What are gastrostomy tubes?
-
A gastrostomy tube, or G-tube, is a small tube placed directly into a child’s stomach for the purpose of providing food, fluid, or medicines without having to go through the mouth.
-
Gastrostomy tubes appear like a small cap on the outside of a child’s stomach.
How common are they?
Gastrostomy tubes are placed in children for many reasons, including prematurity, feeding problems, and brain disorders, and they have become more prevalent as lifesaving medical treatments for children have improved.
Who is the treatment team?
-
A child with a G-tube may be under the care of a pediatric gastroenterologist or surgeon.
-
Often a nurse or dietitian is available at the specialist’s office to answer questions related to the G-tube.
What are some elements of a Care Plan for gastrostomy tubes?
The child’s Care Plan will include flushing, giving feedings and medications, and venting the tube.
-
Flushing the G-tube
-
It is important to flush the G-tube before and after any tube feedings, before and after any medications, or at least every 8 hours. Flushing involves putting water in a syringe and injecting it into the G-tube.
-
-
To give feedings through a G-tube, you will need
-
Catheter-tip syringe (35 or 60 mL)
-
Formula
-
Measuring cup
-
Extension set, if desired
-
Procedure
-
Explain the procedure to the child.
-
Wash your hands with soap and water.
-
Assemble all the supplies.
-
Pour the correct amount of formula into a clean measuring cup or clean baby bottle.
-
Place the child in a comfortable position. If possible, place the child in a high chair at the table during mealtimes.
-
Insert the syringe tip into the feeding tube.
-
Flush tubing with 3 to 5 mL of water or as directed by the child’s health care professional prior to starting the formula feeding.
-
Slowly pour the formula into the syringe.
-
Unclamp the feeding tube. The feeding rate can be controlled by raising or lowering the syringe. The feeding should take about the same amount of time as it would take a child to drink the formula—about 15 to 20 minutes. Stop the feeding if the child becomes nauseated, shows signs of abdominal discomfort, is vomiting, or has difficulty breathing.
-
If the child cannot be fed by mouth, oral stimulation with a pacifier can be provided during the gastrostomy feeding.
-
When all the formula has been given, flush the tubing with water as directed by the child’s health care professional, recap the tube or disconnect all tubing, and close the cap on the G-tube button.
-
Try burping the child after each feeding if appropriate.
-
Medicines can be pushed directly into the G-tube through a syringe.
-
Rinse the feeding supplies with warm water after each feeding and allow to air-dry. Replace syringes and extension sets every 2 weeks.
-
-
If the formula is backing up, try
-
Changing the position of the tubing to slow the rate
-
Changing the child’s position
-
Flushing the feeding tube with 3 to 5 mL of tap water
-
-
-
Venting the tube
-
You may need to vent the child’s tube to remove excess air or fluid in the child’s stomach.
-
Open the G-tube port and attach to a drainage device (eg, mucous trap, drainage bag). You may be asked to measure and record the amount of drainage.
-
What adaptations may be needed?
Dietary considerations
-
Children in school or child care who have G-tubes often will require feedings or medications through the tube.
-
Discuss ways to develop the child’s oral motor skills if the G-tube is for feeding problems. Often, using a pacifier during feedings promotes oral motor skills.
Physical environment
-
Staff should be trained in how to open a G-tube so that extra gas in the stomach can escape.
-
Do not allow the child to pull on the tube. A one-piece, snap T-shirt works best for infants and toddlers. Keep the tube secured beneath the child’s clothing.
-
It is important to know what size and type tube the child has.
-
Designate at least one caregiver/teacher per shift as the G-tube captain. Plan an in-service for all staff to promote comfort with this device.
What should be considered an emergency?
-
Call emergency medical services/911 if
-
The child’s stomach is hard and bloated, and you cannot vent the G-tube.
-
The child develops forceful vomiting.
-
-
Notify parents/guardians if
-
The G-tube is pulled out. You can cover the area with a small, clean dressing and tape. The tube needs to be replaced within 4 hours.
-
You notice redness, irritation, or foul odor around the stomach.
-
The G-tube is leaking.
-
Skin or excess tissue seems to be growing around the tube opening.
-
The G-tube is clogged and flushing does not help.
-
What types of training or policies are advised?
-
Medical administration
-
Tube feeding
-
Standard precautions
What are some resources?
-
Cincinnati Children’s Hospital Medical Center, 513/636-4200, 800/344-2462, 513/636-4900 (TTY)
-
New York State Department of Health Emergency Medical Services,www.health.state.ny.us/nysdoh/ems/pdf/referencecard.pdf
Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.
Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics.
Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.
The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.