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 a gastrostomy tube (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 G-tube, is placed in the stomach to help with feeding or venting of stomach gas. There are 2 main types of G-tubes that are placed into the stomach:

• A G-tube that is placed in the stomach and has a tube that stays on the outside. This tube is held in place by a small fluid-filled balloon inside the stomach.
• A skin-level G-tube button. It has a cap that opens and closes and a tube that is attached just for feedings. This type of tube may not be placed right away, but may be an option for your child later.

Talk to your healthcare provider to find out which kind of tube is best for your child.

Home Care of a 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.

1. Cleaning and Caring for the Gastrostomy Site
   • Wash your hands with soap and water before you touch the area.
   • Use warm water and soap to clean around the gastrostomy site 2 or 3 times per day or as needed.
   • Make sure that you gently scrub off all crusted areas on the skin around the tube and on the tube itself. You may need to use a mix of hydrogen peroxide diluted with water (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.
   • Ask your healthcare provider what kind of ointment to use if the area looks red or sore.
2. Securing the G-tube

   The end of the G-tube needs to stay snug against the inside wall of the stomach. The G-tube should be about 12.5 to 13 inches long 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. That way 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 healthcare provider 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.

3. Bathing

   Your healthcare provider will tell you when it is safe for your child to start taking baths or showers again. When your child is able to take a bath, remember:

   • Clamp the G-tube or close the valve on the gastrostomy button before bathing.
   • Make sure the water is not too warm, so that it does not irritate tender skin.
   • Use only mild soaps and soft washcloths.
4. 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 cummerbund (or girdle) made of cloth or BandNet (an elastic, netlike material) 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.

5. Clothes

   Overalls, "onesies," or sleepers are helpful for young children who might try to pull out the tube. Clothing helps protect the gastrostomy site. Older children do not need any special kind of clothing.

6. School

   When your child goes to school, make sure that your child's teacher and school nurse know about your child's gastrostomy. Let them know what to do and who to call in an emergency.

7. Travel

   Your child can travel with a G-tube, as long as he or she has a travel kit of emergency supplies. The travel kit should include:

   • Foley catheter (your healthcare team can give you the correct size that will best replace your child’s 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

• Leaking around the tube

  To keep stomach contents from leaking onto skin, gently pull on the G-tube so that the tube is snug against the inside stomach wall. Leaking from a button may be caused by valve problems or a broken balloon used for holding the tube in place. Call your healthcare provider if leaking continues.

• Blocked tube

  Food or medicine may build up in the tube or body fluids may crust around the opening and block the tube. Flush the tube with 10 ml of warm water to clear any blockage. If the tube still seems blocked, call your healthcare provider.

• Drainage around the gastrostomy

  Some drainage around the gastrostomy is normal, especially soon after the gastrostomy is put in. Clean the skin around it often. Make sure you remove all crusted areas from the tube itself. This helps prevent infection.

• Tissue around the gastrostomy

  A small amount of red, moist tissue may grow around the gastrostomy. This is called granulation tissue. This is normal. If the there is a lot of tissue, the area becomes sore, or the tissue interferes with care, call your healthcare provider.

• Vomiting or diarrhea

  Vomiting and diarrhea may be caused by the tube moving into the stomach and blocking the stomach outlet. Measure the length of the G-tube daily from the exit site on the stomach to the end of the tube. Compare this number with the measurement you made earlier. If the tube is shorter, gently pull on the G-tube to make sure that the balloon 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 healthcare provider.

• Bloating and retching

  Gas and overfeeding can cause bloating of the stomach and retching. If this happens, unclamp the G-tube or open the button. This allows air to escape and relieves the problem.

• G-Tube wears out

  Most tubes will last for 3 to 6 months, if your child needs one for that long. Over time, the rubber tube breaks down and gets harder to use. Many times the end used to add the feeding formula breaks off or splits. 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 feeding supplies with you. If the gastrostomy tube or button has accidentally been pulled out, bring it with you.

When should I call my child's healthcare provider?

Call your child’s healthcare provider if your child:

• has a fever or unusual smell or pus around the tube
• has a hard swollen belly 1 hour after feeding
• has diarrhea after feedings
• is still hungry after feedings
• seems to be in pain