An Introduction to Your Child's Gastrostomy Tube | Patient Education

What is a gastrostomy?

A gastromony is a surgical procedure to make an opening in the stomach to insert a tube for nutritional support.

Download An Introduction to Your Child’s Gastrostomy Tube Handbook

The word gastrostomy is made up of two terms:
- “Gastro” means stomach
- “Ostomy” means opening
- Together “gastrostomy” means an opening into the stomach
The inserted tube is often called a G-tube or GT
The opening on the skin is called a “stoma”
Sometimes called an “enteral tube” because it delivers food and liquids into the digestive system or intestine

Why does my child need a gastrostomy tube?

To provide food when he/she cannot eat enough to grow and be healthy
To give medications
To give liquids
To release air or gas that may collect in the stomach (also called “venting”) or to drain the stomach

What is a G-tube?

A soft flexible tube that is surgically placed into the stomach through a small opening in the skin
The G-tube can stay in place until it is no longer needed

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How is the gastrostomy tube placed?

In the operating room by a surgeon or pediatric gastroenterologist
Usually your child is in the operating room for 1 to 2 hours

What will happen after surgery?

Your child will have nothing to eat or drink for up to 24 hours after surgery but will have fluids through an IV
Your child may feel sore for a day or two and the area may be swollen
We will give your child medications for pain
There may be some sutures near the G-tube
You will start to learn about caring for the G-tube right away
We will clean the skin around the tube with saline and gauze or cotton tip applicators at first
The new site may have some drainage until it heals
A tract connecting the stomach to the outside skin develops around the tube as the stoma heals
Your child may only have sponge baths for the first 2 weeks

Your child’s nurses will help you learn and practice how to care for the G-tube. We want you to feel comfortable with these new skills before you go home. The case manager will arrange for the tube feeding supplies you need.

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Gastrostomy tubes

There are several types of gastrostomy tubes. The doctor will choose the best one for your child. It may be necessary to change the type or size of the G-tube as your child grows and his/her medical needs change.

Percutaneous Endoscopic Gastrostomy Tube (PEG tube)

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Low Profile Device
(such as MIC-KEY or Mini-One Buttons)

This is a skin level device
It is inserted into the stomach through the abdominal wall
There is an inflatable balloon at the end of the tube inside the stomach that is filled with water to hold the G-tube in place
The balloon port is the little opening labeled “BAL” on the side of the G-tube
An extension set is attached to the key shaped opening to give fluids and feedings
When not in use, the feeding port is covered with an attached cap
An anti-reflux valve is located inside the G-tube to help prevent the stomach contents from leaking out of the G-tube.
- The extension set will open the valve.
- Flush thoroughly with water to keep the valve clean and working properly.

A small opening is made in the skin of the abdomen. Another small opening is made in the stomach wall. The tube is passed through the openings into the stomach. This heals as a tract somewhat like the tract that forms with a pierced ear. When the tract has healed, the G-tube can be removed and replaced easily. However, the tract will close quickly if the G-tube falls out and is not replaced.

Post-op care

The area around the gastrostomy may be tender for several days. Discomfort usually can be treated with pain medications
A small amount of drainage around the G-tube is normal
There may be a dressing under the G-tube to prevent tube movement
Do not turn the G-tube until it is healed
Sponge bathe for the first two weeks after placement

Home Care

Keep the G-tube and the stoma (the skin around the tube) clean and dry
Clean the skin around the G-tube 1 to 2 times each day with soap and water
The G-tube is replaced about every 3 months.
At your follow-up appointment, the clinic staff will teach you how to change the G-tube at home, and how and when to check the water in the balloon.
A dressing under the extension set can help stabilize and prevent movement, but is not required.

Extension sets

Remove extension set from GT when not in use
If your child is receiving feedings over more than an hour, secure the extension set to the skin with tape to prevent pulling on the G-tube
Extensions sets are disposable and should be changed every week
The supply company providing your G-tube supplies should send you 4 to 5 sets every month
Clean the extension set with soap and water after every use
Do not use if clogged or dirty
The extension set may be available in different lengths (12 or 24 inch)
The most commonly used extension for feeding has a right angle connector and a y-port
The straight bolus extension set is useful for venting the G-tube or for large volume bolus

How to attach the extension set:

Align the black line of the extension set with the black line on the feeding port.
Insert the connector into the feeding port.
Rotate it clockwise to lock it in place.

