Studentdate of Birth Bus

Studentdate of Birth Bus

StudentDate of Birth Bus

SchoolGrade Teacher(s)

Parent/GuardianHome CellWork

A gastrostomy is a surgical opening into the stomach through the surface of the abdomen. A flexible rubber tube (G-tube) or a gastrostomy-feeding device (G-button) is placed into the opening and allows for nutritional formulas, fluids, and/or medications to be delivered directly to the stomach. The device remains in place at all times and is closed between feedings to prevent leakage of the stomach contents. Feedings are given by either the bolus (over 10-30 min.) or continuous method (adjusting flow rate, using tubing valve or pump). An adapter with tubing is connected to the G-button for feeding. The gastric device may also be used to release air/gas and to measure/drain residual gastric contents. /
G-Tube

Written healthcare provider orders/directions and parent/legal guardian permission and provision of formula are required for tube feeding at school. Ready-to-feed commercial formula is recommended. Homemade blenderized formula recipes risk inaccurate mixing, which may alter the nutrients and calorie content; separation of solids and liquids in the solution, which may clog the tube; and contamination due to improper handling, preparation, or storage. If a blenderized formula is brought to school, it should be refrigerated until mealtime and warmed to room temperatureby holding the container with the formula under warm water for several minutes. A microwave should not be used for this procedure due to its uneven heat distribution.

Procedure / Points to remember
  1. Wash hands.
/ Anticipating the tasks to be done, the risk involved, and the personal protective equipment needed will enhance protection of both the caregiver and student.
  1. Assemble equipment:
  • Formula at room temperature
  • 60-ml/cc catheter-tipped syringe or other container for feeding (e.g., bottle, bag)
  • Clamp or cap for end of tube (optional)
  • Water, if prescribed  Feeding pump, if prescribed
  • Tape  IV Pole (optional)
  • Gloves
/ Identify size and type of G-tube.
Some students get cramps if the feeding solution is too cold. Shake can well to mix. Check expiration date.
Water is used to flush tubing after feeding.
Tape is used to secure the G-tube to clothing.
  1. Explain the procedure to the student at his or her level of understanding. Encourage the student to participate as much as possible.
/ By encouraging the student to assist in the procedure, the caregiver helps the student achieve maximum self-care skills.
  1. Position student.
/ Student may be sitting or lying on right side with head elevated at a 30-degree angle. When positioning student, make sure clamp is not pressing on skin.
  1. Wash hands. Put on gloves.

  1. Check G-tube site for redness, tenderness, swelling, irritation, presence of pus, bleeding, or leakage.
/ Report abnormal findings to the school nurse, immediately. Notify the parent/legal guardian.
  1. If checking the residual is ordered:
  • Insert the catheter-tipped syringe (with barrel/plunger) to the G-tube.
  • Unclamp the tubing and gently drawback on the plunger to remove any liquid or medication that may be left in the stomach.
  • Return residual to stomach.
  • Clamptubing, disconnect the syringe, and remove plunger from syringe.
/ Note the amount. Adjust the feeding volume according to healthcare provider’s orders, if a residual is present. If the residual is greater than recommended, hold feeding, wait 30–45 minutes, and check again.
  1. Reinsert catheter tip of syringe into tubing.

  1. Unclamp tube, and allow bubbles to escape.

Procedure for gastrostomy tube (G-tube) feeding: gravity bolus or continuous feeding by pump method (continued):
Procedure / Points to Remember
If medications are prescribed, administer before or after feeding, according to student-specific orders in IHP.
  1. The feeding may be delivered by syringe, bag, or bottle.
Feeding Bag:
  • Clamp the tubing on the feeding bag and add room-temperature formula to the bag; then unclamp and allow formula to fill the tubing to the tip; then, re-clamp. Hang bag on pole.
  • If using a pump, place tubing into pump mechanism and set for proper flow rate.
  • Connect tubing of feeding bag with G-tube.
  • Unclamp tubing on feeding bag.
  • If not using a pump, adjust flow rate, using clamp on feeding tube or raising/lowering the bag.
  • If using a pump, press start.
  • When bag is empty, clamp feeding bag tubing.
/ Be alert to any unusual changes in the student’s tolerance of the feeding. Nausea/vomiting, cramping, or diarrhea may indicate that the feeding is being given too quickly or the formula is too cold.
For continuous feeding, add more formula when bag is empty.
Feeding with Syringe:
  • Remove plunger from feeding syringe and insert catheter tip of syringe into G-tube.
  • Pour room-temperature formula into the syringe.
  • Elevate syringe and unclamp tubing.
  • Continue to pour feeding into syringe as contents empty into stomach.
  • Raise or lower syringe to adjust flow rate as ordered.
/ Syringe should be held 6 inches above level of stomach or at prescribed height. Keep syringe partially filled to prevent air from entering stomach.
  1. Flush tubing, after feeding.
Feeding Bag:
  • Add enough lukewarm water to feeding bag to clear formula from tubing and flush the tubing.
  • Clamp feeding bag tubing.
  • Remove the feeding bag from G-tube.
Syringe:
  • Pour prescribed amount of water into syringe and flush tubing.
  • Remove the feeding syringe, after flushing the tubing with water.
/ Water will clear tubing of formula and medications. Flushing the G-tube with water after a feeding prevents clogging.
Depending on the age and capabilities of the student, have him or her assist with the feeding by holding syringe or pouring fluid into it.
  1. If burping/venting the G-tube is ordered: Connect 30-60 ml catheter-tipped syringe with barrel/plunger removed to the G-tube. When finished, remove barrel of syringe.
/ Burping/venting allows the tubing to be open to air and release of gas bubbles from the stomach.
  1. Clamp tubing and reinsert cap into end of tubing.

