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Clinical Hub,Patient Education,Health and Nutrition Facts For You,GI

Caring for Your Gastrostomy (4350)

Caring for Your Gastrostomy (4350) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, GI

4350













Caring for Your
Gastrostomy



1




Table of Contents

What Is a Gastrostomy Tube (G-tube)? .......................................................................................... 2
Types of Gastrostomy Tubes .......................................................................................................... 3
Cleaning the Gastrostomy Site ........................................................................................................ 4
Gastrostomy Feedings ..................................................................................................................... 5
Giving Medicines ............................................................................................................................ 8
Changing a Balloon-Type Gastrostomy Tube ................................................................................. 9
Common Problems ....................................................................................................................... 11
Common Questions and Answers ................................................................................................. 14
Home Supplies List ....................................................................................................................... 15
A Ready Reference Guide ............................................................................................................. 16




2
What Is a Gastrostomy Tube (G-tube)?

It is a tube that enters the stomach through the outer abdomen. It can be used to give food and
medicines if you cannot swallow. It can also be used to drain fluids from the stomach. The tube
can be placed in surgery or in the clinic.



Food, fluids, and medications go …and pass down the tube into
into the G-tube, instead of into the mouth the stomach.





3
Types of Gastrostomy Tubes

The type of tube you use may change,
depending on your needs.

 PEG (Percutaneous tube):

1. Used if tube is placed by the GI doctor
or surgeon.
2. Must be removed by specially trained
doctor or nurse.
3. Life of this type of tube is 1-2 years.



 Balloon-type G-tube (Foley catheter or
replacement tube):

1. Has a balloon that needs to be inflated
with water to hold it in place.
2. May be removed and replaced by
patient or caretaker.
3. Life of this type of tube is about 2-6
months.

Types of Skin-Level Devices

 Button (mushroom-type device)

1. May be placed a few months after G-
tube opening is fully healed.
2. Requires clinic visit for placement and
removal.
3. Life of this type of device is 1-2 years.

 MICKEY or AMT Mini Button®
(balloon-type)
1. May be placed 3 months after PEG
placement when opening is fully healed.
2. Caregiver can be taught to replace as
device is secured by a balloon.
3. Life of this type of device is 3-6 months.
This may vary due to weight change
and/or medicines.













4
Cleaning the Gastrostomy Site

How often should the site be cleaned?
Once a day is fine, though more often if there is drainage around the tube. One of the easiest
ways to clean your site is in the shower. Be sure to rotate the tube and allow water to flow under
the skin disc to clean the area. Soap is not necessary.

If you are not able to shower, please use the following steps.

What to Do Tips

1. Wash your hands.

2. Clean the skin and tube with gauze pads and water.
If there is crust around the tube, dip the gauze in
warm water. Wrap it around the crusted area. After
about 5 minutes, remove the gauze and wipe away
crusting. Dry well.

3. Inspect the skin around the site. Call your doctor or
nurse practitioner if you notice:
drainage bleeding excess tissue
redness swelling


4. For the first three weeks, the skin disc must not
be loosened except by your health care provider!
After 3 weeks, the skin disc may be moved to a
comfortable distance from your skin. Rotate tube
daily. Note the numbered marking on tube to make
sure the tube is staying in the right place. If there are
no markings, note the length of the tube.

5. Tuck the G-tube under your clothing to prevent
accidental pulls.

6. Wash your hands when done.




Moisture can irritate skin. Avoid
dressings. If a dressing is needed,
gently place it on top of skin disc.
Change morning and night or
when soiled.

It's normal to have a little clear
drainage around the G-tube
opening. When this drainage
dries, it becomes a light brown
crust


If the tube is not well secured, it
can prevent healing or the balloon
can slip into the intestine. This
could cause leaking, diarrhea,
or vomiting.


Try wrapping a piece of tape
around the end of the tube. Then,
stick a pin through the tape and
fasten it to your clothing.






5

Gastrostomy Feedings

What to Feed:

Formula Name: _________________________________________________________________
Names of Equivalent Products: _____________________________________________________
Name of Manufacturer: ___________________________________________________________
Total amount of formula per day: ___________________________________________________
Total amount of water per day: _____________________________________________________
Additional Vitamins/Minerals/Supplements: __________________________________________

When to Feed:

Give can/cc of every hours or times per day.
Flush the tube with ml/cc water after each feeding.

When to delay feeding:

If you have nausea, feel full, or the tube does not flush freely, try again in one hour. If this goes on,
call your doctor.


