Home Care of Your Child

After a Gastrostomy

Guidelines
for Parents
 Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
What Is a Gastrostomy? . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Supplemental feedings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Tubes and Other Devices . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Mushroom tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Foley catheters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
MIC™ tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
PEG tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Gastroenteric tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Gastrostomy buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
More information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Caring for the Skin around a Gastrostomy Site . . . . . . . . . . . . . . 12
Protecting the Tube . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Caring for a Gastrostomy Button . . . . . . . . . . . . . . . . . . . . . 13
Dressing a Gastrostomy Site with the Retention Disk . . . . . . . . . . . 14
Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Dressing a Gastrostomy Site without the Retention Disk . . . . . . . . . . 16
Feeding Your Child through the Tube . . . . . . . . . . . . . . . . . . . 18
Using the dietician as a resource . . . . . . . . . . . . . . . . . . . . . . . . . .18
Continuous drip (pump) feeding . . . . . . . . . . . . . . . . . . . . . . . . . 18
Bolus (gravity) feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Feeding with a button . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Measuring the formula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Burping or venting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Gastroesophageal reflux (GER) . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Helpful Hints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Giving Medications through the Tube . . . . . . . . . . . . . . . . . . . 20
Caring for Your Child’s Other Issues . . . . . . . . . . . . . . . . . . . . 21
Mouth and teeth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Emotional and developmental needs . . . . . . . . . . . . . . . . . . . . . . . .21
Emergency Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Replacing a Dislodged Tube . . . . . . . . . . . . . . . . . . . . . . . . 22
Before the site has healed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
After the site has healed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Tube Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Plugged tube . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Punctured, split, or damaged tube . . . . . . . . . . . . . . . . . . . . . . . . .24
Tube migration into the small intestine . . . . . . . . . . . . . . . . . . . . . . 24
Slipped MIC tube . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Skin Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Leakage and skin burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Granulation tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Call for Advice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Frequently Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . 28
Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

iv
 Introduction
Your child has a gastrostomy (ga-STRAW-stom-ee). Doctors have
made an opening into your child’s stomach, through the abdomen,
and inserted a feeding tube. The gastrostomy was placed because
your child has not been able to take in adequate nutrition by mouth.
You may feel overwhelmed by all that has happened to you and your
family. You may also feel worried about taking care of the gastros-
tomy at home. You may wonder if you will be able to learn the skills
you need.

These feelings are normal. At first, most parents feel insecure about
managing a gastrostomy. Before you leave the hospital, nurses will
teach you, step by step, how to feed your child and how to keep the
gastrostomy site clean and healthy. A specially trained nurse—called
an enterostomal (en-ter-o-STO-mul) therapist— will meet with you
and answer questions. You will also learn where to find supplies and
how to get help when you need it.

This handbook is yours to keep and use at home. The instructions

inside are only guidelines. Your doctor may change the recommenda-
tions, according to your child’s particular needs. Always follow your
doctor’s directions.

We have tried to include pronunciation guides and definitions of

unfamiliar words. There is also a short glossary at the end of this
book. Please remember to ask questions. This is the only way your
doctors and nurses can know if you do not understand.

ea se as
Pl
k
qu

es
Asking questions along the way tion
s!
is the best way to learn.

Home Care of Your Child after an Gastrostomy 1

What is a Gastrostomy?
Normal feeding requires food and
drink to pass through the mouth,
down the esophagus (e-SOF-uh-gus),
and into the stomach. We obtain the
nutrients we need to sustain life and
health from the food and drink we
digest. This process can be disrupted
by problems such as birth defects,
uncontrollable reflux (frequent
regurgitation, or vomiting, after
feedings), brain damage, or injury
to the esophagus. These problems,
and others, may require doctors to Trachea (to lungs)
provide a different way for nutri-
ents to get into the stomach. Some
people need to have a tube placed for
Esophagus (to stomach)
supplemental feeding.

A gastrostomy tube (G-tube) pro-

vides a way to deliver liquid nutri-
Stomach
ents directly into the gastrointestinal
Small intestine
tract. This is called enteral
• duodenum
(EN-ter-al) feeding. The G-tube is
for supplemental feedings to main- • jejunum

tain a healthy body weight. A • ileum

doctor will make an opening Large intestine

in the abdomen called a
stoma (STO-muh) and
place a G-tube through the
stoma into the stomach.

2
 Supplemental feedings
Some children are able to eat or
drink, but because of neurological
or other problems, they are not able
to eat or drink enough to maintain
a healthy body weight. Additional
nutrients can be given through the
gastrostomy tube. Your child may
only need supplemental feeding
through the tube. If so, your doctor
Gastrostomy tube
or the hospital dietitian will help
you choose a formula that provides
the additional nutrition your
child requires.

There are many kinds of gastrostomy

tubes. This booklet will introduce

Stoma

Skin

Abdominal wall

Stomach

Home Care of Your Child

Home Care of after anafter
your Child Gastrostomy
an Gastrostomy 3
Tubes and Other Devices Feeding port

you to the following: mushroom

tubes, Foley catheters, MIC™ tubes, Feeding port

PEG tubes, gastroenteric tubes, and

gastrostomy buttons.

Mushroom tubes
The tip of a Malecot or Pezzer tube is
shaped like the cap of a mushroom.
This tip holds the tube inside the
stomach. These “mushroom” tubes
are inexpensive and can be used for
four to six months. Surgeons always
replace such tubes because the mush-
room tip must be carefully stretched
so that it will fit through the stoma.

Foley catheters
Balloon port
These tubes have a balloon tip that is
inflated with water to keep it in the Feeding port
stomach. They are inexpensive, read-
ily available, and a good choice to
use in a travel or emergency kit. The
major advantage of a Foley catheter
is that it is easy to insert. One draw- Mushroom tube Mushroom tube
back is that it is quite long for small Malecot Pezzer
children. Its lifespan is also four to
six months.

