Gastrostomy tubes are surgically-placed feeding tubes that enter the stomach directly via the abdominal wall. G-tubes are placed in infants with neurologic or anatomic problems precluding feeding by mouth for a prolonged period of time.

Postoperative care of the wound site is directed toward prevention of infection and irritation. The area should be cleansed at least daily or as often as needed to keep the area free of drainage. The initial post-op dressing change is performed within 3-5 days by the pediatric surgeons.

Secure tube position is of the utmost importance in the immediate post-op period. The baby’s nurse should assess tube position and note any changes. Also assess G-tube drainage and monitor the infant’s abdominal exam with measurement of girth, auscultation of bowel sounds, and visualization and palpation of dilated loops of bowel.

Subsequent daily dressing changes may be performed by the patient’s nurse.

The area around the tube should be cleaned with mild soap and water and then covered with a split 2x2 gauze. The baby’s nurse should note the presence of any bleeding or excoriation around the site. Ensure that the tube is pulled snugly to the abdominal wall and secured to the abdomen using a nipple and tape. Alternate placement of tape with each dressing change to decrease skin irritation.

Once the gastrostomy button is fitted, the infant may be bathed as the button is immersible in water. When cleaning around the button, the button should be rotated full circle to allow all the skin around the tube to be cleaned.

Elevate the HOB if possible before feedings and for 30 – 60 minutes after feeds. The infant should be placed in a semi-Fowler’s position before and after feeding. Formula for all G-tube feeds should be at room temperature.

Continuous feeds should be delivered via infusion pump.

Intermittent/bolus feeds should be delivered by gravity over a minimum of 15 – 20 minutes. The infant should be offered a pacifier for non-nutritive sucking during G-tube feeds. The tube should be cleared with 1 –2 cc of sterile water after the feeding is completed. Depending on physician order, after intermittent feeds the G-tube may be clamped off or left open to air at a level of 10 – 12 cm above the infant for 15-30 minutes to allow the infant to eliminate gas via the tube.

If the infant is receiving bolus feeds, residuals may be checked before feeds by aspirating the amount of undigested formula remaining in the stomach. Residuals may be discarded or reinstalled and the volume subtracted from the amount of formula to be infused, depending on physician order.

Once a gastrostomy button has been fitted, if the infant is receiving bolus feeds, the feeding tube is usually disconnected and the button capped after a feeding is finished. However, the feeding tube may be left in place for 15-20 minutes after the feeding if the infant has problems with excessive gas or regurgitation after feeds.

A gastrostomy tube or button should not limit the activities of an infant in any way. After the immediate post-op period, pain should not be present.

References:

Huth MM, O’Brien E. The gastrostomy feeding button. Pediatric Nursing. July-Aug 1987. Pgs. 241-245.

Paarlbery J, Balint JP. Gastrostromy tube: Practical guidelines for home care. Pediatric Nursing. Mar- Apr 1985. Pgs. 99-102.