Gastrostomy Tube, Adult

A gastrostomy tube is a tube that is placed into the stomach. It is also called a "G-tube." This tube is used for:

  • Feeding.

  • Giving medication.

CLEANING THE G-TUBE SITE

  • Wash your hands with soap and water.

  • Remove the old dressing (if any). Some styles of G-tubes may need a dressing inserted between the skin and the G-tube. Other types of G-tubes do not require a dressing. Ask your caregiver if a dressing is needed.

  • Check the area where the tube enters the skin (insertion site) for redness, swelling, or pus-like (purulent) drainage. A small amount of clear or tan liquid drainage is normal. Check to make sure scar tissue (skin) is not growing around the insertion site. This could have a raised, bumpy appearance.

  • A cotton swab can be used to clean the skin around the tube:

  • When the G-tube is first put in, a normal saline solution or water can be used to clean the skin.

  • Mild soap and warm water can be used when the skin around the G-tube site has healed.

  • Roll the cotton swab around the G-tube insertion site to remove any drainage or crusting at the insertion site.

RESIDUALS

Feeding tube residuals are the amount of liquids that are in the stomach at any given time. Residuals may be checked before giving feedings, medications, or as instructed by your caregiver.

  • Ask your caregiver if there are instances when you would not start tube feedings depending on the amount or type of contents withdrawn from the stomach.

  • Check residuals by attaching a syringe to the G-tube and pull back on the syringe plunger. Note the amount and return the residual back into the stomach.

FLUSHING THE G-TUBE

  • The G-tube should be periodically flushed with clean warm water to keep it from clogging.

  • Flush the G-tube after feedings or medications. Draw up 30 mLs of warm water in a syringe. Connect the syringe to the G-tube and slowly push the water into the tube.

  • Do not push feedings, medications, or flushes rapidly. Flush the G-tube gently and slowly.

  • Only use syringes made for G-tubes to flush medications or feedings.

  • Your caregiver may want the G-tube flushed more often or with more water. If this is the case, follow your caregiver's instructions.

FEEDINGS

Your caregiver will determine whether feedings are given as a bolus (a certain amount given at one time and at scheduled times) or whether feedings will be given continuously on a feeding pump.

  • Formulas should be given at room temperature.

  • If feedings are continuous, no more than 4 hours worth of feedings should be placed in the feeding bag. This helps prevent spoilage or accidental excess infusion.

  • Cover and place unused formula in the refrigerator.

  • If feedings are continuous, stop the feedings when medications or flushes are given. Be sure to restart the feedings.

  • Feeding bags and syringes should be replaced as instructed by your caregiver.

GIVING MEDICATION

  • In general, it is best if all medications are in a liquid form for G-tube administration. Liquid medications are less likely to clog the G-tube.

  • Mix the liquid medication with 30 mLs (or amount recommended by your caregiver) of warm water.

  • Draw up the medication into the syringe.

  • Attach the syringe to the G-tube and slowly push the mixture into the G-tube.

  • After giving the medication, draw up 30 mLs of warm water in the syringe and slowly flush the G-tube.

  • For pills or capsules, check with your caregiver first before crushing medications. Some pills are not effective if they are crushed. Some capsules are sustained release medications.

  • If appropriate, crush the pill or capsule and mix with 30 mLs of warm water. Using the syringe, slowly push the medication through the tube, then flush the tube with another 30 mLs of tap water.

G-TUBE PROBLEMS

G-tube was pulled out.

  • Cause: May have been pulled out accidentally.

  • Solutions: Cover the opening with clean dressing and tape. Call your caregiver right away. The G-tube should be put in as soon as possible (within 4 hours) so the G-tube opening (tract) does not close. The G-tube needs to be put in at a healthcare setting. An X-ray needs to be done to confirm placement before the G-tube can be used again.

Redness, irritation, soreness, or foul odor around the gastrostomy site.

  • Cause: May be caused by leakage or infection.

  • Solutions: Call your caregiver right away.

Large amount of leakage of fluid or mucus-like liquid present (a large amount means it soaks clothing).

  • Cause: Many reasons could cause the G-tube to leak.

  • Solutions: Call your caregiver to discuss the amount of leakage.

Skin or scar tissue appears to be growing where tube enters skin.

  • Cause: Tissue growth may develop around the insertion site if the G-tube is moved or pulled on excessively.

  • Solutions: Secure tube with tape so that excess movement does not occur. Call your caregiver.

G-tube is clogged.

  • Cause: Thick formula or medication.

  • Solutions: Try to slowly push warm water into the tube with a large syringe. Never try to push any object into the tube to unclog it. Do not force fluid into the G-tube. If you are unable to unclog the tube, call your caregiver right away.

TIPS

  • Head of Bed (HOB) position refers to the upright position of a person's upper body.

  • When giving medications or a feeding bolus, keep the HOB up as told by your caregiver. Do this during the feeding and for 1 hour after the feeding or medication administration.

  • If continuous feedings are being given, it is best to keep the HOB up as told by your caregiver. When ADLs (Activities of Daily Living) are performed and the HOB needs to be flat, be sure to turn the feeding pump off. Restart the feeding pump when the HOB is returned to the recommended height.

  • Do not pull or put tension on the tube.

  • To prevent fluid backflow, kink the G-tube before removing the cap or disconnecting a syringe.

  • Check the G-tube length every day. Measure from the insertion site to the end of the G-tube. If the length is longer than previous measurements, the tube may be coming out. Call your caregiver if you notice increasing G-tube length.

  • Oral care, such as brushing teeth, must be continued.

  • You may need to remove excess air (vent) from the G-tube. Your caregiver will tell you if this is needed.

  • Always call your caregiver if you have questions or problems with the G-tube.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have severe abdominal pain, tenderness, or abdominal bloating(distension).

  • You have nausea or vomiting.

  • You are constipated or have problems moving your bowels.

  • The G-tube insertion site is red, swollen, has a foul smell, or has yellow or brown drainage.

  • You have difficulty breathing or shortness of breath.

  • You have a fever.

  • You have a large amount of feeding tube residuals.

  • The G-tube is clogged and cannot be flushed.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.