Foley catheter

4
 MIC™ tubes
These are modified Foley catheters.
Like the Foley, the MIC™ is held
Adapter
in place with a water-inflated
balloon tip. Added features include
the following:

• a separate port (or opening)

for medications,

• a numbered scale on the side of the

tube so that you can see how much
of the tube is inside the body,

• an attached disk that anchors the

Feeding port
tube to the abdomen, and

• an overall shorter length.

Balloon port

Medication port
A MIC™ tube usually lasts six to
eight months. The feeding
extension tube should last at least
a month.

Retention disk

Gastric port

Home Care of Your Child after an Gastrostomy 5

Tubes and Other Devices
continued
6
PEG tubes
PEG (percutaneous endoscopic
gastrostomy) tubes are placed using
PEG tube
an endoscope (a lighted telescope) Medication port
BardTM
passed down the throat into the
stomach. After the tube is cor-
rectly positioned, short crosspieces
of tubing or bolster keep the tube in
place. The PEG tube should not be Feeding port Bolster
changed or replaced for at least eight
to 10 weeks, giving the stoma time
to heal adequately. A PEG tube may
Feeding port
last a year or more.

Gastric port
Medication port

PEG tube
MICTM

External bolster

Internal bolster

6
 Gastroenteric tubes
Gastric port Gastroenteric (gastro-en-TARE-ic)
Jejunal port tubes, also called GJ or gastro-jejunal
Balloon port (gastro-JI-joon-ul), are used when
stomach emptying is a problem.
These tubes are sometimes identi-
fied by their brand names, including
MIC™ and Corpack™. A gastroen-
Gastric port teric tube has two ports: the gastric
port, which goes into the stomach,
and the jejunal port, which goes into
the small bowel. The jejunum is the
portion of the small intestine that
extends from the duodenum to the
ileum (see drawing on page 2).

A gastroenteric tube is held inside

the stomach by means of a water-
Jejunal port filled balloon or a foam disk. An
outside disk helps hold the tube in
Medication place against the skin. A child with
port
this type of tube should only be fed
PEG GT tube continuously through the jejunal
MICTM port (see page 18). The jejunal port
Jejunal port
must be flushed every four to six
Gastric port
hours with tap water to prevent clog-
ging. The gastric port should also be
flushed regularly.

NEVER turn or twist a

gastroenteric tube

PEG GT tube
CorpackTM
Gastric port

Jejunal port

Home Care of Your Child after an Gastrostomy 7

Tubes and Other Devices
continued
Button

Stoma
Gastrostomy buttons
A gastrostomy button is a feeding
device that fits into the stoma and Skin
sits close to the surface of the skin. Abdominal wall
This device must be ordered ac-
cording to abdominal wall measure-
ments. Several brands and models
are available.
Stomach
Wearing a button allows the child
more mobility than he or she would
have with a tube. A button is also ?
less likely to be pulled out.

Some physicians will place a button Top view Side view

during the original surgery, often
surgeons place a tube initially then
change to a button after the stoma
tract has healed—about six weeks Shaft size
after surgery. In time, your doctor
may replace your child’s original tube
with a button, depending on the
child’s condition and how the tube
was originally inserted. Button
BardTM
Both continuous and bolus (or
gravity drip) feedings (pages 18–19)
can be given through a gastrostomy
button.

Feeding adapter

8
Side view

Top view Side view

Balloon port

Button
MICTM

Adapter

Top view Side view

Adapter

Button
Genie

Top view

Side view

Home Care of Your Child after an Gastrostomy 9

Supplies
You must have specific supplies read-
ily available to care for your child’s
gastrostomy. You should decide on a
convenient location where you can Gauze

organize the supplies. During your

training, you will learn about these
specialized items and receive infor-
mation about where to buy them.
You will need the following items:

• Two Foley catheters, one catheter

the same size as your child’s current
tube and a second catheter that
Water-soluble lubrication jelly
is one size smaller

• A catheter plug

• Water-soluble lubrication jelly

(K-Y Jelly®)
Dressing tape
• 60-cc catheter-tipped syringe

• 5-cc syringe
Cotton-tipped
• Dressing tape (Mefix® tape) applications

• Scissors with blunt tips

• 3- by 3-inch and 4- by 4-inch

gauze dressing

• Cotton-tipped applicators (swabs,

Q-Tips®) or clean washcloths
60-cc syringe
• Mild, unscented soap

• Water

• Instruction card, detached from

the back cover of this booklet

5-cc syringe

Whenever your child leaves home,

you will need to take an emergency
kit with him or her. See page 22 for
items to be included in the kit. (The
emergency kit should be with your
child at all times.)

10
 More information about supplies The 60-cc catheter-tipped syringe
Balloon port In an emergency, replace your child’s is used for bolus feedings. It is also
Use to inflate the
tube, no matter which type it is, with used to aspirate (draw out) stomach
balloon on the catheter
a Foley catheter. contents during tube replacement
and to flush the tube after feedings.
After the G-tube or PEG tube site The 5-cc syringe is required with
has healed, you should try to use tubes that have an inflatable balloon.
a Foley tube that is the same size It is used to inflate the balloon on
as the one you are replacing (see the Foley catheter or MIC™ tube (see
page 23). The small size Foley pages 4 and 13).
Foley catheter should be used during the first
The soap you use should be mild. It
two months .
should not contain any perfume that
might irritate your child’s skin. Be
sure to rinse the soap away thor-
If your child’s gastrostomy tube is not
oughly, as soap left on the skin can
a Foley catheter, you should familiar-
also irritate it.
ize yourself with the instructions for
inserting a Foley (see page 23). Use drinking-quality water to rinse
soap from the gastrostomy site dur-
Inflated balloon The catheter plug is a stopper that
ing your daily cleansing routine and
fits into the end of the mushroom
to flush the tube of leftover formula
tube or Foley catheter to prevent the
or medication.
formula and stomach contents from
Catheter plug flowing back out the catheter. Use blunt-tipped scissors to cut the
dressing and tape as described in this
The lubrication jelly should be a
booklet (see page 14). Sharp tips are
water-soluble lubricant. Do not use
more likely to cause accidental injury
petroleum jelly, such as Vaseline®.
or damage the tube.
The jelly will lubricate the end of
the catheter so that it will slide easily
into place.
Blunt-tipped
scissors

