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Hi. I'm here today to discuss gastrostomy tube or g-tube education with you. A g-tube
is a silicone tube that's placed in your child's abdomen through a hole in the stomach made
by the doctor. Your child probable has a g-tube because they are unable to eat enough food
by mouth to supply a good amount of calories for their body to grow at a normal rate. There
are many different types of g-tubes. Our clinic chooses to only use buttons. A button is a
small tube that lies close to your child's skin on the outside, and has a removable extension
tube that is used form feeding, administering medications and venting or burping your child.
So we will review how to take care of your child's g-tube and the skin around it, common
problems, how to feed and administer medications though the tube, how to vent or burp your
child through the g-tube, and what to do if the tube comes out.
So are you ready to get started? Let's go! So this is the BARD, low profile non-balloon
device. By low profile I mean it sits close to your child's skin on the outside. Non-balloon
meaning it is held into place by a stump or mushroom piece. It does have a removable extension
tube that's used for feeding and administrating medications. It comes with a spate decompression
tube that is used for venting or burping your child, but don't worry about that we will
get to it later. The thing to remember about these is that neither one of them lock into
place meaning the tube could pop out during a feed. It does have an anti-reflux valve
to prevent stomach contents from leaking out of the tube. Typically we like to see the
BARD button replaced once per year if there are no issues before then. It can be done
in the surgery clinic. It is quick and easy. It may be uncomfortable for your child, but
we will do everything we can to keep them as comfortable as possible.
So this is the MIC-Key low profile, balloon device. By profile, again, I mean it sits
close to your child's skin on the outside. Balloon meaning it is held into your child's
stomach by a balloon filled with 5mL of water. It also comes with a separate removable extension
tube that's used for feeding, administering medications and venting. The tube locks into
place making it secure during feeds. Typically we like to see the MIC-KEY button replaced
every 6-9 months if there are no issues before then. It can be done in the surgery clinic,
and is quick, easy, virtually painless for your child.
So the last g-tube we use in our clinic is the MINI-ONE low profile, balloon device.
It's virtually the same as the MIC-KEY, the only difference is that it has a smaller profile
on the outside. How to care for the G-tube and the skin around
it The most common questions I get in regards
to g-tubes are how to take care of the skin around it. It's important to keep the skin
clean and dry, and to look for signs of redness and irritation after each feeding. Your routine
should be simple, and the less products you use the better. What I like to do is take
3 cotton swabs with plane soap and water. You will start by dipping the first cotton
swab in the soap and water. Start underneath the g-tube all the way around, and work your
way out. The second swab dipped in plane water with the same motion, start underneath the
g-tube all the way around and work your way out. The third swab is a dry one. Same motion,
start underneath the g-tube and work your way out. It's important to turn the g-tube
half a turn after each feeding to prevent it from indenting into the skin, and causing
redness and irritation. Common Issues: Drainage and Granulation
Even though you have kept your child's g-tube nice, clean and dry there are some common
problems that can occur; sometimes we don't have an answer for it. The most common problems
are drainage and granulation tissue. Starting with drainage, it can be cream, yellow
or brown in color. It could be due to the fill volume of the g-tube. Make sure to check
the balloon in the button. Make sure it is filled with 5mL of water. It also may be due
to your g-tube being too tight or too loose. Drainage can also occur out of the center
of the g-tube which could be due to a stuck anti-reflux valve. If this occurs flush it
with 30mL of water may help prevent that from happening. Leakage can cause the skin to be
irritated and red around the g-tube. If this happens make sure to use a barrier cream,
and leave it open to air as much as possible. Granulation tissue is excess tissue that can
grow underneath the skin underneath your child's g-tube. It can be very annoying for parents
as it does not go away on its own. It appears as dark red and bleeds easily. One treatment
you can use at home is tea tree oil. You can apply it to the granulation tissue 2-3 times
a day for 2 weeks. You have to be pretty consistent with it. If the granulation tissue does not
go away after that give the surgery clinic a call and we can treat it with silver nitrate
or a steroid cream. Granulation tissue may interfere with the position of the g-tube,
and cause stomach contents to leak out. It's important to take care of the granulation
tissue when you first notice it as it will not go away on its own.
How to feed through a G-tube There are two way s to feed through a g-tube,
the first being continuous feeding, which is over several hours or all the time. The
second being bolus feedings which is a shorter feeding typically over 20-30 minutes. Both
are easy to do, and your child's nutrition doctor will set up their feeding schedule
before they leave the hospital. Any questions in regards to feedings you'll contact the
gastroenterology nutrition department. If your child has a MIC-KEY button it comes
with two different types of tubes in the kit. The first one is a longer skinnier tube that
can be used for continuous feedings, and the second is a shorter fatter tube that can be
used for bolus feedings. In order to feed through the MIC-KEY button you will open the
flap on the g-tube, line up the two black markings (one on the button and one on the
tubing), push it in, turn your tubing clockwise, and you will notice it locks into place. When
your feeding is finished in order to disconnect, turn your tubing counterclockwise, line up
the two black markings, and pull the tubing out. Don't forget to close the flap on the
g-tube. If your child has a BARD non-balloon device,
in the kit comes 3 different tubes. The first one is a longer skinnier tube that can be
used for continuous feedings, the second is a shorter fatter tube that can used for quick
bolus feedings, and the third is a separate decompression tube used for venting your child.