6
Other Instructions:
_____________________________________________________________________________
_____________________________________________________________________________
_______________________________________________________________________________

Supplies:

ξ Tube feeding formula
ξ 60 ml ENFit syringe and/or feeding bag
ξ Clamp or catheter cap (for G-tube)
ξ ENFit adapter tube (for skin level device)
(Optional)
ξ Pump stand or IV pole
ξ Feeding pump with feeding bag
ξ 3-way stopcock (ACE ENFit enteral valve
connector)


ξ Water



7
How to Do Feedings

What to Do Why

1. Wash hands with soap and warm water
for 30 seconds.

2. Connect syringe or feeding bag to G-
tube. If using a skin level device,
connect the adapter tube to the device
and then the syringe or feeding bag.
Flush with 10-30 ml/cc water.

3. Sitting up or lie on right side with head
raised 30-45 θ is best.

4. Give the feeding at room temperature.

If using a pump:
Connect G-tube to pump tubing, open
the flow clamp and turn on pump. Be
sure pump is set at the correct rate. The
correct rate is __________. Your nurse
or home care provider will show you
how to use a pump.

Note: Need to use adapter tube with the
skin level device.

If not using a pump:
a) Syringe Method:
Remove plunger from syringe and
connect syringe to G-tube. Raise
syringe 4-5 inches above the stomach
and pour the feeding into the syringe.
Allow the feeding to drop into the
stomach by itself. Feedings should take
10-15 minutes. For thicker feedings,
you may need to gently push the
feeding with the plunger. Never force
feedings into the G-tube.
Helps remove germs and prevent infection.



Flushing before feeding helps you to check if
the tube is open



This helps the stomach empty and decreases
regurgitation.

Cold feedings can cause stomach cramps.














If a large amount of feeding enters the
stomach too quickly, it can cause swelling of
the stomach, vomiting, or retching. To slow
down the feeding, lower the syringe.










8

b) Feeding bag method:
Close clamp. Fill the feeding bag with
the desired amount of formula.
Suspend the feeding bag at least two
feet above your head. Run tube feeding
through empty tubing. Attach to G-
tube. Open clamp and regulate flow.

5. When feeding is done, flush the G-tube
with 30 mL of tap water or amount
recommended by the dietician to meet
your daily water needs.

6. Clamp or cap tube or remove skin level
feeding adapter. Adapter tubes and
feeding bags are reusable.

7. Clean your supplies by rinsing the
syringe, bag, and/or tube with cool
water. Then swish with warm water
and a small amount of liquid
dishwashing detergent. Rinse. Hang to
dry. Change tube feeding bags every
3 days.

8. NOTE: If the plunger cannot be easily
inserted into the syringe, try a few
drops of vegetable oil. Change syringe
weekly.







Some people handle their feedings better if
the tube is vented (left open and suspended)
for 1/2 to 1 hour after feeding to let out
excess air.





















Giving Medicines

Medicine can be given with a syringe through the G-tube. Crush and dissolve pills in water (not
formula) so that they do not clog the tube. You may want to ask your doctor about getting the
medicine in liquid form. Never crush enteric-coated or time-release capsules. Flush the tube
with 30 – 60 mL of water before and after giving medicines.




9

Changing a Balloon-Type Gastrostomy Tube

The first tube change must be done by a doctor.

Change the tube if:
ξ It becomes plugged;
ξ It accidentally falls out;
ξ Your doctor recommends routine changes
.
Supplies Tips

ξ G-tube with inflatable balloon (size will be
ordered by doctor or nurse practitioner)
ξ Water
ξ 2 syringes and needle
ξ 1 inch tape
ξ Lubricating jelly (water soluble) such as
KY jelly or Surgilube (not Vaseline )


It's normal for some stomach juices to spill
out during the tube change. It's also
common for a few drops of blood to ooze
from the site during the change. If there are
more than a few drops of blood, call your
doctor.








10
What to Do

1. Wash your hands.

2. Take a new G-tube and test the balloon
for leaks Using a syringe, draw up 5
mL of water. Inject the water into the
smaller balloon port. Wait 2 minutes.
If there is no leak after 2 minutes,
withdraw the water. If the balloon
leaks, toss it out and test a new one.

3. To remove the odl tube, unclamp the G-
tube. Using a different syringe,
withdraw water from the balloon.
Discard.

4. Coat the tip of the new tube with a
lubricating jelly. Do not use
Vaseline .

5. Insert the new tube.

While holding the tube at a 90 θ angle to
the stomach, gently insert it about 3-4
inches into the opening.

6. Using the syringe, inject the amount of
water specified on package into the
balloon port.

7. Make sure that the balloon is against
the wall of the stomach by gently
pulling the tube back until you meet
resistance.