Washcloth

Home Care of Your Child after an Gastrostomy 11

Caring for the Skin around a Gastrostomy Site
It is always important to keep the
skin around your child’s gastrostomy
site clean and dry. Each time you
clean or dress the site, you should
inspect it closely for signs of skin Surgically placed
gastrostomy tube
breakdown. Eventually a skin-lined
tract will form along the walls of the Skin
stoma. A barrier (diaper) cream Abdominal wall
may be used on the skin around the
Sutures
tube to prevent burns from the stom-
ach content.
If the skin around the tube or button
looks red and irritated, it is prob-
ably because acidic stomach contents
are leaking out onto the skin and
burning it. Treat burns with a barrier Surgically placed tube PEG tube
cream and change the dressings more If your child’s tube was surgically If your child has a PEG placement,
frequently (two or three times a day). placed, clean the skin around the clean the skin with mild soap and wa-
gastrostomy site with mild soap and ter and turn the tube daily. You will
Dressing changes and site care should
water, checking each time to be sure need to dress this daily for 2 weeks
be done before feedings or no sooner
that the tube is positioned correctly. while the site heals. You may place
than one hour after feedings. The Change the dressing two or three 2- by 2-inch gauze around the tube
specific steps and procedures may times a week or whenever it gets wet if there is leakage from the stomach.
vary, depending on whether your or soiled. You may need someone to You may need someone to help hold
child’s tube was placed by traditional help you hold your child while you your child while you care for the site
surgery or through the use of an do this. Surgically placed tubes do not and retape the tube.
endoscope (PEG). need to be turned.
For a GJ tube, follow either basic
All tubes are not the same. To prop- Refer to pages 14–17 for step-by- surgical or PEG site care instructions,
erly care for your child, it is step instructions about dressings and
depending on how the tube was
important to know what type of site care. placed.
tube was placed.

DO NOT turn a GJ tube.

What is the difference between a surgically placed G-tube and a PEG tube?

G-Tube – gastrostomy tube PEG Tube – Percutaneous Gastrostomy button

Endoscopic Gastrostomy Daily care of the skin around a
Placed surgically – opening through the
Placed endoscopically – endoscope is gastrostomy button includes cleans-
passed down the throat into the stomach
abdominal wall into the stomach (going
and a hole is made through the abdomi-
ing with mild soap and water.
from outside to in)
nal wall. (going from inside – out)
Stomach is not sutured to abdominal wall
Stomach is sutured to abdominal wall
(greater possibility of tube dislodgement)
Healing time is 2 months Healing time is 2 months
Dressing is changed every 2-3 days or Dressing is changed daily and the tube is
when wet/soiled (do not turn tube) turned daily
Site care with dressing change Site care daily

12
Protecting the Tube
The gastrostomy tube (all types) must If your child’s tube construction CARING FOR A
be securely anchored so that it cannot: includes a water-filled balloon, check GASTROSTOMY BUTTON
the volume of water as directed.
• migrate(move) inward, possibly The gastrostomy button does not require
Hold on to the button or tube as you
blocking the pylorus (entrance into a dressing but may be recommended
insert a 5-cc syringe into the balloon
the small intestine), by your physician. Still, the site must be
port and withdraw the water. If the
cleaned carefully every day and inspected
• migrate outward,necessitating an syringe is full, squirt the water back for any sign of skin breakdown. These
emergency replacement, or into the balloon. If you see less than are the steps to follow:
5 cc (3 cc for infants) in the syringe,
• move back and forth, stretching
the opening so that stomach con-
empty it. Then refill the syringe
and re-inflate the balloon with
1.
Wash your hands with soap and water.
tents leak out onto the skin,
5 cc (3 cc for infants) of sterile or Restrain your child’s hands, if necessary.
• move back and forth, causing distilled water. Wait 30 minutes,
granulation tissue (refer to
page 25).
and check the volume again. If it is
still low, you will know the tube is
2.
Clean around the button with mild
leaking and needs to be replaced. See soap and water, using a cotton-
The tubing must also be anchored so
instructions on pages 22 and 23. tipped applicator (Q-Tip®). Start
that the loose end cannot be pulled
cleaning next to the button, then
out. The mushroom tube, Foley Avoid direct pressure on the gastros- move outward.
catheter, and MIC™ tube each have tomy site and protect it from trauma.
a long loose end. You should secure
the tube by taping that loose end to
During some exercises or physical
therapy, you may be advised to place
3.
Rinse away the soap with cotton-
your child’s abdomen (see step 9 on a foam donut around the gastros- tipped applicators dipped in water.
page 15 or step 10 on page 17). tomy site. This donut cushions the Dry the area with cotton-tipped
area and helps to equalize pressure. applicators.
If the tape is irritating or if your
Your physical therapist will help you
child pulls at the tube, you may
want to consider dressing your child obtain or make one. 4.
Apply a barrier cream to the skin and
in a “onesie,” which holds the tube
cover with a 2-inch square gauze.
close to the body. A foam donut can
Do this with each dressing change.
also provide effective protection (see Cut a slit
diagram below). up to the middle of the gauze, slide
the gauze under the button and
tape it to the skin.

A foam donut can provide protection for the gastrostomy site

Home Care of Your Child after an Gastrostomy 13

Dressing a Gastrostomy Site with the Retention Disk
1. 4. 7.
Wash your hands with soap Clean around the tube with soap Cut a piece of Mefix® tape in a
and water. and water, using a clean washcloth square larger than the dressing and
or cotton-tipped applicators. Always cut one side in to the center of the
start cleaning next to the tube, then square, so the tape can go around
2.
If necessary, restrain your child’s
move outward. the tube. Place the tape on top of
the gauze on the blue disk, dressing,
hands or have someone help hold Rinse away the soap with cotton- and skin. (Do not place tape directly
your child. tipped applicators dipped in water. on the blue disk or on any type of
Dry the area with cotton-tipped tube with a retention disk, as this
applicators.
3. may cause the disk and tube to dis-
lodge when removing the tape.)
Remove the old dressing, making
sure to hold on to the tube when
taking off the tape.
3.
8.
5.
Apply barrier cream if the skin is red
or irritated.