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ENFit^® cleaning procedures

Low Profile Feeding Tubes Extension Sets

Tips for keeping ENFit feeding tube ports clean. Inspect before you connect!

Priming Feeding Sets - Stop priming before fluid reaches the end of the tube.

ENFit Syringe Draw Up - Wipe medication and nutrition from tip/outer threads, keep fluids out of dead space before connecting to feeding tube.

For best results, follow these instructions to clean tubes at least once a day or whenever material is visible

Tube Cleaning Supplies & Terms

Note: Use a disposable brush or follow manufacturer’s instructions if using ENFit specific cleaning brush.

Steps

ENFit® Cleaning Procedures step1 — Wash hands with soap and water or use gloves. Rinse brush with tap water.

ENFit® Cleaning Procedures step2 — Disconnect extension set, soak in clean water or rinse under faucet for at least one minute.

ENFit® Cleaning Procedures step3 — Wet toothbrush and rotate in bottom of moat and grooves of cap for 15 seconds.

ENFit® Cleaning Procedures step4 — Fill syringe then flush or rinse with clean tap water.

ENFit® Cleaning Procedures step 5 — Wipe feeding tube port and cap dry with gauze Clean supplies and allow to air dry.

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Percutaneous Endoscopic Gastrostomy Tube (PEG tube)

This tube is usually placed by a pediatric gastroenterologist or interventional radiologist
The PEG tube is changed after about 3 months by the specialist and replaced with another type of G-tube (usually a MIC-KEY)
Inside the stomach is a dome-shaped bumper that sits against the stomach wall to hold the tube in place
On the outside against the skin is a retention ring that keeps the PEG tube in place

Post-op care

The area around the gastrostomy may be tender for several Discomfort usually can be treated with pain medications
A small amount of drainage around the PEG tube is normal
There is usually no dressing under the retention ring
The PEG tube is turned two times a day
The centimeter marking at the skin is checked every day (see picture)
Sponge bathe for the first two weeks after placement

Home care

Clean the skin under the retention ring 1 to 2 times a day with soap and water
Do not use any dressings or gauze under the retention ring
Make sure the retention ring sits on the skin without indentations from the ring
Secure the PEG tube at all times to the abdomen with tape about 2 to 3 inches away from the insertion You may use a gauze bolster to support the tube if needed.
Every day, check the centimeter marking on the PEG tube where it enters the skin. The marking should be the same every day
If the centimeter marking at the skin is a bigger number, gently pull the PEG tube back to the proper marking and adjust the retention ring
If the centimeter marking at the skin is a smaller number, the PEG tube may be out of Call your specialist or go to the Emergency Room. Do not give anything through the tube.

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Tube feeding

Place your child in a comfortable position during feedings.

You may:

Hold your child
Place your child in a car seat, stroller, wheelchair, chair or high chair
Have a second person help you with the feeding
Place your child so his/her head is higher than the rest of the body

You and your child’s healthcare team will come up with a feeding plan that meets your child’s nutritional needs and is also most appropriate for his/ her medical condition.

Feedings usually begin the day after surgery. The initial feed will be a small amount to make sure your child’s stomach is ready for feeds.

Then, the amount of formula is gradually increased to what will be given at home.

Although formula contains water, it is usually not enough for your child’s needs. The feeding plan will include additional water to be given either before, after or in between feedings.

It is also recommended to flush the G-tube/extension set with 5 to 10 mLs of water before and after feedings to keep tube from clogging.

There are three ways that tube feedings may be given:

Bolus by gravity with a syringe
Bolus by gravity with a feeding bag
Bolus, continuous or cycled by pump with a feeding bag

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1. Bolus Feeding with Syringe by Gravity

With this method, formula flows out of the syringe into the feeding tube and the stomach
This method may also be called gavage feed
The bolus is given like a meal, usually over 20 to 30 minutes
Larger amounts can be given over a short period of time

Supplies:

Formula (remember to rinse off the top of the unopened can)
Water
60 mL syringe with plunger removed
5 or 10mL syringe for water flush
Extension set (if used)

Steps for feeding:

