GASTROSTOMY: TUBES, FEEDING AND CARE

(GAS-STROS-STOW-ME)

CONTENTS

What is a gastrostomy page 3

Surgery page 4

Before surgery

What surgery is done

After surgery

What is a Gastrostomy Tube (G-Tube) page 6

Changing the gastrostomy tube

The Button Gastrostomy page 8

Advantages of the Button

Disadvantages of the Button

Inserting the Button

Button Care

Skin Care page 11

General Information

If you have a G-Tube

If you have a Button

Care of irritated skin page 13

Weepy skin #1

Weepy skin #2

Rash

Granulation tissue

Dressing Changes page 15

Stomahesive

D-TAD

Feedings page 18

Feeding

Increasing feedings

Nipple feedings

Other feeding information

Supplies & Equipment page 22

Supplies

Cleaning & storing tubes

Helpful Hints page 23

Medicines

Mouth care

Baby care

Play

Doctor visits

Call the doctor if….. page 24

WHAT IS A GASTROSTOMY

1.  A Gastrostomy is an opening or hole (stoma) directly into your baby’s stomach. It is a way to feed babies who are not able to suck or swallow well enough for good nutrition.

2.  A Gastrostomy Tube (G-Tube) is the tube placed through the stoma (hole) directly into the stomach.


SURGERY

BEFORE SURGERY

  1. The Neonatologist will talk with you about where the surgery should be done.
  1. Surgery may be performed at Cape Fear Valley Medical Center. Occasionally, babies are transferred to either Duke University Medical Center or The University Hospital at Chapel Hill for the surgery.

a.  If the decision is made to transfer your baby to another hospital you will be asked to sign a consent giving Cape Fear Valley Medical Center permission to transfer your baby.

b.  If your baby is transferred to another hospital:

·  The doctors there will also talk with you about your baby’s surgery.

·  Once your baby’s condition is stable and the doctors are happy with the baby’s progress, the baby is usually returned to Cape Fear Valley Medical Center’s Neonatal Intensive Care Unit.

  1. The surgery is done in the Operating Room and the baby is asleep for the surgery. You will be asked to sign a consent (give permission) for the surgery.

WHAT SURGERY IS DONE

1.  The surgeon makes a small opening or hole in the skin on the baby’s tummy and into his stomach.

2.  He inserts (places) a Gastrostomy tube through the opening on the tummy and into the stomach.

3.  Sometimes, a Nissen Fundoplication is done at the same time the gastrostomy tube is placed.

4.  This surgical procedure tightens the valve between the esophagus (tube connecting the mouth and stomach) and your baby’s stomach.

5.  Part of the baby’s stomach is wrapped around the esophagus, like a scarf is wrapped around the neck.

6.  The Nissan Fundoplication helps stop formula and stomach juices from sloshing up into the esophagus (tube going from the mouth to the stomach). This is called reflux.

7.  Reflux can make your baby:

a.  Spit-up often

b.  Irritate the esophagus

c.  Have breathing problems (apnea)

d.  Cause formula and stomach juices to get into the baby’s lungs.

AFTER SURGERY

  1. The G-Tube will be hung in the baby’s crib or isolette to “test the stomach” for about 24 hours. During this time your baby will continue to receive his/her IV fluids.
  1. Feedings are usually started through the G-Tube 2-3 days after surgery. When to start the feedings is different for every baby, the doctor will decide when it’s best for your baby to start feedings.
  1. Feedings are started very slowly! The baby’s doctor makes feeding changes.
  1. If your baby was transferred out for the surgery, when doctors and the surgeon are satisfied with how well your baby is doing, they usually transfer the baby back to the Neonatal Intensive Care Unit at Cape Fear Valley Medical Center.
  1. Once the baby has returned to our Neonatal Intensive Care Unit, we will continue teaching you how to feed and care for your baby and the G-Tube.

WHAT IS A GASTROSTOMY TUBE (G-TUBE)

1.  The G-Tube is a tube placed through the stoma (hole) directly into the stomach.

2.  A G-Tube is used for babies who may not be able to eat well for a long time—the baby who has a problem with his heart; esophagus; mouth (such as a cleft palate) or may be on a ventilator for a long time;

3.  The first G-Tube may be sewn in place until the opening in the skin and stomach heal together. The G-Tube is usually not changed for the 1st 2-4 weeks after surgery.