6.
Place a 2- by 2-inch or 3- by 3-inch
drain sponge around the tube and
below the blue disk, as shown. Place
another piece of gauze drain sponge
on top of the retention disk.

Gauze should be placed on top and

under the blue disk

14
8.
Take another strip of tape and fold it
in half with the sticky side outward, TIPS
place one side on the skin, lay the
 Always check the position of the
tube on top, then fold the tape over
tube and disk during your cleansing
the tube.
routine. To check the position of the
MIC™ tube, see if the disk is set at
the correct measurement on the side
of the tube. If it has slipped from its
original setting, gently pull on the
tube until you meet resistance, then
slide the disk down to the skin, allow-
ing 1 or
2 mm (millimeters) of space (the thick-
ness of a dime) between the disk and
the skin.

 An oily buildup from the formula oc-

casionally accumulates at the feeding
port, preventing the closure from
fitting snugly. If this happens, you
should clean the plug and port with

9. diet soda on a cotton swab, rinse with

water, and dry thoroughly.
Finally, to maintain the position of
the tube and protect it, cut a If your child’s tube comes out and the



third piece of Mefix®‚ tape about tube has a blue disk on it, save the

4- by 6 inches in size. Take the paper blue disk. If you are unable to save
the disk or if you do not have a blue
backing off the tape and place the
disk at all, follow the set of proce-
middle of the tape on top of
dures listed on the next page.
the tube without pushing the
tube down. Arrange
the tape like a tent
over the tube, pressing
down the edges so they
adhere to the skin.

Home Care of Your Child after an Gastrostomy 15

Dressing a Gastrostomy Site without the Retention Disk
1. 5. 7.
Wash your hands with soap Apply barrier cream on the skin. This Fold the tube on top of the 3- by
and water. should be done with every dressing 3-inch dressing.
change to help prevent the skin from

2. being irritated.

If necessary, restrain your child’s

hands or have someone help hold 6.
your child. Fold a 3- by 3-inch gauze dressing in
half and place it to one side of the

3. tube.

Remove the old dressing, making

sure to hold on to the tube when 8.
taking off the tape. Fold a 4- by 4-inch gauze
dressing in half and place it on top
of the tube over the 3- by 3-inch
4. dressing.
Clean around the tube with soap
and water, using a clean washcloth
and/or cotton-tipped applicators. Al-
ways start cleaning next to the tube,
then move outward. Rinse away the
soap with cotton-tipped applicators
dipped in water. Dry the area with
cotton-tipped applicators.

s tions!
Pl e
ea u
se ask q

16
9. 10.
Cut two pieces of Mefix® tape and Cut another strip of Mefix® tape
tape the dressing to the skin. and place one side (sticky side out-
ward) on the skin. Lay the tube on
top, then fold the tape over
the tube.7.

Home Care of Your Child after an Gastrostomy 17

Feeding your Child through the Tube
A hospital dietitian will work with Read the manufacturer’s directions
the doctors to decide which method for your particular pump and set it
of feeding is best for your child. They up according to those instructions.
Use the dietitian as
will also determine the appropriate The directions will include informa-
a resource
formula for your child. After you tion about how often to change the
leave the hospital, that dietitian is formula bag. Use the formula bags
available to help you if you have and tubing recommended by the
any questions about the formula manufacturer. In the hospital, nurses
or the amount you should give in fill the formula bag every four hours.
each feeding. The outpatient clinic You can usually place an eight-hour
dietitian can also answer questions supply in the bag at home.
for you.

There are two basic methods of de-

If your child is on continuous
livering nutrients through a gastros-
feedings, the feeding tube must
tomy tube: continuous drip feeding
be flushed every four to six hours
and bolus feeding.
with 5 to 10 cc (3 to 5 cc for in-
fants) of warm water. If your child
Continuous drip (pump) feeding
is on nighttime feedings, flush the
The continuous drip feeding method
tube every four to six hours dur-
uses a mechanical pump to con-
ing the feeding and again after
trol the flow of specially prepared
the feeding is completed with 5
formula into the child’s stomach or
to 10 cc (3 to 5 cc for infants) of
bowel. Some children receive pump
warm water. You can use a smaller
feedings for prolonged periods of
amount of water if your child is
time, up to 24 hours a day. Others
small or on fluid restriction.
receive feedings during the nighttime
hours only.

The major problem with continuous

drip feeding is that the tube tends to
become plugged. When this occurs,
try flushing the tube with 5 to 10 cc
(3 to 5 cc for infants) of warm water.
If that does not clear the tube, try
pulling back slightly with an empty
syringe, then add the water, and
repeat the flushing action. Avoid
using excessive force when flushing
the tube.