Wash your hands
Attach extension set (if used)
Make sure G-tube or extension set is clamped
Attach syringe to G-tube or extension set
Pour desired amount of formula into syringe
Unclamp extension set or tube
Allow formula to flow in by gravity
Add water to syringe for flush at end of feeding
When feeding is finished, clamp tube
Disconnect and wash extension set and syringe, allow to air dry
Refrigerate any unused formula and use within 24 hours

The higher you hold the syringe, the faster it flows
If formula doesn’t flow, push gently with the Do not force
Add more formula to the syringe before it empties to prevent unnecessary air from entering the stomach
Adjust the flow rate by raising or lowering the syringe in relation to the child’s stomach

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2. Bolus Feeding by Gravity Bag

With this method, formula flows out of a bag into the feeding tube and the stomach
The bolus is given like a meal, usually over 20 to 30 minutes
The bag hangs above the child
The roller clamp on the bag is adjusted to control the flow of the formula
The feeding bag is changed every day

Supplies:

Formula (remember to rinse off the top of the unopened can)
Water
Gravity bag
5 or 10 mL syringe for water flush
Extension set (if used)

Steps for feeding:

Wash your hands
Hang bag 18" or higher above your child’s stomach
Make sure roller clamp on bag is closed (do not attach bag to your child until primed with formula)
Open bag and pour in formula, close top of bag
Prime tubing by slowly opening roller clamp and allow formula to flow until formula reaches the end tip of the tubing
Close roller clamp
Attach extension set to G-tube (if used)
Make sure G-tube or extension set is clamped
Attach gravity bag tubing to G-tube or extension set
Unclamp extension set or G-tube
Open roller clamp to allow formula to flow in by gravity
Control how quickly the formula flows in by partially closing or opening the roller clamp
When feeding is finished, clamp G-tube or extension set
Flush with recommended amount of water
Disconnect and wash extension set and bag, allow to air dry
Refrigerate any unused formula and use within 24 hours

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3. Enteral Pump Feeding

With this method, a machine pumps formula from a bag through the G-tube into the stomach. Teaching about the pump will be arranged with the enteral supply company before your child is discharged from the hospital.

There are multiple ways of giving feedings with a pump:

Bolus: Feeding given over 30 minutes to several hours
Continuous: Feedings given over a longer time period, for example, overnight or 24 hours per day
Cycled: Feedings given over a longer time period with breaks in between

Supplies:

Formula (remember to rinse off the top of the unopened can)
Water
Pump and feeding bag
5 or 10 mL syringe for water flush
Extension set (if used)

Steps for feeding with pump:

Wash hands
Fill feeding bag with formula
Connect feeding bag to pump and prime according to pump instructions
Program pump settings as instructed
Attach extension set (if used) to G-tube and flush with water
Attach pump tubing to G-tube or extension set
Unclamp G-tube or extension set
Start pump and watch to make sure feeding has started properly
For bolus or overnight feeding:
- At the end of the feeding, flush G-tube/extension set with water
- Disconnect and wash extension set, and allow to air dry
- The enteral supply company will instruct you on how to care for the feeding bag
- Use a new feeding bag every 24 hours
For continuous or cycled feedings:
- The enteral supply company will instruct you on how to care for the feeding bag
- Use a new feeding bag every 24 hours
- Disconnect and wash the extension set (if used) every day before setting up a new feeding bag
- Change extension set (if used) weekly
Refrigerate any unused formula and use within 24 hours

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Steps to vent tube:

Wash hands
Remove plunger from 60 mL syringe
Attach syringe (without plunger) to clamped feeding tube or extension set
Hold syringe above the level of your child’s stomach
Unclamp tube or extension set
Press lightly on the stomach or lift the legs
Excess gas will bubble up into the syringe. It is normal for formula/stomach contents to rise into the syringe
If liquid is seen in the syringe, allow it to flow back by gravity before clamping the tube/extension set and removing the syringe

“Venting”

Your child may get uncomfortable due to excess air or gas in his/her stomach. Venting allows air to escape from the stomach. Some children may need venting more frequently and/or during feedings. Your healthcare team may also recommend use of a Farrell Bag System.

