Gastrostomy Care

What is a gastrostomy?

A gastrostomy is a surgically created opening in the stomach. A gastrostomy is needed if you are not able to eat enough for adequate nutrition during treatment. Extra food and fluids are given through a gastrostomy tube, also called a G-tube.

Gastrostomy surgery is usually done under a general anesthetic. This means you will be asleep during the surgery and will not feel any pain.

What is a gastrostomy tube?

A gastrostomy tube is placed is placed in the stomach to help with feeding or venting of stomach gas. There are 2 main types of G-tubes:

• A G-tube that is placed in the stomach during surgery and has a tube that stays on the outside. This tube is held in place by a small fluid-filled balloon inside the stomach.
• A percutaneous endoscopic gastrostomy (PEG) tube placed in the stomach using a scope passed through the mouth into the stomach. A balloon or plastic disc (cap) in the stomach holds the tube in place.

Talk to your healthcare provider to find out which kind of tube is best for you.

How do I care for a gastrostomy at home?

You or your caregiver will need to learn to care for the gastrostomy. Your medical care team will teach you what you need to know to feel safe and comfortable taking care of the gastrostomy at home.

Cleaning and caring for the gastrostomy site

• Wash your hands with soap and water before and after touching the area.
• Use warm water and soap to clean around the gastrostomy site 2 to 3 times a day or as needed.
• Make sure that you gently soak or scrub off all crusted areas on the skin around the tube and on the tube itself. You may need to use a diluted solution of hydrogen peroxide (1/2 peroxide and 1/2 water) with Q-tips to clean around the tube site.
• After cleaning, rinse around the area with plain water and pat dry.
• You may use an antibiotic ointment around the site if the area looks red or sore.

Securing the G-tube

The end of the G-tube needs to remain snug against the inside wall of the stomach. The G-tube should be about 12.5 to 13 inches long from the exit site on the stomach to the other end of the tube. Measure your G-tube and record the length. When your G-tube is snug against the stomach wall and correctly in place, use permanent ink to mark the tube at the spot the tube comes out of the stomach. Then you can easily check if the tube is correctly in place by looking for the mark.

There are several ways to secure the G-tube to the skin on the stomach. A good way is to place a cotton roll (like the dentist may use in your mouth) on either side of the G-tube and tape the tube to the skin. Talk to your healthcare provider about any other specific instructions for taping down the G-tube.

Check daily to make sure that the end of the G-tube is in place by gently pulling on the tube until you feel resistance. Then tape the tube down securely.

Bathing

Your healthcare provider will tell you when it is safe to start taking baths or showers again. When you are able to take a bath or shower, remember to:

• Clamp the G-tube before bathing.
• Avoid overly warm water that can irritate tender skin at the tube site.
• Use only mild soaps and soft washcloths.

Activity

Your healthcare provider will tell you when you can go back to your normal activities. You will usually be told to avoid lifting for 6 weeks after open surgery but there are fewer restrictions after PEG tube placement. Make sure that the G-tube is carefully secured under clothing. A cummerbund (or girdle) made of cloth or BandNet (an elastic, netlike material) can help to secure the G-tube.

A G-tube should not keep you from returning to work or from most activities. If you have questions, ask your healthcare provider.

Traveling

A gastrostomy need not limit your opportunity to travel. Always take a travel kit of emergency supplies with you.

The travel kit should include:

• Foley catheter (ask your healthcare provider what catheter size will best replace your catheter)
• 6-cc (6-mL) syringe
• K-Y jelly
• paper towels
• container for tap water
• C-clamp or rubber band
• tape measure
• emergency phone numbers.

What problems might I have with a gastrostomy?

Possible problems with a gastrostomy include:

• Leaking around the gastrostomy tube

  To prevent leakage of stomach contents, gently pull on the G-tube so that the balloon is snug against the inside stomach wall. Call your healthcare provider if leaking continues.

• Blocked gastrostomy

  Blockage can be caused by a buildup of food or medicine in the tube or by body fluids crusted around the opening. Flush the tube with 10 mL of warm water to clear the tube of any blockage. If the tube still seems blocked, call your healthcare provider's office.

• Drainage around the gastrostomy

  Some drainage around the gastrostomy tube is normal, especially soon after the gastrostomy is put in. Clean the skin around it often. Make sure you remove all crusted areas from the tube itself. This should help lessen the chances of infection.

• Granulation tissue around the gastrostomy

  A small amount of red, moist tissue may develop around the gastrostomy. This is called granulation tissue. Do not be alarmed. If there is a lot of tissue, the area becomes sore, or the tissue interferes with care, call your healthcare provider.

• Vomiting or diarrhea

  Vomiting and diarrhea may be caused by the tube moving forward into the stomach and blocking the stomach outlet. Measure the length of the G-tube daily from the exit site on the stomach to the end of the tube. Compare this number with the measurement you made earlier. If the tube is shorter, gently pull on the G-tube to make sure that the balloon is snug against the inside of the stomach wall. If you are not able to gently pull the G-tube and secure it into position, call your healthcare provider.

• Bloating and retching

  Excessive gas and overfeeding can cause bloating of the stomach and retching. Unclamping the G-tube will allow air to escape and gradually relieve the problem.

• G-tube breaking

  Most tubes last for 3 to 6 months, if you need one for that long. Eventually the rubber tube breaks down and gets harder to use. Many times the end used to add the feeding formula breaks off or splits. These are signs that the tube needs to be replaced.

What should I do if I need to make an emergency trip to the hospital?

If you need to go to the hospital or the emergency room, bring your emergency kit and any helpful information you have about your gastrostomy. You should always bring your feeding supplies to prevent charges for extra supplies. If the gastrostomy tube or button has accidentally been pulled out, bring it with you.

Date: ___________________________________________________

Size of Tube: ___________________________________________

Type of Tube: ___________________________________________