Gastrostomy tubes are feeding tubes placed through the abdomen into the stomach. Gastrostomy tubes are used to give children formula, liquids, and medicines. These tubes are placed by aPediatric Surgeon or by a Pediatric Gastroenterologist. A gastrostomy tube is placed one of two ways: 1) percutaneously and 2) surgically.
At hospital discharge, a referral will be made to have a nurse visit your home. The nurse will help you care for the gastrostomy tube and give feedings and medications and, in general, serve as a resource in your home.
- Surgically Inserted Gastrostomy Tubes
- Percutaneous Endoscopic Gastronomy (PEG) Tubes
- Gastrostomy Tube Homecare
Surgically Inserted Gastrostomy Tubes
The pediatric surgeon places a gastrostomy tube in the operating room under general anesthesia. This operation is done through a small incision (cut) on the abdomen. The surgeon may place a temporary tube, called a Malecot®, into the gastrostomy opening. The Malecot® will be stitched to the skin and left in place for several weeks. The Malecot® allows the gastrostomy tract to heal well before a ballon type gastrostomy tube is inserted. A Malecot® tube is about twelve inches long, and most of the tube extends out of the abdomen.
After the gastrostomy tube is placed your child will remain in the hospital for observation and care. An IV (intravenous line) will be placed in the operating room before the procedure and this will be used to give fluids, antibiotics and pain medications while your child is recovering. Feedings are usually started the day after the gastronomy is placed.
Changing the Malecot® To a Balloon Gastrostomy Tube
After a few weeks, the Malecot® will be removed by the surgeon or the surgical nurse and a skin level balloon gastrostomy tube will be placed. These tubes are made of silicone. They are held in the stomach by a water-filled balloon. When the nurse inserts the device, she will teach you how to take care for the tube. For more information watch the following guides:
- Introduction to the AMT Mini Balloon Button
- Care and Replacemnt Guide for the AMT Mini Balloon Button
- Bolus Feeding Guide for the AMT Mini Balloon Button
- Continuous Feeding Guide for the AMT Mini Balloon Button
Percutaneous Endoscopic Gastrostomy (PEG) Tube
A PEG Tube, or Percutaneous Endoscopic Gastrostomy tube, is placed by a Pediatric Gastroenterologist in the operating room. The PEG tube is inserted using a telescopic instrument, called an endoscope. The endoscope is a small tube with a light and camera on the end that lets the Gastroenterologist see into the esophagus (food tube) and stomach. The endoscope allows the doctor to choose the best location in the stomach to place the PEG tube. Once the location is chosen, a small opening is made on the outside of abdomen into the stomach. After the opening is made, the top part of the PEG tube is pulled up out of the stomach through this opening. The top of the tube rests on the skin and the bottom part of the PEG, which is shaped like bulb, remains inside the stomach. This bulb shape anchors the tube in the stomach and prevents it from coming out.
After the PEG tube is placed your child will be admitted to the hospital for observation and care. The hospital stay is usually three days. Prior to the procedure, an IV (intravenous line) will be placed in the operating room. This will be used to give fluids, antibiotics and pain medication, for one to two days, as your child is recovering. Feedings will be started through the PEG tube within one or two days.
The PEG tube which is made of silicone, must stay in the stomach for about three months to allow the tract (hole) to heal between the abdomen and the stomach. The tract must be well healed so it is safe for the gastrostomy tube to be changed.
If your child requires continuous feeding with the gastrostomy tube, a pump and supplies will be ordered by the GI or surgical nurse from a home care supply company. The equipment and supplies will be delivered to your home or to the hospital before your child is discharged. You will be taught to use the pump by a representative from the home care company or home nursing agency, as pumps differ from hospital to home. Feeding bags, replacement gastrostomy tubes, extension sets, syringes, gauze, tape and formula will be ordered for your child by the GI or surgical nurse.
- General Feedings Guidelines
- What if a tube comes out before the gastrostomy tract has healed?
- What to do for common problems
- Specific Guidelines for Surgically Implanted Tubes
- Specific Guidlines for Percutaneous Endoscopic Gastrostomy (PEG) Tube
- Ordering Additional Supplies
General Feedings Guidelines
Give feedings and medications as directed by your nurse or doctor. Flush the gastrostomy tube with 10-15cc's of warm water after every feeding or medication. This prevents clogging and keeps the tube as clean as possible. If you are giving continuous drip feeding into a PEG tube you may want to tape connections to prevent disconnection of the extension set from the tube and spillage of feedings. If you are using a balloon gastrostomy, such as an AMT mini-one tube, check the volume of water in the balloon every week and refill as necessary to maintain the amount of water prescribed by your child's doctor or nurse (Do not perform this until at least 2 months after the tube was initially placed).
What if the tube comes out before the gastrostomy tract has healed?
It rarely happens with a PEG tube and sometimes happens with the Malecot® or balloon gastrostomy tubes. If the tube becomes accidentally dislodged call your child's doctor at either the GI (415-476-5892) or surgical office (415-476-2538) for instructions.
If you do not speak to a doctor or nurse after thirty (30) minutes take your child and gastrostomy supplies to the nearest emergency room for tube reinsertion. A tube will be placed into the gastrostomy tract to prevent closure and the need for another operation. If the emergency room doctors and nurses have questions, they can call the pediatric gastroenterologist, or surgeon who placed the tube.
If you do not have a replacement gastrostomy tube to take with you, a FOLEY® catheter of the same size or smaller can be inserted as a replacement tube. Often, a special x-ray called a "gastrostomy tube dye study" will need to be taken to make sure the newly placed tube is in the stomach. A FOLEY® catheter can be used for feeding and stomach decompression at home. Call your GI or surgical doctor or nurse if your child required a visit to the emergency room for care of his or her gastrostomy tube.
