They are feeding tubes that are placed through the abdomen into the stomach.
Gastrostomy tubes give formula, fluids, and medications to children. These tubes are placed by a Pediatric Surgeon or by a Pediatric Gastroenterologist. A gastrostomy tube is placed in two ways: 1) percutaneously and 2) surgically.
At hospital discharge, a referral will be made for a nurse to visit the patient’s home. The nurse will help you take care of the gastrostomy tube and give you food and medicine, and, in general, it will serve as a resource in the patient’s home.
The pediatric surgeon places a gastrostomy tube in the operating room under general anesthesia. This operation is done through a small incision (cut) in the abdomen. The surgeon can place a temporary tube, called Malecot, into the gastrostomy opening. The Malecot will be sewn to the skin and left in place for several weeks.
The Malecot allows the gastrostomy tract to heal well before inserting a balloon-type gastrostomy tube. A Malecot line is approximately twelve inches long, and most of the box extends outside the abdomen.
After placing the gastrostomy tube, the child will remain in the hospital for observation and care. An intravenous (IV) line will be placed in the operating room before the procedure, administering fluids, antibiotics, and analgesics while your child is recovering. The feeds are usually started the day after the gastronomy is placed.
After a few weeks, the surgeon or surgical nurse will remove the Malecot and place a gastrostomy tube with a balloon at the skin level. These tubes are made of silicone. They hold in their stomach a balloon full of water.
When the nurse inserts the device, she will teach the child’s representative how to care for the tube.
Percutaneous endoscopic gastrostomy tube (PEG)
Gastronomy tubes, peg tube, a PEG tube, or percutaneous endoscopic gastrostomy tube is placed by a pediatric gastroenterologist in the operating room. The GEP tube is inserted with a telescopic instrument called an endoscope.
The endoscope is a small tube with a light and a camera at the end that allows the gastroenterologist to see the esophagus (food tube) and the stomach. The endoscope allows the doctor to choose the best location in the stomach to place the GEP tube. Once the site is selected, a small opening is made in the outer part of the abdomen towards the stomach.
After opening, the upper part of the GEP tube is pulled out of the stomach through this opening. The upper part of the tube rests on the skin, and the lower part of the PEG, which is bulbous, remains inside the stomach. This bulb shape anchors the line in the stomach and prevents it from coming out.
After placing the GEP tube, the child will be admitted to the hospital for observation and care. The stay in the hospital is usually three days. Before the procedure, an intravenous line (IV) will be placed in the operating room.
This will be used to administer fluids, antibiotics, and pain killers, for one or two days, as your child recovers. The feeds will be started through the GEP tube within one or two days.
The GEP tube, made of silicone, should remain in the stomach for about three months to allow the tract (hole) to heal between the abdomen and the stomach. The parcel must be well cured so that it is safe to change the gastrostomy tube.
If the child needs continuous feeding with the gastrostomy tube, the GI or surgical nurse will order a pump and supplies from a home care delivery company. The equipment and supplies will be delivered to your home or hospital before the child is discharged.
The child’s parent will be taught to use the pump by a representative of the home care company or the home nursing agency since the pumps differ from hospital to hospital.
The GI or surgical nurse will order feeding bags, replacement gastrostomy tubes, extension sets, syringes, gauze, tape, and formula for your child.
General feeding guidelines
Administer food and medications as directed by your nurse or doctor. Rinse the gastrostomy tube with 10-15cc warm water after each feeding or medication. This prevents clogging and keeps the box as clean as possible.
If you are feeding continuous drip feed into a GEP tube, you may want to connect it with tape to prevent the tube extension set disconnection and spilling from the outlets.
If a balloon gastrostomy is being used, such as an AMT mini-one tube, the volume of water in the balloon should be checked weekly and refilled as necessary to maintain the amount of water prescribed by the doctor or nurse ( Do not do this until at least two months after the tube was initially placed).
What happens if the tube comes out before the gastrostomy tract has healed?
It rarely happens with a PEG tube and sometimes with Malecot gastrostomy tubes or balloons. If the line accidentally comes off, call the med for instructions.
If a doctor or nurse is not contacted after thirty (30) minutes, the child and gastrostomy supplies should be taken to the nearest emergency room to reinsert the tube. A tube will be placed in the gastrostomy tract to avoid closure and the need for another operation.
If doctors and nurses in the emergency room have questions, they can call the pediatric gastroenterologist or the surgeon who placed the tube.
If you do not have a replacement gastrostomy tube to carry, you can insert a FOLEY catheter of the same size or smaller as a replacement tube. It will often be necessary to take a special x-ray called a “gastrostomy tube dye study” to ensure that the newly placed line is in the stomach.
A FOLEY catheter can be used to feed and decompress the stomach at home. Call your GI or surgical doctor or nurse if your child requires a visit to the emergency room to care for your gastrostomy tube.
What should be done with the following problems?
Redness around the site
The skin may be slightly pink after the initial insertion. You should see a decrease in this pink color over time. Call the nurse or doctor if the skin becomes sensitive, warm, or red.
The drainage that dries on the skin is called a scab. Scab formation and drainage are standard in gastrostomy tubes. It can eliminate crusting and drainage with warm water.
If the tube is hit or rubbed, there may be a small amount of blood around the box. Applying pressure should stop the bleeding for up to ten minutes. If bleeding does not control, call the child’s doctor or nurse. The blood that enters the tube is not normal. You should contact the child’s doctor or go to the nearest emergency room if this happens.
Granulation tissue appears in most children at some time after the gastrostomy tube is placed. This tissue is common and not dangerous. It grows directly around the gastrostomy orifice and looks elevated, red, and may ooze fluid or bleed easily.
The granulation tissue should be treated when it first appears. Your child’s nurse or doctor can do this in the office. An ointment or special cream will be prescribed to apply to the granulation tissue (not the surrounding skin) up to four times a day until the granulation tissue disappears.
If a child has a fever, you should call the pediatrician.