Continuous drip feeding

18
 Feeding with a button
The extension tubes that come with
gastrostomy buttons can be washed
and rinsed with soap and water, like
dishes. They will last for at least a
month if cleaned thoroughly and
rinsed well after each use. You will
need to purchase replacement exten-
sion tubes from your home medical
Bolus supply company.
feeding
Measuring the formula
As you mix and measure formula
for feedings, remember that there
Bolus (gravity) feeding This approximates normal feeding are 30 cc per ounce. The hospital
A bolus feeding is given with a 60-cc time for an infant or child. If your dietitian can help you determine how
catheter-tipped syringe. Formula child acts uncomfortable or gags much formula your child needs each
is poured through the syringe and during feeding, decrease the rate of day and how to space the feedings.
allowed to flow slowly into the stom- flow so the feeding takes 50 to 60 If your child is an infant, remember
ach by gravity. minutes. This avoids painful stretch- that his or her stomach is small.
ing of the stomach in children whose Many infants with gastrostomies
To feed your child by the bolus
stomachs empty slowly. have also had an operation called a
method, prepare the formula at
Nissen. This procedure stops reflux
room temperature. Flush the gastros- If the formula does not begin
but makes the stomach even smaller.
tomy tube with the 5 to 10 cc (3 to flowing, put the plunger back into
Carefully measuring the amount of
5 cc for infants) of warm water. the syringe and push lightly. Then
formula and controlling the rate of
Remove the plunger from the syringe remove the plunger.
intake will help keep your baby com-
and attach the syringe to the gas-
Watch the volume of formula in the fortable. If your child is irritable or
trostomy tube. Fill the syringe with
syringe and continue adding formula gagging, give smaller feedings more
formula half- to three-quarters full.
until your child has received a full frequently and make sure the formula
Hold the syringe high enough to feeding. Do not allow the syringe to is lukewarm.
allow the feeding to flow slowly into become entirely empty until the end
your child’s stomach. The height of of the feeding. An empty syringe will
the syringe controls the flow rate: allow air to enter the stomach and
placing it high will cause the formula cause discomfort or bloating. Flush
to flow more quickly into the stom- the gastrostomy tube with the rec-
ach. The syringe should be positioned ommended amount of warm water
so the feeding takes 20 to 30 minutes. to clean out any remaining formula.
When the feeding is completed, re-
move the syringe. Finally, replace the
catheter plug on the end of the tube.
If your child has a button, remove
the adapter and close the button.

Home Care of Your Child after an Gastrostomy 19

Feeding Your Child through the Tube
continued
Giving Medication
Burping or venting (decompres- Gastroesophageal reflux (GER) Medications can be administered
sion of the stomach) Placing a gastrostomy tube increases through the gastrostomy tube. Re-
Sometimes children swallow too the tendency for gastroesophageal quest the liquid form of a medication
much air and get a bloated stomach. (gastro-e-SOF-uh-GEE-ul) reflux. when you are having your prescription
If they have had a Nissen (see previ- Reflux means that stomach acid and filled. Explain the situation to your
ous page), they will not burp as easily contents flow back up the esopha- pharmacist and ask for help.
as other children. In these cases, gus. Some of the symptoms of reflux If the medication is not available in
decompression of the stomach is are vomiting, heartburn, coughing, liquid form, the next best choice is an
necessary. Remove the plunger from gagging, retching, respiratory symp- uncoated tablet, which can be crushed
an empty syringe, attach it to the toms, and failure to gain weight. If into a fine powder and dissolved in
this seems to describe your child’s water. Your pharmacist may be able to
gastrostomy tube, and allow the air
situation, contact your pediatrician, suggest other liquids that will help
to escape from the stomach. (This is
family physician, gastroenterologist, dissolve a tablet. Do not crush coated
sometimes called “burping” or “vent-
or surgeon. or time-release tablets or capsules.
ing” through the tube.) If this does
These could cause injury to the lining
not seem to provide enough relief, of the stomach or intestine, or plug
place the syringe, with the plunger the tube.
in it, on the end of the tube and HELPFUL HINTS Consult your physician before giving
slowly aspirate or withdraw the air. If
◆ Provide a pacifier for infants to bulk-forming laxatives such as Meta-
formula or stomach contents appear, mucil through the tube. These types of
use during the feeding process.
slowly push back into the stomach, laxatives form a semi solid mass that
This helps satisfy an infant’s need
stopping before any air goes in. This may block the feeding tube. It is
to suck, but it will also teach your
should be done one-half hour to baby the connection between best to avoid giving bulk-forming
one hour after a bolus feeding, when sucking and a full stomach. laxatives through the feeding tube
your child is fussy or has been cry- whenever possible.
◆ If your child begins to cry during
ing, or if your child is gagging and Do not give the following medications
a feeding, the food will not flow
retching. If your child is on continu- smoothly into the stomach. It through the feeding tube, because
ous feeding, stop to burp or vent is best to stop the feeding, calm they will obstruct (clog) the tube:
every two or three hours. your child, and then continue • Biaxin (will turn into cement-like
the feeding. substance in the tube)
◆ If your child cries after a feeding, it • Calcium carbonate
may be from pain caused by swal-
lowed air which can be relieved by • Carafate
burping or venting the stomach. • Depakot sprinkles (or any type
of medication that comes in the
sprinkles form)
• Enzymes
• Laxatives

20
 Caring for Your Child’s Other Issues
Do not mix a medication with food.
Always push a medication through
the tube into the stomach by itself.
Ask your pharmacist which medica-
tions should be given on an empty
stomach and which should be given
at mealtime. When you administer a
medication, always flush the gastros-
tomy tube with the 5 to 10 cc (3
to 5 cc for infants) before and 10 to
15 cc (3 to 5 cc for infants) after it
is given.
If you must give more than one
medication at the same time of day, Mouth and teeth Emotional and
do not mix them together. Flush the Children with gastrostomies should developmental needs
tube, give the first medication, flush have oral care at least once a day. You Feeding routines are important
the tube with 3 cc of warm water, should gently brush the teeth, gums, in promoting family bonding and
and give the second medication. and tongue with a soft toothbrush. A normal development. You and your
Flush with 10 to 15 cc (3 to 5 cc mild mouthwash may also be wiped child must not miss out on these
for infants) when you are finished. experiences, even though you are
around inside the mouth, if desired.
Flushing assures that all the medi- busy managing the technical details
You may also want to use a moistur-
cation has gone through the tube
izer on your child’s lips to prevent of gastrostomy feeding. You should
into the stomach. This is especially
dryness and chapping. hold and cuddle your baby during
important with closely measured
medications, such as anticonvulsants. the tube feeding and show special
This daily exercise is important, not affection when doing site care and
You must be certain that your child
only for oral hygiene, but also to dressing changes.
receives the full dosage prescribed.
let your child experience the feel of
When giving medications through a having things in his or her mouth. When old enough to sit up for feed-
button, connect the adapter and ad- By consistently doing this, you are ings, your child benefits even more
minister the medications as described from interaction with caregivers.
preparing your child to learn to eat
above, then remove the adapter. Moms and dads often make silly faces
by mouth. It is important that this
time be a pleasant experience. An and funny noises, or engage in other
occupational therapist can give you play with babies at mealtime. You
other suggestions about helping your will want to do this also. Playful in-
NEVER insert a syringe teraction is important for your child’s
child accept oral sensations.
directly into the button. normal development, and it can be
fun for both of you. Once you gain
confidence in your ability to handle
the gastrostomy feeding and tube
care, you can relax and treat your
child as normally as possible.