8. Clean the site. Then move the skin disc
down to the skin level and tape the tube
in place. If you have a skin level
device, please refer to the package
insert

9. Wash your hands.
Tips





If you meet resistance, remove the tube and
try again a little harder. Turn the tube to a
different angle. If you cannot insert the
tube, call your doctor.





A balloon that is placed snugly against the
wall of the stomach helps prevent stomach
contents from leaking.


If the balloon is not well secured, it can slip
down into the intestines and cause a
blockage.




11
Common Problems
1. Blocked tube
2. Leaking around the tube
3. Leaking from feeding end of tube
4. Redness around the tube
5. Bleeding around tube
6. Tissue buildup around tube
7. Tube falls out
8. Vomiting
9. Diarrhea
10. Dehydration
11. Constipation
12. Gas, bloating, cramping
1. Blocked Tube

ξ Milk the tube by squeezing it between your fingers. Start at the top and work toward the
stomach.
ξ Firmly flush the tube using 15-30 ml of warm water. If that fails, change the tube if
snstructed to do so.
ξ Call your doctor or nurse practitioner.
ξ Prevent blockage by always thoroughly flushing tube with 30-60 ml water after feedings
and before and after medicines.

2. Leaking Around Tube

ξ Be sure the balloon is snugly against the wall of the stomach. This provides a seal, which
helps prevent leakage.
ξ Leaking is often a signal that tissue build-up has started or the tube is out of place. Please
call your doctor.
ξ If there is leakage, protect the skin with zinc oxide ointment, and change the dressing
when it is wet.
ξ The acid in the leaking stomach juices can irritate the skin. For relief, change dressing
often and wash irritated skin with water. You may need to see your doctor or nurse if it
becomes a problem.
ξ Measure the tube to check its placement in the stomach. (A tube that moves up and down
in the stomach can cause irritation and widen the opening.)
ξ When you change the tube, remove the old tube and wait 10-15 minutes before placing
the new tube. This lets the opening close a bit so that the new tube will fit more tightly.

3. Leaking from feeding end of tube
ξ Call your nurse or doctor.

4. Redness around the Tube

ξ Keep skin around the tube clean and dry. (Some redness is normal, but moisture can
irritate the skin and lead to an infection.)
ξ Clean the skin around the site more often using plain water.
ξ Keep irritated areas open to air if possible.
ξ Ask a nurse about other ways to fasten the tube in place.
ξ Call the nurse or doctor if you see signs of infection (redness, swelling, rash, unusual
drainage).



12
5. Bleeding Around the Tube

ξ If you notice more than a few drops of blood, call your doctor or nurse. Some bleeding is
normal during the tube change due to irritation.
ξ Keep the tube well secured to prevent accidental pulling.

6. Tissue Buildup around Tube

The growth of tissue around the tube is normal because the body tries to repair itself. The
nurse practitioner may need to remove some of this excess tissue. This can be done in the
clinic. Call the clinic if tissue builds up or bleeding occurs.

7. Tube Falls Out

ξ If the tube has not been changed by a doctor for the first time, cover the opening with a
clean dressing. Call your clinic or go to the local emergency room for the tube change.
ξ If the tube has been changed before, simply change the tube as usual at home.
ξ If a few hours have passed and the same sized tube will not go in easily, use a smaller
sized tube. Then, wait a week to change the tube again and insert the correct sized tube.

NOTE: Although this is not an emergency, if the tube is not put in shortly after coming out,
the opening can begin to close. It is best for the tube to be replaced within 2 hours of
coming out. You may even use the old tube until you can have a new one put in. Tape the
old tube in place, as the balloon will not stay inflated.

8. Vomiting

ξ Check the tube placement to be sure that the balloon is against the wall of the stomach,
not slipping in and out. If the balloon slips into the intestine, it can cause a blockage and
vomiting and swelling of the stomach.
ξ Do the feeding sitting upright or propped up on pillows (45 θ) if lying down.
ξ Try smaller feedings more often. Make sure the total amount for the day is the same.
ξ Infection may cause vomiting. Be sure equipment is well cleaned and rinsed between
feedings. Wash your hands between contacts with persons who are ill.

Call your doctor if vomiting persists more than once. The type or strength of the formula
may need to be changed.

9. Diarrhea

ξ Diarrhea means frequent, loose, watery stools. Looser stools may be normal with certain
types of tube feeding. A few loose stools in a 24-hour period are not a problem.
ξ Avoid formula hanging for longer than 6-8 hours.



13

ξ Check the tube to be sure that the balloon is against the wall of the stomach. If the tube is
too low in the stomach, the feeding will enter the intestine too quickly, causing diarrhea.
ξ Give the tube feeding more slowly.
ξ Give more water after each feeding to replace water lost in the diarrhea.
ξ If the diarrhea does not stop after 2 or 3 days, call your doctor.

