If a child is unable to eat after surgery, a gastrostomy tube may be inserted directly into the stomach so the child to continue to receive nutrition.
Gastrostomy Tubes & Feedings: A Parent's Guide
Use our guide in reference to:
Administering feedings through the feeding tube
Changing the dressings and cleaning around the tube
Problems that may occur with the gastrostomy tube or the insertion site
The information contained in this material should not be used as a substitute for the medical care and advice of your physician. There may be individual circumstances of your child's healthcare that cause a variation in treatment.
Gastrostomy: An opening or “hole” between the abdominal wall and the stomach for the purpose of giving stomach feedings (done in the operating room)
Nissen fundoplication: An operation to prevent food and liquids from going from the stomach up into the esophagus
Gastrostomy tube (GT or G-tube): A tube placed through the gastrostomy opening to give feedings and keep the hole open
Low profile gastrostomy tube or “button”: A small type of gastrostomy tube with a separate piece that attaches for feedings (some tubes referred to as buttons include MIC-Key and Bard button)
Bolus feeding: A feeding given over 30 to 45 minutes, by gravity or on a feeding pump, one to five times per day, depending on how much the child eats or drinks by mouth
Continuous feeding: A feeding given over 12 to 24 hours, that is usually easier to give with a pump that controls the rate at which the feedings are given
Types of Gastrostomy Tubes
If your child has a Malecot tube with a drain tube attachment device, the first visit will be one week after the operation, where you will learn how to change the dressing. Call the surgeon's office to schedule the appointment. The second appointment is eight weeks after the operation. At that visit, the Malecot will be changed to a MIC-key.
Important note: The first tube change for patients with a Malecot is only done on Tuesdays at 1 or 1:30 p.m. This appointment may take 1 to 2 hours. After the tube is changed from the Malecot to the MIC-key, your child will have to go to radiology to check placement.
If your child has a MIC-key placed at the time of the operation, the first visit will be two weeks after the surgery to have the incision and GT site checked.
MIC-keys are changed every 4 to 6 months. You will be taught how to change the tube.
At the end of each feeding and after every medication, the tube must be flushed or rinsed with 5 to 10 ml of water to prevent the tube from becoming clogged with formula or medication.
Note: When possible, have your physician order a liquid form of the medications that you will be giving through the tube. Some pills can be crushed, mixed with water and given through the tube. However, when capsules are opened, they will clump together in the tube and may clog it.
Children with reflux who have a fundoplication may have difficulty with gas pain. To relieve this, attach a 30 cc or 60 cc syringe, without the plunger, to the tube for 10 to 15 minutes after each feeding to allow air to escape. Children that receive continuous feedings may have their feeding interrupted for 10 minutes every 3 to 4 hours for venting.
Children can take a bath four days after the operation. Change the dressing after the bath if it is wet or loose and no longer stabilizes the tube.
Dressings & Skin Care
Clean the skin around the tube daily with a wash cloth, gauze or a cotton swab moistened with water
Do not use hydrogen peroxide or alcohol around the tube
Ointments such as Bacitracin or Neosporin are not necessary and are generally discouraged
Several dressing types may be used to secure the gastrostomy after surgery. The dressing is very important because it:
Holds the tube in place, allowing the gastrostomy site to heal
Decreases the chance that the tube will be pulled out accidentally
The clear plastic type dressing over the MIC-key should be removed 5 days after surgery
Pulling or stretching a corner of this dressing along the skin releases it from the skin easily
No dressing is necessary around this tube
Clean with soap and water, or just water, daily
A 2x2-inch gauze pad may be used if there is drainage
Elastic wraps are helpful to stabilize the tube
The gauze pad should be changed every two to three days
Change more often if it gets wet
If the child is taking daily tub baths, the gauze pad should be changed after each bath because the gauze will be wet
A 2x2-inch gauze or split gauze pad and tape should be used.
Clean around the tube with soap and water
Apply one 2x2-inch gauze or split 2x2-inch gauze pad under the plastic ring
Tape all four sides of the ring
Use a Coban or an Ace wrap if necessary for additional security
Measure a piece of Coban or elastic wrap 3 to 4 inches longer than the abdominal circumference
On each end, cut 2-inch slits in the middle and place slits overlapping on top of the bolster
Use velcro or tape to secure the wrap
The physician will set up follow-up appointments for dressing and/or tube changes
Use the Hollister drain tube attachment device
Change every five to seven days or sooner if it comes loose from the skin
Between changes, clean around the tube with cotton tip applicator
To Remove Old Tube Holder
Squeeze top of holder and push strap back through slot, or unclip the clip
Gently remove holder from skin and throw away
Wash skin with water, or soap and water
To Apply New Holder: See Pictures in the Packaging of the Dressing
Remove paper from the inner area of holder
Leave outer paper ring in place
Split the tube along pre-cut line
Place on skin around the tube
Wrap strap around the tube and insert into the slot
Pull gently on the strap until it squeezes the tube slightly
Push down gently on the tube as the strap is tightened to prevent the tube from being pulled up too tightly against stomach wall
Tuck extra strap into the slot
Remove the outer paper from paper tape and tape to the skin
Small amounts of leakage from around the tube: You may use a dressing under the gastrostomy tube to keep clothes clean.
Granulation tissue: This is pink tissue that occurs as a reaction to the tube. It may bleed or produce an odor. This tissue is not of great concern but may lead to leakage around the tube. Make an appointment in the office; this tissue growth can be easily treated.
Redness around the tube: A small area of redness is normal. Infection around a gastrostomy tube is uncommon. If the area is bright red, increasing in size, or swollen and warm, schedule an appointment for evaluation. This is not an emergency but should be evaluated in the office within several days.
The tube is loose but not out (this applies only to “Buttons” or low profile tubes): Tape the edges of the “button” down. This will keep the tube in place and the gastrostomy hole open. You may continue to give feedings and medications through the tube. Schedule an appointment to have the tube replaced. As long as the tube is in the track, you do not have to be seen immediately.
Emergencies or Requiring Immediate Attention
The tube falls out or gets pulled out: If the operation to place the tube was done longer than four months ago and you have been taught how to replace the tube, insert replacement tube. If you are unsuccessful, you must seek medical attention within six hours.
All of the formula or feeding is leaking at the site: Small amounts of leakage or drainage around a GT are ALWAYS normal. If all or most of the formula is leaking, however, the tube may no longer be all the way in the stomach and should be evaluated to prevent damage to the tract.
These pages have been adapted from materials developed by Susan Luck, MD; Marleta Reynolds, MD; Srikumar Pillai, MD; Teri Coha, APRN-CNS, CWON; and Kerri Keller, CNP.