Home Care of Your Child after an Gastrostomy 21

 Replacing a Dislodged Tube
A gastrostomy site takes about 2 BEFORE the site has healed
months to heal. Serious problems If the tube becomes dislodged before
can occur if the tube is accidentally the gastrostomy site has healed
pulled out before the site is healed. (two months), immediately follow

EMERGENCY KIT
Important The stoma can close or narrow in a
very short period of time (20 to 30
these steps:

Supplies must always be readily available

in case the G-tube is dislodged. Assemble
minutes) so that reinsertion of the
tube becomes difficult or hazardous.
1.
Wash your hands thoroughly with
an emergency kit and take it with your Occasionally reinsertion of the tube
child whenever you leave home. The kit soap and water.
may push the stomach away from
should include the following:

• Two Foley catheters, one catheter

the abdominal wall, allowing the
tube to enter the abdominal cavity. 2.
the same size as your child’s current Have someone help you by holding
This creates a dangerous situation
tube and a second tube that is one your child’s hands.
in which stomach contents can leak
size smaller
into the cavity. The best way to
• Catheter plug guard against dislodging the tube is
to keep it taped securely to the skin
3.
• Water-soluble lubrication jelly Lubricate the smaller-sized Foley
at all times, especially during feed- catheter with a water-soluble lubri-
• 60-cc catheter-tipped syringe
ings. You should also get help hold- cant and gently insert it about 2½
• 5-cc syringe
ing your child for dressing changes to 3 inches into the opening. Never
• Medical tape during the initial weeks after the force the tube into the stoma.
tube is placed. Always remember:
• Scissors with blunt tips
know where the end of the tube is You may use the water-soluble lu-
• 3- by 3-inch and 4- by 4-inch gauze
before you move your child. brication jelly packet as a measuring
dressings
guide, as shown below.
• Sterile or distilled water

• Instruction card, detached from the

back cover of this booklet 3 inches

The packet is approximately 3 inches.

22
4. AFTER the site has healed

If the tube becomes dislodged

6.
Cap the tube with a catheter plug When you are able to see stomach
and then tape the tube in place. after the tract has healed, follow contents in the end of the catheter,
these steps: proceed to cap the tube with a

5. 1.
catheter plug. Then fill a 5-cc syringe
with sterile water. Connect the sy-
Immediately call the physician who
Wash your hands thoroughly with ringe to the balloon port of the Foley
placed the tube for instructions on
soap and water. catheter and inflate the balloon with
what to do next.
water. Gently pull up on the catheter
Physician
2. until you feel resistance. Hold down
the plunger of the syringe, twist, and
Restrain your child’s hands
Phone number pull it off.
if necessary.

You can reach the surgeon on call

at 801.662.2950 or the gastroen- 3. 7.
Replace the dressing as outlined on
terologist on call at 801.662.2900. Lubricate the Foley catheter (the same
pages 16–17 in the section titled
Radiologists can be reached at size as the tube that was dislodged)
“Dressing a Gastrostomy Site with-
801.662.1801. Call the Primary with a water-soluble lubricant and
out the Retention Disk.”
Children’s Hospital operator at gently insert it about 2½ to 3 inches
801.662.1000 for help reaching any into the opening. Never force the
of these doctors. tube into the stoma. If you are un- 8.
able to insert the same-size catheter, Tape the tube securely in place as

6. try using the smaller one. directed in steps 9 and 10 on page

15 or page 17.
Do not use the tube for feeding until
the position is checked according to 4. 9.
the doctor’s directions. Tape the tube onto the abdomen to
hold it in place while you work. Flush the tube with 10 to 15 cc of
After your child’s gastrostomy site warm water (5 to 10 cc for infants).
has healed, a dislodged tube is
easier to manage. Nevertheless, it is
5. 10.
Check the placement of the catheter
important to act promptly before the
by looking for stomach contents Use the tube as previously instructed.
stoma begins to close.
(formula, mucous, green drainage)
dripping out of the end of the cath-
eter. If you don’t see any stomach
NEVER force the tube into contents, gently draw them up
the stoma. into the tube with an empty 60-cc
catheter-tipped syringe.

Home Care of Your Child after an Gastrostomy 23

Tube Problems
Plugged tube Tube migration into the
You must be diligent in flushing the small intestine
gastrostomy tube with 10 to 15 cc Sometimes a tube will migrate into
(3 to 5 cc for infant) of warm water the lower stomach or small intestine,
after every bolus feeding in order to causing blockage. Symptoms include
prevent leftover formula from abdominal pain, vomiting, a distend-
plugging the tube. Flush the tube ed stomach, and failure of feedings
immediately after a feeding, before to empty out of the stomach. During
the formula has a chance to dry and each dressing change, before the tape
stick to the sides. Flush the tube is applied, check for inward migra-
every four to six hours during con- tion of the tube by gently and slowly
tinuous feeding. pulling upward on the tube until you
meet resistance. Then tape the tube
If the tube becomes plugged, flush in place.
it with 5 to 10 cc (3 to 5 cc for in-
fants) of warm water. If this does not Slipped MIC™ tube
open the tube, attach an empty If the tube has slipped in (migrated
60-cc catheter-tipped syringe and inward) and there is “play” between
pull back lightly on the plunger. the disk and the abdominal wall,
This will create a slight suction, gently pull the tube up until you
which may loosen the plug. Do meet resistance, then slide the disk
not pull hard; suction could dam- down to the skin, leaving 1 to 2 mm
age the stomach lining. Then repeat of space (the thickness of a dime)
the flushing action with 10 cc (5 cc between the disk and the skin.
infants) of warm water.

