Gastrostomy Tube, Child

A gastrostomy tube is also called a G-tube. This is a tube that is placed into your child's stomach through the skin of the abdominal wall. This tube is used to feed your child and can also be used to vent your child's stomach for air or drainage. The G-tube can be placed endoscopically (with a small narrow device) or by surgery. There are 2 types of G-tubes:

  • Those with a balloon.

  • Those without a balloon.

Those G-tubes with a balloon use the balloon to keep the G-tube in place. G-tubes without a balloon have another device to keep it in place. The healing process takes about 3 weeks. After that time, a passageway has formed between the stomach and skin. While healing, a small piece of gauze is taped around the tube. This helps to absorb drainage from the site. Sometimes, a small protective device may be taped around the base of the tube to keep the tube from kinking or bending. This also helps keep the tube in place and keeps your child more comfortable.

CLEANING AND DRESSING THE WOUND

  • Wash your hands with soap and water.

  • Remove the old dressing and check the area for redness, swelling, or pus-like (purulent) drainage. A small amount of clear or tan liquid drainage is normal. Also watch to make sure additional skin is not growing around the tube.

  • Clean the skin around the tube using a moist cotton swab. Roll the cotton swab on the skin around the G-tube to remove any drainage or crusting at the tube. Use a clean cotton swab and clean skin away from the tube. Clean around the suture gently.

  • Redress with a slit gauze dressing. You may anchor the end of the tube by putting a piece of tape around the tube and pinning it to a folded piece of tape on your child's stomach.

  • The site should be kept clean and dry. Do not use ointments around the tube site unless directed by your child's caregiver.

FLUSHING THE G-TUBE

Use a large catheter-tip syringe and slowly push 15 mLs of clean tap water into the tube. Flush the tube after every feeding and after all medications are given to keep the tube open and clean.

GIVING MEDICATION OR FEEDING

Before feeding or giving medication, check to make sure the tube is clear. Check for placement by attaching a syringe to the tube and pulling back to check for stomach contents or air. Then slowly push 10 mLs of tap water through the tube.

GIVING MEDICATION

  • If the medications are liquid, mix them with 15 mLs of tap water. Slowly push the mixture into the tube with the large catheter-tip syringe. Then slowly flush the tube with 15 mLs of tap water.

  • 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 15 mLs of warm water. Using the syringe, slowly push the medication through the tube, then flush the tube with another 15 mLs of tap water.

VENTING THE TUBE

You may need to vent your child's G-tube to remove excess air and fluid from his or her stomach. Your child's caregiver will tell you if this is needed. The following are two ways to vent your child's G-tube.

  • Attaching the G-tube to a drainage device, such as a mucus trap, drainage bag, or a diaper, will provide constant venting.

  • To vent the tube as needed, you may connect a catheter-tip syringe to the G-tube to aspirate the excess air or fluid from the stomach. Use this method for bloating, distension, or gagging. If this is a repeated need, contact your child's caregiver.

PROTECTING THE TUBE

  • Do not allow your child to pull on the tube. Keep the child's T-shirt over the tube. One-piece, snap T-shirts work best for infants and toddlers. Most children get used to the tube after a while, but until they do, they may need to wear elbow splints to keep them from pulling at the tube. Ask your child's caregiver about obtaining a splint if necessary.

  • Be sure to keep the end of the tube closed (either plugged, or if ordered, connected to a drainage bag) to keep the tube from leaking.

CHECKING THE BALLOON

If your child's G-tube has a balloon, it should be checked every week. The needed volume of fluid in the balloon can be found in the manufacturer's specifications.

CHANGING THE G-TUBE

It is advisable to learn how to replace or change your child's G-tube. Your caregiver can arrange for you to learn this skill.

PROBLEM SOLVING

G-tube was pulled out.

  • Cause: May have been pulled out accidentally.

  • Solution: If you have been trained, the G-tube should be replaced. If for some reason it cannot be replaced, cover the opening with a clean dressing and tape and then call your caregiver. The G-tube needs to be put in as soon as possible (within 4 hours) to avoid closure of the tract.

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

  • Cause: May be caused by leakage or infection.

  • Solution: Continue routine care and contact your caregiver.

Large amount of leakage of fluid or mucus-like liquid present (large amounts means it soaks a gauze 3 or more times a day).

  • Cause: Stretching of tract.

  • Solution: Change dressing frequently. Call your caregiver.

Skin or scar appears to be growing where tube enters skin. May have a rosebud appearance.

  • Cause: Overgrowth of tissue because of movement of the tube in the tract.

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

G-tube is clogged.

  • Cause: Thick formula or medication.

  • Solution: Try to instill warm water or other fluid as directed by your caregiver for 10 to 15 minutes. Then slowly push warm water into the tube with a 20 mL regular-tip syringe. Never try to push any object into the tube to unclog it. If you are unable to unclog the tube, call your caregiver.

TIPS

  • Be sure to block the tubing with the supplied external clamp before removing the cap or disconnecting a syringe to prevent backflow.

  • If your child has a G-tube with a balloon, check for level of tube placement every day. If the length of the tube seems less than normal, call your child's caregiver.

  • Be sure to check the fluid in a G-tube with a balloon every week.

  • It is important to allow your child to have pleasant sensations during feeding. This can be done by allowing your child to suck on a pacifier during the feeding, and by talking to and allowing your child to face you during the feeding. You may also hold your child at this time.

  • Always call your child's caregiver if you have questions or problems.