Gastrostomy tubes are soft, flexible tubes, which are placed in the stomach and used for feeding individuals who have difficulty eating.
The gastrostomy tube is inserted during surgery. A small hole called a “stoma” or “gastrostomy” is made in the abdomen. The tube usually remains in the stoma. If the tube is removed, the stoma may get smaller and even close.
Gastrostomy tubes may be used full-time with no oral feedings, or part-time as a feeding supplement for liquids or during illness. Your doctor will let you know what can be eaten orally and what should be given through the tube.
Caring for gastrostomy tubes is simple. Your nurse or doctor can teach you how to change the tubes at home. Because each person’s needs are different, blanks have been left under some areas in this handout for you to enter the correct amounts or numbers given to you by your doctor or nurse.
Feeding Through a Gastrostomy Tube
- Before feeding, check to see if the stomach is empty, if directed to do so by the patient’s doctor. Attach a syringe to the feeding tube and pull back on the plunger.
- If the fluid drawn back is greater than _____ ml, return this fluid back into the stomach and do not feed at this time. Recheck it again 15-30 minutes later.
- If the fluid is less than _____ ml, you may begin the feeding.
- To be certain the tube remains securely positioned, gently pull back on the tube until slight resistance is felt.
- On a Foley tube, wrap tape (preferably microfoam tape) around the tube 1/4 inch above the skin. This prevents the tube from being pulled into the stomach.
- On a PEG tube, position the crossbar or disc 1/4 inch above the skin. If the tube is snugged up too tightly, it can cause sores. The fit will need to be adjusted as the patient grows.
- If the G-tube is a button with an inflatable balloon, do not try to achieve a different fit by altering the water in the balloon. See a provider to resize.
Positioning the Patient
- Place the patient in a comfortable position either upright or at an incline. Infants should be placed in an infant seat or held.
- It is best not to feed the patient when they are lying flat. If necessary, place them on their right side.
Giving the Feeding
- Attach a 60ml syringe to the gastrostomy tube.
- Fill the syringe with feeding formula.
- Raise the syringe and tube 4 to 4 3/4 inches above the abdominal wall.
- Feed slowly, taking 20-30 minutes.
- Fill the syringe with the remaining fluid before it is empty, to avoid putting air into the stomach.
- Fill the feeding bag with the desired amount of fluid.
- Drain fluid to the end of the tube to remove the excess air in the tubing.
- Connect the tubing to the gastrostomy tube.
- Begin the pump at the rate of _____ ml per hour.
After the Feeding
- Put _____ ml of water in the feeding bag or syringe and repeat the same feeding procedure to clean the tubing.
- Disconnect the syringe or the tubing and plug the end of the gastrostomy tube.
- The patient should sit up for 30 minutes after each feeding.
- Medicines given by gastrostomy should be in liquid form or, if approved by your doctor, finely crushed and dissolved in liquid. Try to avoid medicines in sprinkle form. These may clog the G-tube.
- Give medicines by the gravity method using a syringe. If it is a button style G-tube, use the bolus extension tube to give crushed medicine. Do not use the right angle tube for this.
- Flush with 10-30 ml of water after giving medicines. Your doctor or nurse will tell you how much water to use based on the patient’s size and need for fluids.
Gastrostomy Site Care
- Keep the tube clamped between feedings to prevent liquid or gastric juices from leaking out and to prevent air from entering the stomach. Disconnect the extension tube if you have a G-tube button.
- Keep the site clean by washing daily with a mild soap and water. Do not use hydrogen peroxide unless directed to do so by your doctor.
- Do not use any medicine around the gastrostomy tube unless directed by your doctor.
- Keep the area open to the air as much as possible—just covered by clothing, not a gauze pad.
- Do not pull hard or jerk on the gastrostomy tube. This could enlarge the stoma and cause irritating gastric juices to leak onto the skin. Do not allow the tube to dangle, especially when moving the patient.
- Make sure pelvic straps, seat belts and other such devices do not press on the gastrostomy tube.
- Do not insert gauze pads under the tube to tighten it. The tube should move up and down a little. One layer of gauze to absorb small leaks is okay.
- If the G-tube is a button with an inflatable balloon, insert _____ cc of water into the balloon. (Do not use less than 5 cc.)
Emergency or Illness and Vomiting
- Vomiting. If the patient begins to retch and tries to vomit, unclamp the gastrostomy tube, or access the button with the bolus exhaust tube unclamped to relieve pressure and allow the stomach contents to escape. This is called venting. If a patient has a Nissen fundoplication, it’s especially important to vent the G-tube if gagging occurs. Call your doctor if gagging or retching persists.
- Poisoning. In case of poisoning, NEVER GIVE the patient syrup of ipecac to induce vomiting. Call your doctor or the poison control center immediately for instruction about other responses. Be sure poison center personnel know the person has a feeding tube. Keep all poisons out of the patient’s reach.
- Illness. If the patient is sick, feedings and formula may need to be changed. Ask your doctor if the diet should be altered.
- Clogging. If the tube clogs, call Telehealth Nursing for instructions. Rinsing the tube between medication dosing and feedings will usually prevent clogging.
- Leaking. If there is leaking at the tube site, call Telehealth Nursing for instructions. If leaking occurs, protect the skin from irritation by applying zinc oxide (diaper rash cream) to the tube site, and keep the site covered with gauze.
- Reinserting the Tube. If you have been told to reinsert the patient’s Foley gastrostomy tube if it falls out, insert the tube and check for placement. If the tube needs to be reinserted at the hospital, cover the stoma site with dressing and tape. The tube needs to be replaced within a few hours or the hole may begin to close. Your local doctor or emergency room should be able to reinsert the tube for you.
This information is for educational purposes only. It is not intended to replace the advice of your health care providers. If you have any questions, talk with your doctor or others on your health care team. If you are a Gillette patient with urgent questions or concerns, please contact Telehealth Nursing at 651-229-3890.