NOTE: Consult your dietician. Changing to a tube feeding with fiber may help.

10 Dehydration

Vomiting, diarrhea, a fever and sweating cause the body to lose fluids. You may not get
thirsty so you must be very careful to note the signs of dehydration and call your doctor.
They will tell you what kind of extra fluid to give. Symptoms include:


 Decreased or more concentrated urine
 Crying with no tears
 Dry skin that has no recoil when squeezed
 Fatigue or irritability
 Dizziness
 Dry mouth and lips
 Sunken eyes
 Headache

11. Constipation

ξ Constipation may be due to a low fluid intake, too little fiber in the feeding or a side
effect of medicine.
ξ This is common in the elderly or those with limited activity.
ξ Giving extra water or fruit juice (especially prune or apple juice) between feedings may
be helpful.
ξ If you have chronic constipation, call your nurse or doctor. Often, a different formula
may be prescribed.

12. Gas, Bloating, Cramping

Consider the points outlined for diarrhea. Also, try to get rid of all air from the tube feeding
system before connecting to the G-tube. You may open the tube while it’s raised to allow
extra air to escape. It’s best done if lying down with the tube held straight up. Be sure to
have a towel handy in case fluid is released. Recap once the air is out and fluid starts to
come out.



14
Common Questions and Answers

Is there anything special I should know about the percutaneous gastrostomy (the one placed
in the clinic)?

Yes. The first time the tube is changed a GI specialist must do it. A special procedure is
needed to remove the internal bumper that holds the G-tube in the stomach.

What happens when I no longer need the gastrostomy tube?

Your doctor can explain the medical reasons for the tube and when it is no longer needed.
Most often, after the tube is removed, the holeclose over in a few days. Sometimes it may
take several weeks to close. Surgery is not needed to close the gastrostomy tube site in most
cases.

Does someone who can change the gastrostomy tube always need to be with me in case the
tube accidentally comes out?

No, if the tube comes out, you will be all right. However, because the opening starts to
close soon, the tube should be replaced within 2 hours by someone trained to do so.

Is there anything special I should know about traveling?

Remember to take all the supplies needed for feeding: syringe, formula, tubing, bottled
water, etc. Opened formula can be stored in a cooler to prevent spoilage. It is a good idea
to also take along an extra tube, some tape, and supplies for changing the tube in case it
comes out. Some families use a small canvas bag that is always filled with supplies needed
for travel.

Can I sleep on my stomach?

Yes. After the surgical site has healed, most people are quite comfortable on their stomachs.















15
Home Supplies List

Tube Feeding Formula:_______________________________________

For gastrostomy tubes:

ξ 60 mL ENFitsyringe
ξ Feeding bag (optional)
ξ Tube clamp if needed
ξ Cap for end of tube
ξ Tape 1"
ξ Cotton swabs or gauze
ξ Smaller syringes for medicines
ξ Lubricating jelly (water soluble)

For G-Tube skin level devices:

ξ 60 mL ENFit syringe
ξ Feeding bag (optional)
ξ Tube clamp if needed
ξ Cap for end of tube
ξ Tape, 1"
ξ Cotton swabs or gauze
ξ Smaller ENFit syringes for medicines
ξ Lubricating jelly (water soluble)
ξ Adapter tube


Additional supplies for pump feedings:

ξ Pump
ξ Feeding bags

You will be given a 3-day supply before discharge from the nursing staff. Future supplies may
be obtained through your home care provider. The special G-tubes, buttons, etc. can be ordered
by the GI clinic. Please check with your nurse or doctor.



16
You and Your Feeding Tube
A Ready Reference Guide


Tube Type: _____________________________________________

Site Care (daily):
1. Cleanse skin and tube with water.
2. Remove any encrusted material with a warm, wet cloth.

Tube Feedings
1. Formula _______________________________________________
2. Amount and Frequency ___________________________________
3. Method:  Syringe  Feeding Bag  Feeding Bag and Pump

Things to watch for
1. Blocked tube.
2. Signs/symptoms of infection - redness, swelling, unusual drainage.
3. Leakage or bleeding around tube.
4. Tissue buildup around tube.
5. Problems with vomiting, diarrhea, dehydration, or constipation.

Phone Numbers

Please call if you have concerns or questions.

Doctor: Phone Number: ______________
Local Doctor: Phone Number: ______________
Nurse Practitioner Phone Number: ______________
Dietitian: Phone Number: ______________
Home Health Agency: Phone Number: ______________



Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 6/2017 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4350.