g tube care guide!

A Guide for Parents G-tube Care at Home childrensMN.org

- 1 - Your child’s gastrostomy information Tube information Brand:______________________________ Size:___________ Date of insertion: ___ / ___ / ___ Balloon volume: __________ ml (if applicable) Feeding method and schedule See your child’s discharge summary for details on the following. Be sure to ask if you do not have this information: r Bolus feedings: What to feed: _____________________ Amount: _________________________ How often: _______________________ r Continuous feedings: Type of pump:_____________________ What to feed: _____________________ Amount: _________________________ How often: _______________________ Pump rate: _______________________ r After feeding, flush tube with ____ ml of room-temperature water. r After feeding, vent for ____ min. r If you give extra water: ____ ml ____ times per day. r Check residual every ____; call if more than ____ ml. Medicine See your child’s discharge summary for medication information. • If medication and feeding are due at the same time, give medication first then feed your child. • Prepare medication according to pharmacy guideline. • Flush tube with ____ml of water. • Give medicine. • F lush tube again with ____ml of water. Understanding units of measure - Cans of liquid food are measured in fluid ounces (fl. oz.) and milliliters (ml). - Measuring cups can show amounts in ounces (oz.) or milliliters (ml). 1 ml = 1 cc 1 fl. oz. = 1 oz. = 30 ml 1 cup = 8 oz. = 240 ml What is a gastrostomy? A gastrostomy (stoma) is a surgical opening made through the skin of the abdomen (belly) and into the stomach. A feeding tube (called a gastrostomy tube or G-tube) is placed through this opening. This allows food and medicine to be given directly into the stomach instead of through the mouth. Giving feedings this way can be done safely at home. The gastrostomy tube can be permanent or temporary. Tube feedings will help your child get enough nutrition to grow, develop, recover from illness, play, and learn. Your child may need a gastrostomy for any of the reasons below: r cannot swallow safely r blockage of the esophagus r abnormal function of the stomach r cannot take enough food by mouth r __________________________________ Gastrostomy Care for G-tubes

- 2 - When should I call for help? Call the doctor if: • redness, pus-like drainage, or bad smell around the stoma • temperature higher than 101°F • continued upset stomach, vomiting, or gas • diarrhea for longer than 24 hours • constipation (hard, painful bowel movements) • bleeding around stoma • fussiness, hard to console • coughing that does not stop • continued increase in abdomen size • residuals are more than the recommended amount for 2 feedings in a row • blood in the residual • tube is accidentally pulled out and you don’t know how to replace it • tube breaks off or is cut off • trouble inserting the tube • tube is too short or too long and you cannot adjust it • leaking around stoma (more than a quarter-sized amount between cleanings) • tube is clogged and you cannot unclog it • trouble breathing - Call 911 • rash or irritated skin around the gastrostomy site • increase in granulation tissue around stoma Phone numbers Primary doctor _____________________________ Gastroenterologist ___________________________ Surgeon ___________________________________ Dietitian___________________________________ Emergency room____________________________ Feeding clinic_______________________________ Home care nurse ____________________________ Medical equipment company___________________ Occupational therapist ________________________ Speech-language pathologist ___________________ Resources Family Resource Centers Minneapolis campus Phone: (612) 813-6816 St. Paul campus Phone: (651) 220-6368 National Digestive Diseases Information Clearinghouse • www.digestive.nddk.nih.gov Oley Foundation • www.oley.org Others: ____________________________________________ ________________________________________ _______________________________________ _________________________________________ Who to contact

- 3 - There are many kinds of feeding tubes, but they all have the same basic parts. • a bumper or balloon inside the stomach to keep the tube from coming out • a stabilization device against the skin, to keep the feeding tube from moving • numbers or marks on the feeding tube so you can tell whether the tube has moved • ports: openings on the outside end of the gastrostomy tube, used to give food or medicines, or to fill the inside balloon with water. There may be 1, 2, or 3 ports. Ports have a flip-top cap that can be closed off when not in use. Ask your nurse to go over the type of device your child has and what each port is for. What kind of feeding tube does my child have? side view close up Your child has this type of device: r Percutaneous endoscopic gastrostomy (PEG) : the first gastrostomy tube placed in surgery. It has 1 or 2 ports and a plastic bumper inside the stomach to secure it. r Gastrostomy tube (or “G-tube”) : has 2 or 3 ports, and a balloon filled with water inside the stomach to secure it. It is placed after the PEG is removed. r Skin-level gastrostomy tube (or “button”): this device lies flat against the skin and has a balloon inside the stomach. This device is sometimes called a “MIC-KEY,” which is a brand name. An adapter tube called an extension set has 2 or 3 ports and is used to give the feedings and medicines. Notes about your child’s device and ports: extension set

- 4 - What will I need to know? Caring for a child with a feeding tube may be a little scary at first. With practice, feeding and caring for your child can be simple and comfortable for you both. Your nurse will teach you and help you become comfortable with your child’s care before you take him or her home. These are the special things you will need to learn: • clean the gastrostomy site • protect the gastrostomy • give feedings through the feeding tube • give medicines through the feeding tube • care for the equipment • help your child develop oral skills • watch for problems and know what to do if they occur There are many variations in these tasks. Please follow the checked instructions specific to your child in this booklet. Sometimes changes must be made based on your child’s needs. How will I care for my child? Supply List Keep these items on hand at home: r clamp or gastrostomy plug r clog zapper, if used r cotton-tipped applicators r extra gastrostomy tube r extension set (for skin-level devices only) r feeding bag, tubing, and pump (for continuous feedings) r gauze drainage sponges r clean cloths r lubricant, if desired r measuring container with pouring spout r mild, pH-balanced soap r stabilizers, if used r syringe, ______ml (catheter-tip) r syringe, 5 ml r white vinegar r wipes or waterless cleanser r Y-adapter repair kit, if used Caring for your child with a gastrostomy tube will require supplies. Here is a list of items that you will need to keep on hand at home. What can I expect after surgery? The anesthesiologist and surgeon will prescribe and explain the medicine that will be used to keep your child comfortable. Your child will have an intravenous line (IV) to provide fluids and pain medicine. At first the gastrostomy tube will not be used for feeding. This is because anesthesia makes the intestines stop working for a while. The doctor will decide when feedings can be started depending on what other procedure may have been done in surgery. Once started, feedings will progress slowly. Safety Precautions Be aware the feeding set tubing can get wrapped around a child's neck, which could lead to strangulation or death. When running a feeding for your child, place the tubing in a way the tubing cannot get tangled around your infant or child. Place the tubing through your child's clothing or towards the foot of the bed. This will help the tubing from getting wrapped around your child's neck if they are to turn or move. If your child is injured by feeding set tubing, report the event to the FDA at DICE@FDA.HSS.GOV or call 1-800-638-2041.