Steps for medication administration
- Wash hands
- Pull up medications in separate syringes
- If tubing or extension set has 2 ports, always insure that they are capped to prevent meds from spilling
- Prime extension set with water
- Add extension set (if used) to G-tube
- Attach syringe with medication to G-tube/extension set port
- Unclamp G-tube/extension set
- Give medication through medication port. Medication should go in easily; do not force
- Clamp between medications and water flushes
- Flush with a small amount of water (1 to 2mL) in between each medication
- Flush afterward with recommended amount of water
- Remove and wash extension set (if used)
- Wash syringes with soap and water and allow to air dry
Medications are the most common cause of a clogged tube
- Only give one medication at a time
- Flush with water between and after meds
- Use liquid medications whenever possible
- Check with MD or pharmacist before crushing pills
- If crushing pills, do so into a fine powder
- and mix with warm water to dissolve
- If medications are thick, dilute in water
- Pull up medications in separate syringes
- Wash extension sets after each use
- Throw away the extension set if it becomes stiff or cannot be cleaned well
- Change extension sets at least weekly
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Tips for adjusting to a
gastrostomy tube
- The feeding plan you start with will change over time
- The healthcare team will work with you to develop a plan that fits your family’s needs and fits with your child’s school, appointment, and sleep schedule
- Activity- most activities including tummy time are allowed
- Ask your team what to do if your child misses a feed. They can help determine where is the best place to fit it in
- Be prepared: always make sure you have enough formula and supplies
- If your child is not taking food by mouth, it is still important to keep the mouth clean
- Brush 2 times per day
- Floss 1 time per day
- For infants, wipe the mouth and teeth with a soft moist cloth at least once a day
- Your child needs to keep the connection between the mouth being used and the stomach getting full. If your child is allowed to have food or liquids by mouth, it is important to offer an oral feeding each time your child gets a tube feeding. If your child is not able to eat by mouth, oral stimulation (or a pacifier for infants) can be offered during tube feedings
- Talk to your healthcare team about other ways to provide for your child’s oral development
Preventing Infection:
- Wash your hands every time you handle the tube, formula, or supplies
- Wash out the bag or place it in the refrigerator between feeds as instructed by your enteral supply company
- Use a new bag every day
- Good oral hygiene prevents bacteria from moving down the airway and causing pneumonia
- Raise the head of the child’s bed to prevent reflux
Securing the tube
- Tape
- Pin to clothes with tape and tabs
- Dress infants in onesies
- Tuck shirts into pants for older children
- Ace wrap
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Newly placed G-tube falls out
Possible Problem
- Accidental dislodgement
- Balloon malfunction
What to do
- Don’t panic
- See emergency kit
- Notify your doctor immediately
- Do not feed through the emergency tube
How to avoid
- Secure extension set in use
- Remove extension set when not in use
- Cover tube so it doesn’t get pulled
Redness, irritation, pain, bleeding (a small amount of drainage is normal)
Possible Problem
- Leaking of formula around tube
- Friction or pulling on the tube
- Infection
What to do
- Make an appointment to see your doctor
- Use barrier cream on the skin around stoma
How to avoid
- Wash hands every time you touch the tube
- Check the skin every day
- Clean the skin 1 to 2 times each day
- Keep any dressing clean and dry
- Notify your doctor if drainage is thick, yellow/green, or foul smelling or if redness /irritation spreads
Leaking at the site
Possible Problem
- Stomach is too full
- Tube fit is too loose
- The balloon has lost water
- The balloon is not up against the stomach wall
What to do
- Slow the feeding rate
- Check amount of water in the balloon
- Use barrier cream to protect skin
- Use dressing to absorb drainage
(short term solution only)
How to avoid
- Vent G-tube
- Make sure balloon has right amount of water
Vomiting/retching and/or Distended abdomen
Possible Problem
- Feeding intolerance
- Too much air or gas
- Stomach too full
What to do
- Vent G-tube before and after feeds or medications
- Slow feed
- Decrease amount given each feeding (may need to give an extra feed to give same daily amount)
How to avoid
- Vent G-tube (see page 20)
- Watch for early cues that your child is uncomfortable
- Use Farrell bag if instructed
Clogged G-tube
Possible Problem
- Medication/Formula stuck in G-tube
What to do
- Attach syringe with warm water
- Use slow Push-pull method to try to unclog G-tube
- Repeat every 10-15 minutes
- Call your doctor if you are unable to clear the clog
How to avoid
- Give medications correctly
- Flush well before and after medications
- See page 21 for tips to avoid clogging G-tubes
Excess pink or red tissue around the stoma
Possible Problem
- Hypergranulation tissue
What to do
- Not dangerous
- Is very common
- The doctor may decide to treat
How to avoid
- Stabilize G-tube/extension set at all times to decrease friction
- Prevent pulling on G-tube
- Keep stoma clean and dry
- Clean with soap and water every day
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Can my child swim or take a bath?
