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 the
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 gastrostomy tube, or G-tube, is placed in
the surgical opening 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 remains on the outside.
- 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 doctor to find out which kind of tube is best
for your child.
Home Care of
a Gastrostomy
As your child's caregiver, you will need to
learn to care for the 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.
- Cleaning and
Caring for the Gastrostomy Site
- Wash your hands with soap and
water before touching the area.
- Use warm water and soap to clean
around the gastrostomy site 2 to 3 times per day or
as needed.
- Make sure that you gently scrub
off all crusted areas on the skin around the tube.
You may need to use a diluted solution of hydrogen
peroxide (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.
- You may use an antibiotic ointment
around the site if the area looks red or sore.
- Securing the
G-tube
The end of the G-tube needs to remain
snug against the inside wall of the stomach. The G-tube
should measure approximately 12.5 to 13 inches in length
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. Now 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 doctor 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.
- Bathing
Because every child's needs are
different, your doctor will determine what is the best
time to begin tub baths for your child. When your child
is able to take a bath, remember:
- Clamp the G-tube or close the
valve on the gastrostomy button prior to placing
your child in the water.
- Avoid overly warm water that can
irritate tender skin.
- Use only mild soaps and soft
washcloths.
- 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 cloth
or bandnet (a netlike material) cummerbund (or girdle)
or bandnet vest 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.
- Clothing
Your child can wear most anything,
although one-piece outfits are best. Overalls, "onesies,"
or sleepers are ideal for active children and help
protect the gastrostomy site.
- Going to
School
If your child is able to go to school,
tell your child's teacher and school nurse about your
child's gastrostomy. You will want to tell them what to
do and who to call in an emergency.
- Traveling
A gastrostomy need not limit your
child's opportunity to travel. A travel kit of emergency
supplies should always go with your child.
The travel kit should include:
- Foley 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 with a Gastrostomy
- Leaking Around
the Gastrostomy Site
To prevent leakage of stomach contents,
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 doctor if
leaking continues.
- Blocked
Gastrostomy
Blockage can be caused by a buildup of
food or medicine in the tube or by body fluids crusted
around the opening. Flush the tube with 10 ml of warm
water to clear the tube of any blockage. If the tube
still seems blocked, call your doctor's office.
- Drainage
Around the Gastrostomy
Some drainage around the gastrostomy is
normal, especially soon after the gastrostomy is put in.
Clean the skin around it frequently. Make sure you
remove all crusted areas from the tube itself. This
should help lessen the buildup of drainage.
- Granulation
Tissue Around the Gastrostomy
A small amount of red, moist tissue may
develop around the gastrostomy. This is called
granulation tissue. Do not be alarmed. If the there is a
lot of tissue, the area becomes sore, or the tissue
interferes with care, call your doctor's office.
- Vomiting or
Diarrhea
Vomiting and diarrhea may be caused by
the tube moving forward into the stomach and blocking
the stomach. Measure the length of the G-tube daily from
the exit site on the stomach to the end of the tube.
Most G-tubes are 12.5 to 13.0 inches in length. If the
tube is shorter than this, gently pull on the G-tube to
make sure that the tube 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 doctor's
office.
- Bloating and
Retching
Excessive gas and overfeeding can cause
bloating of the stomach and retching. Unclamping the
G-tube or opening the button by inserting a
decompression or feeding tube will allow air to escape
and gradually relieve the problem.
- G-Tube
Breaking
Most tubes will last for 3 to 6 months.
Eventually the rubber tube will break down and become
harder to use. Many times the end used to feed with will
break off or split. 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 any helpful
information you have about your child's gastrostomy with
you. You should always bring your feeding supplies with you
so that you don't get charged for extra supplies. If the
gastrostomy tube or button has accidentally been pulled out,
bring it with you.
