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Gastrostomy
A gastrostomy is a surgically created path through the abdominal wall into the stomach. A gastrostomy tube ("G-tube") is a gastric feeding tube, passed through a gastrostomy, designed for the administration of liquid nutrients, fluids, or medications. G-tubes are placed in children who are unable to orally consume enough calories to maintain adequate nutrition and growth or who are at risk for aspiration of oral feedings due to difficulty with oro-pharyngeal control, esophageal motility, and/or gastroesophageal reflux. [Sleigh: 2004]
- Stamm gastrostomy - open surgical procedure
- Janeway gastrostomy - laparoscopic procedure
- Percutaneous Endoscopic Gastrostomy (PEG) - endoscope or image-guided radiography to insure proper g-tube placement
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| from Gastrostomy placement (MedLinePlus) | image of a "gastrostomy button" in place, from Royal Children's Hospital, Melbourne, AU |
Mic-Key gastrostomy tube
- Contains an internal, inflatable balloon which holds the g-tube in place and prohibits displacement
- The balloon is breakable, so g-tube changes are required more frequently than the Bard
- The valve is located on the outside of the body
- Relatively easy to change
- Has a feeding adapter locking mechanism
- Contains a mushroomed shaped tip which prevents displacement
- The mushroom tip is less likely to break than the MIC-Key balloon tip, and therefore needs to be changed less frequently (once per year)
- The valve is located inside the stomach, making the Bard less noticeable than the Mic-Key
- More difficult to change
- Does not have a feeding adapter locking mechanism
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| a Mic-Key button, image from Royal Children's Hospital, Melbourne, AU |
a Bard button, image from Royal Children's Hospital, Melbourne, AU |
Bathing
- Parents should clamp the g-tube or close the valve prior to bathing the child.
- Avoid overtly hot water, which could irritate the surrounding skin.
- Use mild soaps and soft washcloths to avoid further irritation and abrasion.
- Granulation tissue represents a foreign body reaction in the skin surrounding the g-tube. It is red/pinkish inflamed epithelial tissue.
- Excess granulation tissue can be removed by topical application of silver nitrate sticks
- Care should be taken to select the appropriate formula – consultation with local nutrition experts or pediatric gastroenterology may be helpful.
- Formula, milk and water are the only fluids permissible to use through a G-tube.
- The child should always be held upright during a feeding.
- Oral stimulation (chewing, sucking on pacifier) is recommended during the feed to promote normal development.
- Participation at the dinner table, or routine family eating activities should be performed during a G-tube feed to promote socialization.
- The G-tube should be flushed with water after each feeding to avoid obstruction due to drying of residual formula or medications. Recommended flushes are 5-10cc of water for infants and 15-30cc of water for older children.
Placement
- Major complications in a retrospective cohort of 208 patients with gastrostomy placement by interventional radiology included peritonitis (3%), and death (0.4%). [Friedman: 2004]
- Minor complications in this cohort included tube dislodgement (37%), tube leakage (25%), and g-tube skin infection (25%). [Friedman: 2004]
- Children can pull-out their g-tube directly or indirectly through contact while playing.
- Dressing children in a "onesie," a one-piece undershirt with the tube tucked inside, or placing the end of the tubing under the tabs of a disposable diaper can help avoid the tube being pulled out.
Resources
Information & Support
For Professionals
When a G-Tube is dislodged
From the Hasbro Children's Hospital Surgery Handbook – a detailed explanation of what to do when a new (<2 month old) G-tube
becomes dislodged. This is for professionals and includes symptoms of dislodgement.
For Parents and Patients
Support
Parent to Parent G-Tube Tips
Parents of children with feeding tubes share problems and offer successful tips.
General
Gastrostomy Tube Home Care (Cincinnati Children's Hospital)
Parent instructions on caring for a gastrostomy tube. Includes cleaning, flushing, giving meds, venting, protecting and problem
solving
Gastrostomy Feeding by Syringe
From the Cincinnati Children's Hospital website, instructions for parents on gastrostomy feeding. Includes explanation, supplies,
procedure and safety tips. Also available in Spanish.
Ostomy Care
(
246 KB)
transcript from 2007 Medical Home conference call; provides information about ostomy care and resolving problems with gastrostomy
tubes; includes a "Let's Talk About" on gastrostomies.
Tube Feeding with Gravity Feeding Set
Information about gastrostomy-jejunostomy tubes from Cincinnati Children's Hospital Medical Center.
Services
Pediatric Gastroenterology
See all Pediatric Gastroenterology services providers (2) in our database.
For other services related to this condition, browse our Services categories or search our database.
Page Bibliography
Friedman JN, Ahmed S, Connolly B, Chait P, Mahant S.
Complications associated with image-guided gastrostomy and gastrojejunostomy tubes in children.
Pediatrics.
2004;114(2):458-61.
PubMed abstract
Heyman MB, Harmatz P, Acree M, Wilson L, Moskowitz JT, Ferrando S, Folkman S.
Economic and psychologic costs for maternal caregivers of gastrostomy-dependent children.
J Pediatr.
2004;145(4):511-6.
PubMed abstract
Patrick J, Boland M, Stoski D, Murray GE.
Rapid correction of wasting in children with cerebral palsy.
Dev Med Child Neurol.
1986;28(6):734-9.
PubMed abstract
Sleigh G, Brocklehurst P.
Gastrostomy feeding in cerebral palsy: a systematic review.
Arch Dis Child.
2004;89(6):534-9.
PubMed abstract / Full Text