- After 2 weeks, the gastrostomy tract should be healed enough for your child to take a bath or swim in chlorinated water (pool)
- After 4 weeks, your child can swim in lakes, rivers or the ocean
- Clean the gastrostomy site immediately after swimming
- Water may leak into your child’s This is ok for most children
- You may cover the G-tube with a large Band-Aid if desired
Can my child lay on the gastrostomy?
- Yes, after the site is fully healed and no longer tender
- Infants can lie on their stomachs for tummy time
- Older children can sleep on their stomachs
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The opening will start to close within 2 hours, and may be completely closed by 24 hours, so it is important to have a kit ready to use.
What to do if the G-tube falls out:
Don’t panic. Call the doctor immediately.
If the G-tube is newly placed, and you have not yet been seen in the pediatric gastroenterology (GI) clinic, call pediatric surgery 916-734-7844. After 5 p.m. or on weekends or holidays, call the Hospital Operator at 916-734-2011 and ask for the on-call pediatric surgery to be paged.
If you have been seen by a pediatric gastroenterologist, but have not yet learned how to replace the G-tube, call the pediatric GI clinic at 916-734-5912. After 5 p.m. or on weekends or holidays, call the Hospital Operator at 916-734-2011 and ask for the on-call pediatric gastroenterologist to be paged.
If you are unable to reach the doctor by phone, go the nearest emergency room.
Do Not Give Feedings or Medications Through the Emergency Tube
- 2 replacement emergency tubes will be in your emergency kit.
- One tube is the same size as your child’s gastrostomy tube and the other tube is one size smaller.
- The emergency tube is inserted to keep the stoma and gastrostomy tract open
- Always carry the kit with your child
- Never force the tube into the stoma. Try the smaller size tube if needed.
- Do not take more than 10–15 minutes to try to insert the Emergency tube
- Do not inflate the balloon on the emergency tube
Supplies:
- 2 tubes, 1 the size of current G-Tube and 1 a size smaller
(this tube is often called a Foley) - Water soluble lubricating jelly
- Tape
- Catheter plug
Steps:
- Do not panic!
- Wash your hands
- Put a small amount of water soluble lubricating jelly on the end of the emergency tube
- Gently insert the emergency tube 2-3 inches into the stoma\
- Tape the tube to the skin so that it won’t fall out
- Do not give ANYTHING (formula, water, or medications) through the emergency tube
- Call the doctor or go to the nearest emergency room
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Important points
- Be sure your child’s teachers, school nurse, and PE teacher know about the gastrostomy tube
- Always carry your emergency kit
- Do not use meds that are out of date
Call your doctor if your child has signs and symptoms of dehydration:
- No urine in 12 hours for toddlers
- No urine in 8 hours for infants
- Crying without tears
- Very dry mouth or cracked lips
- Sunken soft spot (infants less than 1 year)
- Your child is more sleepy than usual
- Your child feels dizzy
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- Abdomen: Area of body below lungs that contains stomach, intestines, liver and other organs
- Aspiration: Accidentally inhaling liquid (such as stomach contents or formula) into the windpipe and/or the lungs
- Bolus: A large amount of formula delivered through the G-tube
- Enteral nutrition: Giving food directly into the stomach or intestines through a feeding tube
- Esophagus: The muscular tube that connects the mouth to the stomach
- Fontanel or soft spot: Area on a baby’s head where skull has not yet grown together
- Flush: An amount of liquid used to clear formula or medication from the G-tube into the stomach
- Gravity: A force which allows liquids to flow from a higher point to a lower point
- Prime: To fill up tubing with liquid
- Rate: How fast the formula is to be given; for example, an amount of milliliters per hour
- Reflux: Movement of stomach contents up into the esophagus
- Stoma: Surgical opening through which a feeding tube enters the body
- Tract: Path from the stomach to the abdominal wall that forms around the gastrostomy tube
- Vent/Venting: Letting the air or gas out of the stomach
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