Clinical Reference Systems: Pediatric Advisor 10.0
Gastrostomy Care
What is a gastrostomy?
A gastrostomy is a surgically created opening in the
stomach.
A gastrostomy is needed if:
- Your child is not able to eat enough to help him grow.
Extra food is then given through the G-tube.
- Your child has had a stomach wrap procedure to keep food
from coming back up and now needs to get rid of stomach
gas through a gastrostomy opening.
Gastrostomy surgery is usually done under a general
anesthetic. This means your child will be asleep during the
surgery.
What is a G-tube?
A gastrostomy tube, or G-tube, is placed in the surgical
opening to help with feeding or venting of stomach gas.
There are two main types of G-tubes:
- A G-tube that remains on the outside of the stomach.
- A skin-level G-tube that is placed in the stomach. It
has a cap that opens and closes and a tube that is
attached just for feedings. One common brand is called a
button. This type of tube cannot be placed right away,
but may be an option for your child later.
Talk to your doctor to find out which kind of tube is best
for your child.
Home Care of a Gastrostomy
As your child's caregiver, you will need to learn to care
for the gastrostomy. Your medical care team will teach you
what you need to know to feel safe and comfortable taking
care of the gastrostomy at home.
- Cleaning and Caring for the Gastrostomy Site
- Wash your hands with soap and water before touching
the area.
- Use warm water and soap to clean around the
gastrostomy site three times per day or as needed.
- Make sure that you gently scrub off all crusted areas
on the skin around the tube. You may need to use a
diluted solution of hydrogen peroxide (1/2 peroxide
and 1/2 water) with Q-tips to clean around the tube
site.
- After cleaning, rinse around the area with plain water
and pat dry.
- You may use an antibiotic ointment around the site if
the area looks red or sore.
- Securing the G-tube
The end of the G-tube needs to remain snug against the
inside wall of the stomach. The G-tube should measure
approximately 12.5 to 13 inches in length from the exit
site on the stomach to the end of the tube. It is
important that you know the length of your child's tube.
When your child's G-tube is snug against the stomach wall
and correctly in place, use permanent ink to mark the
tube at the spot the tube comes out of the stomach. Now
you easily check if the tube is correctly in place by
looking for the mark.
There are several ways to secure the G-tube to the skin
on the stomach. A good way is to place a cotton roll
(like the dentist uses in your mouth) on either side of
the G-tube and tape the tube to the skin. Talk to your
doctor about any other specific instructions for taping
down the G-tube.
Check daily to make sure that the end of the G-tube is in
place by gently pulling on the tube until you feel
resistance. Then tape the tube down securely.
- Bathing
Because every child's needs are different, your surgeon
will determine what is the best time to begin tub baths
for your child. When your child is able to take a bath,
remember:
- Clamp the G-tube or close the valve on the gastrostomy
button prior to placing your child in the water.
- Avoid overly warm water that can irritate tender skin.
- Use only mild soaps and soft washcloths.
- Your child may begin taking a tub bath on
_____________________.
- Activity
Infants and children with a gastrostomy can participate
in all normal activities such as crawling, walking,
jumping, and swimming. Make certain the G-tube is
carefully secured under clothing. A cloth or bandnet (a
netlike material) cummerbund (or girdle) or bandnet vest
can help to secure the G-tube.
A G-tube should not keep your child from lying on his
stomach. If your child complains that it hurts, you can
put a foam doughnut around the G-tube site to keep
pressure off the stomach.
- Clothing
Your child can wear most anything, although one-piece
outfits are best. Overalls, "onesies," or sleepers are
ideal for active children and help protect the
gastrostomy site.
- Going to School
If you child is able to go to school, tell your child's
teacher and school nurse about your child's gastrostomy.
You will want to tell them what to do and who to call in
an emergency.
- Traveling
A gastrostomy need not limit your child's opportunity to
travel. A travel kit of emergency supplies should always
go with your child.
The travel kit should include:
- foley catheter
- 6-cc syringe (cc = milliliter)
- K-Y jelly
- paper towels
- container for tap water
- C-clamp or rubber band
- tape measure
- emergency phone numbers.
Possible Problems with a Gastrostomy
- Leaking Around the Gastrostomy Site
To prevent leakage of stomach contents, gently pull on
the G-tube so that the tube is snug against the inside
stomach wall. Call your surgeon's office if leaking
continues.
- Blocked Gastrostomy
Blockage can be caused by a buildup of food or medicine
in the tube or by body fluids crusted around the opening.
Flush the tube with 10 ml of warm water to clear the tube
of any blockage. If the tube still seems blocked, call
your surgeon's office.
- Drainage Around the Gastrostomy
Some drainage around the gastrostomy is normal,
especially soon after the gastrostomy is put in. Clean
the skin around it frequently. Make sure you remove all
crusted areas from the tube itself. This should help
lessen the buildup of drainage.
- Granulation Tissue Around the Gastrostomy
A small amount of red, moist tissue may develop around
the gastrostomy. This is called granulation tissue. Do
not be alarmed. If the there is a lot of tissue, the area
becomes sore, or the tissue interferes with care, call
your surgeon's office.
- Vomiting or Diarrhea
Vomiting and diarrhea may be caused by the tube moving
forward into the stomach and blocking the stomach.
Measure the length of the G-tube daily from the exit site
on the stomach to the end of the tube. Most G-tubes are
12.5 to 13.0 inches in length. If the tube is shorter
than this, gently pull on the G-tube to make sure that
the tube is snug against the inside of the stomach wall.
If you are not able to gently pull the G-tube and secure
it into position, call your surgeon's office.
- Bloating and Retching
Excessive gas and overfeeding can cause bloating of the
stomach and retching. Unclamping the G-tube or opening
the button and inserting a decompression tube will allow
air to escape and gradually relieve the problem.
- G-Tube Breaking
Most tubes will last for 3 to 6 months. Eventually the
rubber tube will break down and become harder to use.
Many times the end used to feed with will break off or
split. These are signs that the tube needs to be
replaced.
Emergency Trips to the Hospital
If your child needs to go to the hospital or the emergency
room, take your emergency kit and any helpful information
you have about your child's gastrostomy with you. You should
always bring your feeding supplies with you so that you
don't get charged for extra supplies. If the gastrostomy
tube or button has accidentally been pulled out, bring it
with you.
Date: _____________________________
Size of Tube: _______________________
Type of Tube: _______________________
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