You may vent the tube:

before and after feeds
with diaper changes
as needed

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Medication administration

Steps for medication administration

Wash hands
Pull up medications in separate syringes
If tubing or extension set has 2 ports, always insure that they are capped to prevent meds from spilling
Prime extension set with water
Add extension set (if used) to G-tube
Attach syringe with medication to G-tube/extension set port
Unclamp G-tube/extension set
Give medication through medication port. Medication should go in easily; do not force
Clamp between medications and water flushes
Flush with a small amount of water (1 to 2mL) in between each medication
Flush afterward with recommended amount of water
Remove and wash extension set (if used)
Wash syringes with soap and water and allow to air dry

Medications are the most common cause of a clogged tube

Only give one medication at a time
Flush with water between and after meds
Use liquid medications whenever possible
Check with MD or pharmacist before crushing pills
If crushing pills, do so into a fine powder
and mix with warm water to dissolve
If medications are thick, dilute in water
Pull up medications in separate syringes
Wash extension sets after each use
Throw away the extension set if it becomes stiff or cannot be cleaned well
Change extension sets at least weekly

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Tips for adjusting to a
gastrostomy tube

The feeding plan you start with will change over time
The healthcare team will work with you to develop a plan that fits your family’s needs and fits with your child’s school, appointment, and sleep schedule
Activity- most activities including tummy time are allowed
Ask your team what to do if your child misses a feed. They can help determine where is the best place to fit it in
Be prepared: always make sure you have enough formula and supplies
If your child is not taking food by mouth, it is still important to keep the mouth clean
- Brush 2 times per day
- Floss 1 time per day
- For infants, wipe the mouth and teeth with a soft moist cloth at least once a day
Your child needs to keep the connection between the mouth being used and the stomach getting full. If your child is allowed to have food or liquids by mouth, it is important to offer an oral feeding each time your child gets a tube feeding. If your child is not able to eat by mouth, oral stimulation (or a pacifier for infants) can be offered during tube feedings
Talk to your healthcare team about other ways to provide for your child’s oral development

Preventing Infection:

Wash your hands every time you handle the tube, formula, or supplies
Wash out the bag or place it in the refrigerator between feeds as instructed by your enteral supply company
Use a new bag every day
Good oral hygiene prevents bacteria from moving down the airway and causing pneumonia
Raise the head of the child’s bed to prevent reflux

Securing the tube

Tape
Pin to clothes with tape and tabs
Dress infants in onesies
Tuck shirts into pants for older children
Ace wrap

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Troubleshooting your G-tube

Newly placed G-tube falls out

Possible Problem

Accidental dislodgement
Balloon malfunction

What to do

Don’t panic
See emergency kit
Notify your doctor immediately
Do not feed through the emergency tube

How to avoid

Secure extension set in use
Remove extension set when not in use
Cover tube so it doesn’t get pulled

Redness, irritation, pain, bleeding (a small amount of drainage is normal)

Possible Problem

Leaking of formula around tube
Friction or pulling on the tube
Infection

What to do

Make an appointment to see your doctor
Use barrier cream on the skin around stoma

How to avoid

Wash hands every time you touch the tube
Check the skin every day
Clean the skin 1 to 2 times each day
Keep any dressing clean and dry
Notify your doctor if drainage is thick, yellow/green, or foul smelling or if redness /irritation spreads

Leaking at the site

Possible Problem

Stomach is too full
Tube fit is too loose
The balloon has lost water
The balloon is not up against the stomach wall

What to do

Slow the feeding rate
Check amount of water in the balloon
Use barrier cream to protect skin
Use dressing to absorb drainage
(short term solution only)

How to avoid

Vent G-tube
Make sure balloon has right amount of water

Vomiting/retching and/or Distended abdomen

Possible Problem

Feeding intolerance
Too much air or gas
Stomach too full

What to do

Vent G-tube before and after feeds or medications
Slow feed
Decrease amount given each feeding (may need to give an extra feed to give same daily amount)

How to avoid

Vent G-tube (see page 20)
Watch for early cues that your child is uncomfortable
Use Farrell bag if instructed

Clogged G-tube

Possible Problem

Medication/Formula stuck in G-tube

What to do

Attach syringe with warm water
Use slow Push-pull method to try to unclog G-tube
Repeat every 10-15 minutes
Call your doctor if you are unable to clear the clog

How to avoid

Give medications correctly
Flush well before and after medications
See page 21 for tips to avoid clogging G-tubes

Excess pink or red tissue around the stoma

Possible Problem

Hypergranulation tissue

What to do

Not dangerous
Is very common
The doctor may decide to treat

How to avoid

Stabilize G-tube/extension set at all times to decrease friction
Prevent pulling on G-tube
Keep stoma clean and dry
Clean with soap and water every day

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FAQs

Can my child swim or take a bath?