The decompression tube looks very similar to the feeding tube, the difference being
it has a longer piece on the end the plugs into the button. In order to feed though the
BARD you'll open the flap on the button, simply push in the extension tubing, and that's it.
When your child's feeding is done to disconnect, simply pull out, and close the flap on the
button. Cleaning the MIC-KEY, MINI ONE, and BARD extension
tubing can be done easily with just plain soap and water. Allow them to air dry. Tubing
can last several months if taken care of properly. How to give medicine through a G-tube
Giving medication through your child's g-tube is fairly simple, but there's a few things
you should know. Most liquid medications can be given through the g-tube, but must be flushed
with 5mL of water after. You should never give medication and food together. Always
give them separately, and be sure to flush with 5mL of water after.
So I am going to show you, really quick, how to give medication through the g-tube. You
will open the flap on the button, insert your extension set, turn clockwise (now the MIC-KEYs
and MINI ONEs there is a separate medication port on the side), give your medication, clap
the tube, hook up your 5mL flush of water, unclamp the tubing, push it in, clamp your
tubing back, and disconnect your extension set. Don't forget to close the flap on the
g-tube. How to" burp" or "vent" a G-tube
Just like burping a baby, you will need to burp or vent your child's g-tube. This will
help to release the air out of the stomach making your child feel less bloated. If your
child has had a Nessen they are unable to burp on their own, and will need to be vented
after each feed. It's a good idea to vent about a half an hour to an hour after feeding.
The MIC-KEY button is simple. You will use the same extension tube you used for the feeding.
Undue the flap on the button, reinsert your feeding extension tube, place a syringe without
the plunger into the feeding port, unclamp, hold for a few minutes or until you hear air
release. Once you are done, disconnect and close the flap on the button.
For the BARD button don't forget that there is a separate decompression tube that you'll
need to use. It's the one with the longer end that you actually insert into the button.
Push it in, and you will do the same thing. Insert a syringe without the plunger into
the tubing, hold for a few minutes or until you hear air release, and disconnect.
Reinserting the G-tube Parents tell me all the time that one of the
scariest moments that has happened to their child with the g-tube is when they have walked
into their room and they have notice that the g-tube is out laying in the bed, or when
the school calls and says that the g-tube has accidentally been pulled out. There is
a good chance that this could happen to you at some point, don't panic, we are going to
run through the steps of how to reinsert the g-tube on your won.
If your child has a MIC-KEY or MINI ONE balloon button and it's come out the first thing you're
going to want to do is wash it off with soap and water, and then you need to check the
balloon. To do that you will insert 5mL of water, and check to see if there is a leak
or hole in the balloon. If it holds water, simply pull the water back out, and then we
are going to reinsert it into the hole in the stomach. If it does not hold water it
is still OK, you can reinsert it. Take some lubricant, reinsert into the hole in the stomach,
and refill the balloon with 5mL of water. If you did notice it had a hole or was popped
simply tape it into place. Before using it for feeding again just remember that it's
important to give the surgery department a call and let us know what happened, and we'll
give you further instructions. If your child has a BARD button that has come
out, don't panic, you're going to use the catheter that comes in your emergency g-tube
kit to replace the hole in the stomach. You'll lubricate the catheter insert into the hole
in the stomach only about 2 inches and tape into place. When done give the surgery clinic
a call for further instructions. If you are unable to reinsert the g-tube or
the catheter it is important that you give the surgery clinic a call, or take your child
and the g-tube to a children's emergency room. This is important because the hole in your
child's stomach can close in little as 20 minutes.
We've reviewed a lot of information, but there are just a few more things that you should
know. As your child grows, and their weight fluctuates their g-tube may need to be longer.
If your child's tube is too snug or too loose give the surgery center a call, and schedule
for a g-tube change. It's an exciting time when your child's nutrient doctor tells you
that they no longer need their g-tube because they are able to take enough food by mouth.
After the tube is removed the hole should close on its own. We recommend that you use
a barrier cream and a bandage for the first 48 hours. If you notice that after 4-6 weeks
that the hole has not closed it may need to be done surgically.
I hope you are feeling more comfortable taking care of your child's g-tube. The sooner and
more often you participate in their care and feedings the more confident you will be. Good
luck! I know you can do this!