Hi, my name is Katelynn Maniatis, and I'm a registered dietitian here
at Sunnybrook. Over the next few minutes, we will be discussing
methods of insertion, benefits, care
and feeding of gastrostomy or G tubes.
The gastrostomy or G tube is a feeding tube
that goes through the skin and abdominal wall and allows
liquid nutrition and medications to be
administered directly into the stomach.
G tubes provide a route to deliver nutrition and medication to those who
are having difficulty swallowing
or cannot take enough food by mouth. G tubes help prevent weight loss,
maintain nutritional status and
minimize risk of aspiration. Individuals with cancer,
ALS or those who have had a stroke or trauma
often required G tubes.
Oral intake is encouraged even after G tube insertion.
G tubes can provide liquid nutrition formulas
as either a sole source of nutrition or
to supplement oral intake.
G tubes may be placed by gastroenterology
or interventional radiology. Gastroenterology will insert a
percutaneous endoscopic gastrostomy tube
or PEG tube using an endoscope
which travels through the mouth down the esophagus and into the stomach
to guide tube insertion. Interventional radiology
will use x-ray technology to aid in the insertion
of the tubes. G tubes can be inserted on an inpatient or outpatient basis.
Before your G tube is inserted, you'll be advised not to have anything to eat
for midnight before the night of the procedure. Following tube insertion,
you'll be instructed to either drink clear fluids such as water or apple juice
or be provided with IV fluids to maintain hydration.
Following an abdominal examination by your physician
you'll be able to begin using the G tube
and resume oral intake of regular solid foods
if appropriate.
If swallowing function improves
or risk of aspiration is minimized transitions can be made back to
oral intake. Tubes can be removed and the removal procedure will vary depending on
the method of insertion.
Clean the skin
under the tab and around the tube every day with a Q-tip dipped
in normal saline. Imagine the Q-tip is an arm on a clock
and clean in a clockwise manner around the tube. When you're in the shower
clean the skin around the tube with a mild soap and water and ensure that you
dry the area completely when you're done.
Do not take baths and gauze
dressing is not necessary unless you're having drainage from
the tube site. Clean the tube and stoma site daily.
Wash your hands thoroughly before
completing any tube checks and ensure that you're gently lifting the sides of the tube to
examine the skin around the area.
Signs of infection include fever,
redness, tenderness and
any discharge that may be discolored
or foul-smelling. Secure the free end of the tube
with tape on the abdomen or with a stretch gauze band.
Check to see if the mark on your skin is at the same point
as it was when it was initially placed. Do not pull on the tube
because it can dislodge.
There are two methods that can be utilized when feeding through the G tube:
syringe feeding and feeding by gravity.
Remember to sit in an upright position during feeding and for 30 to 45 minutes
after feeding to prevent regurgitation. The first step would be to wash your
hands thoroughly.
Next, fill the syringe with 60 millimetres of
lukewarm water. Strain out the feeding tube
and check tube placement. The mark on the tube should be the same place as when it
was placed
initially. Hold the tube above stomach height
or pinch the tube and open the stopper or tube tip.
Place the tip of the syringe into the end of your feeding tube
and plunge the water through the tube. Cap the tube tip.
Now you're ready to set up your feeding set.
The first step is to shake the formula well. Make sure you wipe off the top of
the formula can with a clean damp paper towel
and don't forget to check the can for the expiration date.
Close the roller clamp so this means you'll be rolling the clamp down
on the feeling set. Pour the desired amount of formula into the bag
and hang it above head level. Remove the plastic cover
from the tip of the feeding set and insert the tip of the feeling set
into your feeding tube. Open the roller clamp,
so roll it up, to start the feeding. You can adjust the rate that the feed runs
through by opening and closing the ruler clamps. So just simply roll it up or
down
to slow down or speed up the rate. At the end of feeding, close the roller clamp and
disconnect the feeding set from the feeding tube.
Finally flush your tube with 60 millimetres of lukewarm water
and close the feeding tube.
You would follow the same steps to flush your tube with water
as you would if you were using a gravity feeding. The next step would be to
fill the syringe with formula the same way in which you would with water.
Open the tube tip and place the tip of the syringe
into the end of your feeding tube and slowly push the formula in.
Refill the syringe until you've used the desired amount of feed.
After feeding, run another 60 milliliters of
lukewarm through the tube to flush it clear. Hold the tip above stomach
level
or pinch the tube and disconnect the syringe from the tube.
Close your feeding tube.
Medications can be administered through the feeling tube
but just check with your pharmacist to ensure that your medications
are crushable and don't require a liquid form,
which may also be available. Ensure that you're flushing with
water before and after medication administration
and do not mix the medications with the feeding
formula. After feedings,
clean the syringe parts with warm soapy water
and let them air dry. A bottle brush may be useful for cleaning the syringes.
Once per day, soak the syringe parts as well as the feeding set
in a mixture of a quarter cup of vinegar and one cup of water
for five minutes. Rinse with fresh water
and ensure that you're allowing this fresh water to run through the tubing
of the feeling set. Store the supplies
in a container or zip lock bag in the refrigerator
to decrease the risk of bacterial growth.
Do not put substances other than medications or tube feeding formulas
through the tube as they may cause blockage. Sometimes
medications and feeding formula can get stuck
in the tube and cause blockage. This is why you want to ensure that you're
always flushing the tube before and after administration.
If you do see that there is some build up in your tube
when you're flushing, try and apply a bit more force or pressure with that syringe
that you're flushing through.
If this doesn't relieve the blockage then
contact your health-care professional.
Do not pull on the tube because it can dislodge.
If your tube does fall out, it needs to be replaced
as soon as possible. Clean the area and cover with a sterile gauze pad
and come to the hospital as soon as you can.
Always sit upright in a chair or in bed
when feeding. Cover your formula cans
and store them in the refrigerator for up to 24 hours
after they've been opened. If you have a feeling
of uncomfortable fullness or bloating
slow down the rate of feeding. If you're using
a feeding set roll that roller clamp down
to decrease the rate and if you're syringe feeding
then slow down the force or the rate that you're
pushing through the formula. For more information
speak with your registered dietitian or visit the clinical nutrition section
of the Sunnybrook website.