Punctured, split, or damaged

tube parts
If any part of the tube is broken or
cracked, you will need to replace the 60-cc syringe
tube with a Foley catheter. If you
suspect the balloon is leaking, you
can check the volume of water in the
balloon by withdrawing the water
using a syringe. There should be
5 cc (3 cc for infants) in the sy-
ringe. If you withdraw less than that
amount, replace the full volume of
Leur lock
water in the balloon, wait 30 min-
5-cc syringe
utes, and check the volume again. If
the syringe shows less than 5 cc
(3 cc for infants), the balloon is leak-
ing and the tube should be replaced.
Remember to empty the balloon
with the syringe before pulling the
tube out.

24
Skin Problems
Leakage and skin burns Preventable problems
Stomach contents are caustic and Inflammation of the skin
is often caused by leakage
cause skin burns and breakdown.
of stomach contents.
When moisture from the stomach
accumulates on the skin around the
stoma, the skin may become red and
inflamed. If you notice any redness of
the skin, clean the skin more fre-
quently (several times a day), change
the dressings, and apply barrier cream.
Check the tube for one of the follow-
ing conditions: Inflammation at an
advanced stage is
• If you suspect the balloon in a shown here.
MIC™ tube or Foley catheter is
broken or deflated, replace the tube
with a new one. Use a 5-cc syringe
to remove any fluid remaining in
the balloon before pulling the tube
out through the stoma.

• If the stoma has become larger,

the tube may be moving back and
forth, causing stretching and leak- Controllable problem
Granulation tissue is
age. Be certain to anchor the tube
just beginning to form in
securely to the skin. photograph 1 and 2.

• If the problem persists, call your

surgeon’s office for instructions.

Granulation tissue
This growth of tissue is the body’s at-
tempt to close the stoma opening. An 1.
overgrowth of healing tissue around
the base of the stoma can be red-
dish or spongy, and can bleed easily.
Call your doctor if you notice such
symptoms. Your doctor may have
you apply 0.1% Triamcinolone®cream.
Excessive granulation tissue will need
to be removed. The surgeon will
either trim it off under local anesthe-
sia or cauterize it with silver nitrate. 2.
The choice of treatment will depend
on how much the tissue has grown.
Granulation tissue may continue to re-
form, even after multiple treatments.

Home Care of Your Child after an Gastrostomy 25

Tube Problems continued

Infection A heavy growth of

granulation tissue
Actual infection of the stoma or
surrounding skin is not a common
problem. Redness and irritation from
leakage may look like infection, espe-
cially when stomach contents interact
with bacteria on the skin, causing
a foul-smelling, greenish discharge.
Gastric leakage can be seen on the
child’s clothes and dressings, as well as
on the skin. You can usually eliminate A well-healed
the redness resulting from leakage by gastrostomy
changing the dressings more frequent-
ly and using a barrier cream.

If redness on the skin grows when

you can’t see evidence of leakage, if
redness persists despite your efforts
to keep the skin clean and dry, or if
you notice pus, call your surgeon or
gastroenterologist immediately.

Bleeding
A small amount of bleeding may
occur around the stoma during a
tube change. Minimal bleeding is not
serious, but if you see large amounts
of blood, pick-up the phone and dial Call for Advice
Important
911. The stoma may also bleed slightly If you encounter any of the problems outlined
if the tube is moving too much and
in this booklet and have tried the remedies
irritating the site. Careful attention
to proper positioning and taping suggested without improvement, do not hesi-

should eliminate this problem, but tate to call your pediatrician, family physician,
if it persists or worsens, contact your gastroenterologist, or surgeon, or the
pediatrician, family physician, gastro-
enterostomal therapy nurse at Primary Children’s
enterologist, or surgeon.
Hospital for further instructions.

26
 Notes

Home Care of Your Child after an Gastrostomy 27

Frequently Asked Questions
Q: How long does a tube last? Q: May my child bathe/swim?
A: The length of time a child’s A: Your child may have a tub bath Glossary of Terms
gastrostomy tube will last depends after the gastrostomy site has healed.
on what type of tube it is. The He or she may also go into a swim- Aspirate: 1) the act of suctioning a
mushroom tube, Foley catheter, or ming pool. During these activi- liquid or gas with a syringe or catheter, or
MIC™ tube generally last four to ties, the end of the tube should be 2) the act of inhaling liquids, gas, or food
six months. The gastrostomy but- securely closed. For privacy, your into the airway.
ton generally remains functional for child may want to wear a one-piece Bolus: Premeasured feeding placed
3 months. PEG tubes and buttons bathing suit or a T-shirt while swim- into gastrostomy tube over a short period
are usually left in for a year or more. ming. If your child’s gastrostomy of time.
Tubes with inflatable balloons may tube requires gauze dressings, the
develop a leak at any time for un- wet dressings should be removed Caustic: Capable of burning,
known reasons, necessitating a tube and dry ones put on after the bath corroding, dissolving, or eating away
change. If the tube starts to crack or or swim. by chemical action.
break, it is time to change the tube. Decompression: Emptying extra air
Q: Is the tube permanent? (burping or venting) through the tube.
Q: Does the gastrostomy hurt? A: The length of time your child Dressing: A bandage.
A: A well-healed gastrostomy will require a gastrostomy tube Enteral feeding: A method of
will not cause your child any pain. depends on his or her particular delivering nutrients where liquid is given
However, if the skin surrounding the condition—several months to many directly into the gastrointestinal tract.
stoma becomes red and irritated, years. Your surgeon or gastroenter-
the area may be extremely sensitive ologist can tell you more about your Gastrostomy: The surgical construc-