What should I do about the following problems?
Redness around the site
The skin may be slightly pink after initial insertion. You should see a decrease in this pink color over time. If the skin becomes tender, warm or red, call your child's doctor or nurse.
Drainage that dries on the skin is called crusting. Crusting and drainage is common around gastrostomy tubes. You can remove crusting and drainage with warm water.
If tube gets bumped, or is rubbed, there may be a small amount of bleeding from around the tube. Apply pressure should stop the bleeding for up to ten minutes. If the bleeding does not stop, call your child's doctor or nurse. Blood coming through the tube is not normal. If this happens call your child's doctor or go to the nearest emergency room.
Granulation tissue appears in most children at some time after the gastrostomy tube is placed. This tissue is common and not dangerous. It grows directly around the gastrostomy hole and looks raised, red and may ooze fluid or bleed easily. Granulation tissue should be treated when it first appears. This can be done in the office by your child's nurse or doctor. A special ointment or cream will be prescribed to apply to the granulation tissue (not the surrounding skin) up to four times a day until the granulation tissue goes away.
If your child has a fever, call your child's pediatrician.
Vomiting and/or diarrhea
If your child has vomiting and/or diarrhea, call your child's pediatrician and the pediatric GI or surgical nurse or doctor for advice.
Homecare for Surgically Inserted Tubes
Skin Care With a Surgically Inserted Tube
Cleanse the area around the GT with water daily.After cleaning the skin around the gastrostomy tube dry well. If there is a Malecot® in place, make sure it is taped securely in place, to prevent movement.
AMT Mini One Gastrostomy Feeding Extension Sets
When your child has an AMT mini-oneskin level button in place you will be using feeding extension sets. A feeding extension set is a special tube that connects to the gastrostomy tube and allows formula, liquids and medicines to be given into the stomach. There are two types of sets available for use with an AMT mini-one skin level tube. These are a 1) bolus set and a 2) right angle set. The bolus set is used for feedings given by gravity through a syringe. The right angle set is used for slow or continuous feedings, given by a pump. Either tube can serve as a decompression tube to drain air or liquid from the stomach. The decompression tube is used if a child has too much gas (which can't be burped up) or if the child is very uncomfortable and appears to have a bloated or full abdomen. Any AMT mini-one extension set fits any size AMT or MIC-KEY® gastrostomy tube.
Routine Changing Of Balloon Gastrostomy Tubes
The gastrostomy tube will need to be replaced when there is a malfunction, a poor fit or when it has been in for several months. Most parents are taught, in the hospital or office, how to change the gastrostomy tube and are comfortable changing the tube on their own. However, you can bring your child to the office or, in many cases, a home care nurse can be sent to your home to help you change the tube. A spare gastrostomy tube of the same size should be with your child at all times in case the balloon ruptures and replacement is required.
It is important to know the size of your child's gastrostomy tube. It is printed in black letters on top of the gastrostomy tube. We recommend that you write down the size of your child's tube on this document or some place where you can find it when needed. This will help you when reordering supplies and talking with your child's doctors and nurses.
Homecare for Percutaneous Endoscopic Gastrostomy (PEG) Tube
Skin Care With the PEG Tube
Cleanse the area around the GT with water for the first two days after placement. After this, daily bathing with soap and water is all that is necessary. To clean the skin around the PEG tube, lift up the flap, inspect the area; wash the skin with soap and water and dry the skin completely. Most PEG tubes do not need a dressing. A small amount of drainage is normal. Turn the tube with each feeding to prevent skin irritation.
If the tube becomes too loose, spacers, may be placed between the PEG and the skin to provide a better fit. If the tube gets too tight and there are spacers in place, these can be removed anytime, by your GI nurse or doctor.
After three months you may choose to replace the PEG with the same type of tube or you may change to a balloon type gastrostomy tube. Talk with your nurse or doctor about the best tube for your child. If the tube is working well and does not need to be changed at 3 months, it may stay in for up to one year.
PEG Tube Extension Sets
You will receive three types of extension sets. An extension set is a special tube that connects to the gastrostomy tube and allows formula, liquids and medicines to be given into the stomach. There is 1) a bolus set, 2) a right angle set and 3) a decompression tube. The bolus set is used for feedings given by gravity through a syringe. The right angle set is used for slow or continuous feedings given by a pump. The decompression tube (which has a long tip which opens a valve at the base of the tube) allows air and formula to be drained from the stomach, if needed. The decompression tube is used if a child has too much gas (which can't be burped up) or if the child is very uncomfortable and appears to have a bloated or full abdomen. The nurses taking care of your child will show you how to attach and remove each extension tube.
PEG extension tubes must be the same size as the gastrostomy tube in order to fit. PEG tubes have two measurements, the diameter (width) measured in French (FR) size and the length measured in centimeters (CM). These numbers are printed on the inside flap of the PEG. The bolus set and the right angle set must be the same diameter (for example 14 Fr) as the PEG tube. The decompression tube must be the same diameter and the same length (for example 14 Fr and 1.7 cm) in order to fit. We recommend that you write down the size of your child's tube on this document or some place where you can find it when needed. This will help you when reordering supplies and talking with your child's doctors and nurses. The office will also have a record of your child's tube size.
Ordering Additional Supplies
You will need to call the home care company monthly to reorder more supplies, so keep your home care company name and phone number readily available. We recommend you place your order when you have about one week of supplies left. Do not wait until you are out of supplies. Supplies are rarely shipped without a phone call and it is possible to run out of supplies. When your shipment arrives at your home, check the order. If you are missing anything, or the supplies are not correct, call your home care company directly. If you cannot resolve the problem contact your GI or surgical nurse for help. Sometimes a new prescription from your child's doctor is required.