After 2 weeks, the gastrostomy tract should be healed enough for your child to take a bath or swim in chlorinated water (pool)
After 4 weeks, your child can swim in lakes, rivers or the ocean
Clean the gastrostomy site immediately after swimming
Water may leak into your child’s This is ok for most children
You may cover the G-tube with a large Band-Aid if desired

Can my child lay on the gastrostomy?

Yes, after the site is fully healed and no longer tender
Infants can lie on their stomachs for tummy time
Older children can sleep on their stomachs

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G-Tube home emergency kit

The opening will start to close within 2 hours, and may be completely closed by 24 hours, so it is important to have a kit ready to use.

What to do if the G-tube falls out:

Don’t panic. Call the doctor immediately.

If the G-tube is newly placed, and you have not yet been seen in the pediatric gastroenterology (GI) clinic, call pediatric surgery 916-734-7844. After 5 p.m. or on weekends or holidays, call the Hospital Operator at 916-734-2011 and ask for the on-call pediatric surgery to be paged.

If you have been seen by a pediatric gastroenterologist, but have not yet learned how to replace the G-tube, call the pediatric GI clinic at 916-734-5912. After 5 p.m. or on weekends or holidays, call the Hospital Operator at 916-734-2011 and ask for the on-call pediatric gastroenterologist to be paged.

If you are unable to reach the doctor by phone, go the nearest emergency room.

Do Not Give Feedings or Medications Through the Emergency Tube

2 replacement emergency tubes will be in your emergency kit.
One tube is the same size as your child’s gastrostomy tube and the other tube is one size smaller.
The emergency tube is inserted to keep the stoma and gastrostomy tract open
Always carry the kit with your child
Never force the tube into the stoma. Try the smaller size tube if needed.
Do not take more than 10–15 minutes to try to insert the Emergency tube
Do not inflate the balloon on the emergency tube

Supplies:

2 tubes, 1 the size of current G-Tube and 1 a size smaller
(this tube is often called a Foley)
Water soluble lubricating jelly
Tape
Catheter plug

Steps:

Do not panic!
Wash your hands
Put a small amount of water soluble lubricating jelly on the end of the emergency tube
Gently insert the emergency tube 2-3 inches into the stoma\
Tape the tube to the skin so that it won’t fall out
Do not give ANYTHING (formula, water, or medications) through the emergency tube
Call the doctor or go to the nearest emergency room

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Important info

Important points

Be sure your child’s teachers, school nurse, and PE teacher know about the gastrostomy tube
Always carry your emergency kit
Do not use meds that are out of date

Call your doctor if your child has signs and symptoms of dehydration:

No urine in 12 hours for toddlers
No urine in 8 hours for infants
Crying without tears
Very dry mouth or cracked lips
Sunken soft spot (infants less than 1 year)
Your child is more sleepy than usual
Your child feels dizzy

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Important definitions

Abdomen: Area of body below lungs that contains stomach, intestines, liver and other organs
Aspiration: Accidentally inhaling liquid (such as stomach contents or formula) into the windpipe and/or the lungs
Bolus: A large amount of formula delivered through the G-tube
Enteral nutrition: Giving food directly into the stomach or intestines through a feeding tube
Esophagus: The muscular tube that connects the mouth to the stomach
Fontanel or soft spot: Area on a baby’s head where skull has not yet grown together
Flush: An amount of liquid used to clear formula or medication from the G-tube into the stomach
Gravity: A force which allows liquids to flow from a higher point to a lower point
Prime: To fill up tubing with liquid
Rate: How fast the formula is to be given; for example, an amount of milliliters per hour
Reflux: Movement of stomach contents up into the esophagus
Stoma: Surgical opening through which a feeding tube enters the body
Tract: Path from the stomach to the abdominal wall that forms around the gastrostomy tube
Vent/Venting: Letting the air or gas out of the stomach

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An Introduction to Your Child's Gastrostomy Tube | Patient Education | UC Davis Children's Hospital