and uncomfortable. tion of an opening through the abdominal

child’s specific outlook.
wall into the stomach for the placement
of a feeding tube.
Q: May my child sleep on Q: How will the hole close when Gastrostomy button: A stomach
his tummy? the gastrostomy is no longer needed?
feeding device that fits close to the surface
A: Your child may sleep on his A: The stoma will usually close of the skin.
tummy, if he or she feels comfortable completely on its own after about
doing so and is able to roll from one Gastro-jejunal tube: A tube that fits
two to three weeks. A small dress-
through the gastrostomy opening into
side to another. Be sure the tube is ing is all that is needed until a scab
the stomach and is then passed down
properly anchored so that it does not forms over the hole and there is no
into the intestines; also called GJ or a
shift around in the stoma as your more leakage of stomach contents.
gastroenteric tube.
child moves.
Gastrostomies that have been in
Gastrostomy tube: A tube that
place for longer periods of time will
Q: May my child play? shrink in size initially, but a pinhole
fits through the gastrostomy opening into
the stomach, through which feedings can
A: Your child may do anything that opening will often persist. If this
happens, your child will require a
be given directly into the stomach.
does not risk any kind of trauma
simple surgical closure for which he Granulation tissue: Overgrowth
or pressure to the gastrostomy area.
or she will be admitted to the hospi- of healing tissue around the base of
Roughhousing and contact sports
tal for one or two days. the stoma.
that might involve a blow to the
abdomen should be avoided. How- Migrate: To move or change from one
ever, it is important for your child’s position to another.
physical and emotional development Stoma: A surgically constructed open-
to have as few restrictions as possible. ing into a body cavity.

28
To Call for Help
At Primary Children’s Hospital, knowl-
edgeable staff members are available 24
hours a day, every day, to provide infor-
mation and answer questions over the
phone. Help is just a phone call away.
The phone number for your surgeon or
nurse is 801.662.2950.

The number for your gastroenterologist

or nurse is 801.662.2900.

The phone number for the enterostomal

nurse is 801.662.3691.

You may also call the hospital operator

at 801.662.1000 for assistance.

Where to Purchase Supplies?

Call a retail medical supplier to buy the
items you need. You can find them in
the phone book under “medical sup-
ply.” Some home heath care companies
may also be able to obtain supplies and
bill you for them.

Primary Children’s Hospital

100 North Mario Capecchi Drive
Salt Lake City, Utah 84113

29
Replacing a gastrostomy tube
after site has healed
Follow these instructions if the site has healed (2
months after placement).
Use the same-size foley catheter as your child’s tube.
1. Wash your hands with soap and water.
2. Restrain your child’s hands if necessary. Seek the
help of another person to hold your child.
3. Lubricate the Foley catheter with a water-soluble
lubricant, such as K-Y Jelly®.
4. Using the water-soluble lubrication jelly packet as
the measuring guide, measure the Foley catheter
tip 2½ to 3 inches.
5. Insert the catheter 2½ to 3 inches into the open-
ing and tape the end of the tube to your child’s
skin while you continue working.
6. Check the placement of the tube by looking for
stomach contents inside the Foley catheter. If you
see stomach contents proceed to step number 7.
If you do not see stomach contents follow these
instructions:
• Attach the 60-cc catheter tip syringe to the
open end of the Foley.
• Gently pull back the plunger of the syringe to
about the 20-cc to 30-cc mark on the syringe to
aspirate stomach contents.
• If you still cannot see any stomach contents,
push the Foley catheter in another ½ inch and
re-tape. Aspirate a second time using the 60-cc
catheter syringe.
• If no secretions or stomach contents are visible,
stop and call your doctor.
7. Inflate the Foley balloon with 5 cc of water (3 cc
for infants), using the small syringe. Gently pull
back on the catheter until it meets resistance.
8. Fold the 3- by 3-inch gauze dressing in half, then
place it to one side of the tube.
9.  Fold the tube on top of the gauze square and tape.
10. Fold a 4- by 4-inch gauze dressing in half and
place it on top of the tube and the 3-inch dressing.
11. Cut two pieces of tape and tape the dressing down
to the skin.
12. Take another strip of tape and fold it in half with
the sticky side outward. Place one side on the
skin, lay the tube on top of the tape, then fold the
tape over the tube.
13.  Flush the tube with 10 to 15 cc of water (5 to
10 cc for infants).
 Replacing a gastrostomy tube
before site has healed
Follow these instructions if the site has not
healed (within 2 months after placement).

Date when G-tube was placed ______________

Use small-size foley catheter

1. Wash your hands with soap and water.
2.  Restrain your child’s hands if necessary. Seek
the help of another person to hold your child.

Place this card with your travel kit and always keep it with your child.
3. Lubricate the Foley catheter with a water-
soluble lubricant, such as K-Y Jelly®.
4. Using the water-soluble lubricant packet as
the measuring guide, measure the Foley cath-
eter tip 2½ to 3 inches.
5. Insert the catheter 2½ to 3 inches into the
opening and tape the end of the tube to your
child’s skin.
6. Cap the end of the Foley catheter using the
Foley catheter plug to prevent stomach con-
tents from leaking.
7. Tape the tube in place.
8. Call the physician who placed the tube im-
mediately for instructions on what to do next.

Important: If your child’s gastrostomy tube has

been in place for less than 2 months, you may
need to have a contrast study done to make sure
the tube is in the right place after it is replaced.
Contact your surgeon or gastroenterologist.

To Call For Help

Pediatric Surgery Clinic Gastroenterologists
801.662.2950 801.662.2900
After hours, call the After hours, call the
hospital operator at hospital operator at
801.662.1000 for the 801.662.1000 for
surgeon resident on call. the gastroenterologist
resident on call.
Radiologists
801.662.1801

Hospital Operator
801.662.1000

Enterostomal Therapy
Nurse
801.662.3691
©2015 INTERMOUNTAIN HEALTHCARE, Primary Children’s Hospital, Pediatric Education Services.
All rights reserved.
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