Gastrostomy Tubes

1
Gastrostomy Tubes

• Karen Rankin
• karenr_at_chw.edu.au
• Clinical Nurse Consultant
• November 2008

2
(No Transcript)
3
Anatomy
Can be placed intragastrically or via the jejunum
4
Surgical placement
Laparotomy (open procedure as above) Percutaneous
Endoscopic Gastrostomy PEG
5
Gastrostomy Tubes
6
Buttons (low profile)
Each brand has different requirements some have
a flange and some have a balloon which needs to
be checked regularly
7
Complications
Cellulitis or infection

• What is your role?
• check regularly
• report any changes
• observe for redness (can be caused from
  leakage)
• observe for signs of discharge

8
Hypergranulation (proud flesh)

• Overgrowth of tissue around the stoma
• Causes
• non-specific
• tube too loose or too tight
• Treatment can include
• cauterise
• application of copper sulphate crystals
• steroid based creams
• may require medical review

9
Giving Feeds

• Hand washing is a priority
• Use clean equipment
• Decompress the gastrostomy
• Ensure feed volumes meet nutritional
  requirements
• Give feed slowly using gravity
• Medication must be well crushed or dissolved
• Avoid giving using for pureed foods

10
Giving Feeds
Decompress
Attach syringe
Add feed
Give feed using gravity
11
Troubleshooting the tube

• Tube dislodges or is accidentally removed
• replace tube within 30-60 minutes
• have patient seek medical advice urgently
• Tube blocks
• check the tube for kinks
• gently massage the tube between fingers
• gentle pull-push action with warm water
• 5-10 mls infants
• 10-20 mls children

12
Troubleshooting the tube

• Leakage from around the tube
• ensure balloon is inflated properly
• wash around tube with warm soapy water,
  rinse dry
• may need protective dressing or ointment

13
Feeding Complications

• Dehydration ? give more water via tube
• Constipation ? ensure prescribed formula
  fluid is given
• Diarrhoea ? ensure not caused by medication,
  check infusion rate,
  ensure storage and
  preparation of formula is hygienic
• Aspiration ? cease feed, ensure sitting upright
  at least 30 and remain
  upright for 30 minutes
  after feed
• Nausea ? sit upright, give feed at room
  temperature, slow down feed or
  seek medical advice

14
Any questions?