4.  The doctor or nurse practitioner changes the first tube and will probably replace this tube with a Foley Catheter (a tube with a balloon). We still call this a G-Tube.

5.  A mark is placed on the G-Tube close to the baby’s skin or the tube length measured. This way we know the correct amount of tube is hanging outside your baby’s stomach. This is to assure the tube has not moved too far into the stomach.

6.  A special dressing and the catheter’s balloon that stops the tube from being pulled out keep the G-Tube in place. You will be taught how to care for the G-Tube, the stoma and how to feed your baby before discharge.

CHANGING THE GASTROSTOMY TUBE

1.  Always wash your hands before changing dressing or tube.

2.  If the tube comes out, the opening (stoma) may close within 3 hours, so a new tube needs to be placed as quickly as possible.

a.  If you are unable to replace the tube you must take a new G-Tube and the baby to the baby’s doctor.

b.  If you are unable to reach the doctor or are away from home, take the baby and the new G-Tube to your nearest hospital emergency room.

3.  Gather all the supplies together before starting

Stomahesive®or D-TAD / 5 cc Syringe
Tape
/
Tap Water
Scissors / Hy-Tape (½ inch) (Pink Tape)
Foley Catheter (same size) / Cloth to wash skin
Cloth to dry skin

4.  Check the Foley catheter by filling the balloon end with 2-3 cc’s of tap water before inserting tube into baby’s stomach. [this is to make sure the tube & balloon are working correctly.]

5.  Remove the water from the tube before inserting tube into stoma. [make sure it’s working correctly first.

6.  Wet the tip of the tube in tap water.

7.  Put the tip of the tube into the stomach opening (stoma).

8.  Pass the tube into the stomach about 1 inch past the balloon.

9.  Fill the balloon with 2-3 cc’s tap water.

10.  Gently pull tube to position balloon against the wall of stomach. Pulling the tube too tightly will cause the opening to enlarge and formula may leak out around the tube.

11.  Clamp tube.

12.  Apply D-TAD or Stomahesive dressing and tape tube in place.

THE BUTTON GASTROSTOMY

1.  The Button gastrostomy is used in babies who have used a regular gastrostomy tube for a month or more.

2.  Your baby needs to weigh about 10 pounds to use a Button Gastrostomy. This is because the part of the button that is inside the baby’s stomach is larger than the tube you have been using.

3.  The Button has a one-way valve inside that makes it difficult for milk to come out of the stomach and button. This means that babies who have problems with gas may not do well.

4.  A special tube fits in the Button for the feeding. It is removed and the outside flap is closed after each feeding.

ADVANTAGES OF THE BUTTON

  1. You remove the feeding tube after the feeding.
  1. It looks better.
  1. Tube care is easy. You do not need to measure the tube or use special adhesive dressings.
  1. You have fewer skin problems.
  1. It lasts longer. The Button generally lasts 3-4 months before it needs to be replaced. The one-way valve not working is the most common reason the Button needs to be changed.

DISADVANTAGES OF THE BUTTON

  1. You must take the baby to the doctor if the tube comes out or use a Foley Catheter until another Button can be inserted.
  1. The valve that stops the formula from coming back up in the feeding tube may get clogged and the tube may stop working.
  1. The feeding tube may become disconnected if your baby is active during feeding.

INSERTING THE BUTTON

  1. The Button may be inserted in the doctor’s (surgeon) office or in the hospital.
  1. Your baby is given pain medicine before the Button is inserted. It stings when the stoma is stretched before the Button is inserted.
  1. The doctor uses a guide to stretch the Button out so it can be inserted through the stoma and into the stomach.
  1. Your baby will be fussy several hours after the Button is inserted. The doctor may have you use Tylenol® or pain medicine to make the baby comfortable.

a.  Only give the baby the medicine the doctor tells you to.

b.  The baby will recover by the next day, if he has not; call the baby’s doctor.

  1. The stoma may be weepy or bleed slightly the first day or two.
  1. Turn the Button in a complete circle each time you feed the baby the first 3-4 days after the Button in placed—or—follow the instructions of the doctor.

