed over a number of hours. All children with a jejunal feeding tube (in small bowel) must be on continuous feedings.
Intermittent/bolus feedings: larger amounts of formula are given at specific meal times during the day. Gravity set-ups, feeding pumps or syringes are used for these feedings.
For detailed feeding instructions, check out our gastrostomy tube guide.
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Dressing changes
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The doctor/nurse will change your child’s first dressing and have you watch, so you can learn how to do it. Please watch closely. After the nurse changes the first dressing, you or your child’s caregiver will change the dressing once a day (more often if the dressing becomes wet or soiled).
Changing the dressing is also an opportunity to check the feeding tube site signs of infection.
For detailed dressing change instructions, check out our gastrostomy tube guide.
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Daily activities
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Your child can resume normal activities once the stomach and stoma tract have healed.
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Safety measures
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- All feedings must be supervised.
- Have your child sit up at a 30-degree angle (or higher) during feedings to prevent the formula from getting into the breathing tubes.
- Secure the tube to prevent it from being pulled out or choking your child.
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Bathing
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- Your child may have a tub bath 1- 2 weeks after surgery unless your doctor tells you not to. Your child can have a sponge bath or shower before then.
- This is a good time to do the care of the gastrostomy tube and check the skin around the gastrostomy tube.
- While showering or bathing, clamp or cap the G-tube.
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Swimming
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- Your child may go swimming after the stoma tract and skin has healed, unless your doctor tells you not to.
- Shower after swimming and completely dry the surrounding area at the stoma site.
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Clothing
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You do not need special clothing. However, please remember:
- Do not pin the G-tube to your child’s under shirt or underpants. The pin could pierce the tube.
- For babies, a one-piece undershirt with front buttons or snaps makes it easy to reach the gastrostomy tube.
- Avoid clothing with a tight waistband or belt that could pull on the tube.
- Mittens or socks on little hands may help prevent a baby from pulling on the gastrostomy tube.
- Special netting could be used to keep the tube in place.
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Activities
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- After the stoma tract has healed, your child may return to their normal activities and may roll over safely onto their stomach. If your child seems uncomfortable on their tummy, you may want to protect the site.
- Talk with your doctor about contact or rough sports
- Give babies a soother (if your baby will take one) while the feeding is infusing. This can help with feeding, as it imitates the normal process of sucking during feeding.
- Hold your baby while the feeding is infusing to comfort and bond with your baby.
- If your child can sit comfortably, have your child sit at the table during meals, as tolerated
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Travel
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- Careful planning is needed, so make a checklist of things you will need.
- Make sure that you pack extra supplies and have proper storage for formula.
- Use bottled water when you’re not sure if the water is clean
- Carry an emergency kit of supplies with you at all times.
- Keep all supplies together in one place (e.g. large ziplock bag, plastic container)
- Don’t feed your child using the G-tube while in transit
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Car seat and wheelchair modifications
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Make sure that you test your child’s car seat or wheelchair before going home as they may need modifications. If it does need modifications, ask your care team - an occupational therapist may be able to help with any needed modifications.
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Mouth care
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It is very important to care for your child’s mouth, teeth and gums, even if they are not eating.
- For babies, use a wet baby face cloth to gently wipe lips, gums, and tongue or a soft baby toothbrush to clean those first teeth.
- For toddlers to youth, use a soft toothbrush with toothpaste to clean teeth, unless your doctor gives you other instructions.
- Clean lips with a facecloth and lip moisturizer (eg. chapstick)
- You may rinse with alcohol-free mouthwash or mouthwash if advised by your nurse.
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Skin care
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Keep the stoma and surrounding skin as dry and clean as possible. Dressings and tape are not needed with a low-profile combination G/GJ tube.
Despite your best effort to keep your child's skin around the stoma healthy, some common skin problems may occur. Read the FAQ for more information on how to deal with these skin problems.
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Medications
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When your child has a G-tube, you may give liquid medications through the tube. You will have to be careful when doing this, to make sure the tube does not become blocked.
Remember:
- Medications must be in a liquid form. Ask for liquid medication.
- If the medication does not come in a liquid form, ask the pharmacist if the medication can be crushed and mixed with water.
- Each medication must be given separately.
- Check if the medication must be taken on an empty stomach.
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