  1. Apply dressing, if needed, using standard precautions.

  1. Remove gloves. Wash hands with soap and water.

  1. Make sure tubing is secure and tucked inside clothing, not inside diaper or underpants.
/ Tubing may be taped to shirt.
  1. Refer to student-specific guidelines regarding position and activity after feeding.

  1. Wash catheter-tipped syringe and other reusable equipment in soapy water. Rinse thoroughly, dry, and store in a clean area.
/ Most open formula is good for 48 hours when refrigerated. The exceptions are some elemental formulas that are only good for 24 hours. Open formulas should be stored in clean plastic, labeled containers (not the original can) in the refrigerator. Formula should be discarded after 48 hours.
  1. Document feeding, residual amount, and feeding tolerance on feeding log. Document medication on medication administration record/log.
/ Report to school nurse and parent/legal guardian any changes in the student’s usual feeding tolerance pattern.
Possible problems that are an emergency and require immediate attention
Observations / Reason / Actions
Facial color changes and/or Breathing difficulty / This may be due to aspiration of feeding into lungs. /
  • Stop feeding immediately.
  • Call nurse, if not present.
  • Continue to assess situation.
  • Institute Emergency Action Plan, if problem continues.
  • Call 911.
  • Notify parent/guardian.

Possible problems that are not emergencies and require contacting school nurse and parent
Observations / Reasons / Actions
Nausea and/or cramping / Feeding rate may be too fast and/or feeding formula may be too cold. /
  • Check rate of feeding; decrease, if too fast.
  • Check temperature of formula; if too cold, stop feeding, let formula get to room temperature, then administer.
  • If problem continues, contact school nurse and parent/legal guardian.

Vomiting / Same as above or student may have an illness. /
  • Same as above.
  • If all of the previous items have been checked, stop feeding.
  • Call school nurse and parent/legal guardian.
  • Remove residual, if ordered.

Blocked G-tube / May be due to inadequate flushing or very thick fluid. /
  • Never force fluid through the G-tube.
  • Try a catheter-tipped syringe filled with warm water, held high to facilitate movement of fluid.
  • Try to draw back plunger of syringe.
  • If blockage remains, notify school nurse and parent/legal guardian.

Redness, soreness, irritation, bleeding, pus, or drainage around G-tube site / Leaks don’t usually cause problems except minor irritation. Infection may be present f the stoma site is red, sore, swollen, and/or leaking pus or blood. /
  • Make sure tubing is not too loose/not being pulled.
  • Check G-tube site for leakage of feeding/medication; if present, clean stoma site/skin with soap and water.
  • Refer to student- or equipment-specific guidelines for cleaning instructions.
  • Notify school nurse and parent/legal guardian of gastrostomy site problems.

G-tube falls out / G-tube may be pulled by accident. /
  • Cover the site with a dry dressing or large bandage.
  • Do not attempt to replace tube or place anything else in the tract.
  • Notify school nurse and parent/legal guardian.
  • The G-tube will need to be reinsertedonlyby trained personnel to prevent closure of tract.

The healthcare provider needs to be called, if:
Stoma red, sore, swollen, or bleeding Pus leaks from stoma Fever without a cause (cold) Pain during feeding Vomiting

Copies to designated staff and EAP Notebook. File original in IHR.Revised Feb. 2016

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