BUTTON CARE

  1. Flush the tube and Button with 3—5 cc’s of tap water after each feeding. This will stop the Button from getting clogged up as easily.
  1. Clean the inside of the Button with a Q-Tip® and tap water daily.

SKIN CARE

GENERAL INFORMATION

1.  Plan to do the cleaning before feeding the baby.

2.  Gather all equipment before beginning care:

a.  Mild soap (such as Dial® or Ivoryâ or Johnson’s Baby soap)

b.  Warm water

c.  Cloth to wash skin

d.  Cloth to dry skin.

3.  Wash your hands.

4.  Wash the skin with soap and water 1-2 times a day.

5.  Rinse well with clear water.

6.  Pat the skin dry and leave open to air for about 15 minutes.

a.  Do not rub the stoma or the skin around it as this may irritate the area and/or make it bleed.

7.  Inspect the skin for redness or bleeding. If the skin is weepy or if a rash is present, see the section “care of irritated skin” for more information.

IF YOU HAVE A G-TUBE (FOLEY CATHETER)

You will also need the following supplies:

Scissors

Hy-tape ½ inch (Pink Tape)

Stomahesive® or D-TAD

IF YOU HAVE A BUTTON

1.  Gather all equipment before beginning care.

2.  Wash your hands.

3.  Wash the skin with soap and water 1-2 times a day.

4.  Rinse well with clear water.

5.  Pat the skin dry and leave open to air for about 15 minutes.

a.  Do not rub the stoma or the skin around it as this may irritate the area and/or make it bleed.

6.  Inspect the skin for redness or bleeding. If the skin is weepy or if a rash is present, see the section “care of irritated skin” for more information.

7.  Turn the Button a quarter (¼) turn 1-2 times a day. This will change the position of the feeding tube each time.

CARE OF IRRITATED SKIN

WEEPY SKIN METHOD #1

  1. If the skin is weepy or blistered, wash the area with water. Pat dry.
  1. Apply a thin layer of calamine lotion as follows:

a.  Do not shake the bottle.

b.  Let lotion sit until the water comes to the top of the bottle.

c.  Pour off the top water and use the thick pink cream that settled to the bottom

d.  Apply a THIN layer and let it dry to a pink powder.

  1. Place D-TAD or Stomahesive dressing over the dried powder layer.
  1. Call the doctor if the area is not better in 1 week.

WEEPY SKIN METHOD #2

  1. If the skin is weepy or blistered, wash the area with water. Pat dry.
  1. Sprinkle Stomahesive powder on weepy skin.
  1. Dust off extra powder. A cosmetic brush (used only on the baby) works well.
  1. Apply D-TAD or Stomahesive dressing.
  1. Repeat every 3-4 days until skin is healed.
  1. Call the doctor if the area is not better in 1 week.

RASH

  1. If skin looks like it has “prickly heat” or “diaper rash,” wash the area with water. Pat dry.
  1. Apply a THIN coat of Aseptin™ or Micro-Guard™ cream.
  1. Massage the cream into the skin for at least 2 minutes and let dry.
  1. Apply the D-TAD or Stomahesive dressing.
  1. Repeat every 2-3 days until skin is healed.
  1. Call the doctor if the area is not better in 1 week.

CARE OF GRANULATION TISSUE

  1. A build-up of red or pink skin around the stoma and tube is called granulation tissue.
  1. This tissue may become irritated and bleed.
  1. The area may become moist and gushy until the granulation tissue is gone and the area healed.
  1. Clean the area around the G-Tube or Button 2-3 times a day with a solution made of half hydrogen peroxide and half water.
  1. It is helpful to cut a larger hole in the Stomahesive. This lets you clean the area while it is healing.
  1. A tape bridge will keep the tube taped to the Stomahesive and let you clean without changing the Stomahesive dressing often. (see Dressing Change section)
  1. The D-TAD can also be used.
  1. Call the doctor if the area is not better in 1 week.

Note: Granulation tissue is usually due to excessive moisture so it is very important to keep the skin around the stoma as dry as possible and to identify the cause of the excessive moisture.

DRESSING CHANGES

STOMAHESIVE® DRESSING

1.  Change the Stomahesive dressing 2 times a week.

a.  Change the dressing immediately and check the site if

·  The area has an odor (smells badly)

·  You see drainage

·  There is redness and/or swelling.

2.  Gather all your supplies before you begin.