Caring for the G-tube and the tube site
Use the following instructions to care for your child's gastronomy tube (G-tube).
Note: Always wash your hands before and after handling your child's G-tube.
- Monitor the site for infection: It is important to inspect the tube site every day. You should check for signs of infection (fever, redness, swelling, cloudy drainage, and/or hardening around the site). It is particularly important to observe for infection during the first week after placement.
- Dressing: The doctor will remove the dressing at the appropriate time. Unless clearly otherwise instructed, you should leave the dressing off. If your tube site has a lot of drainage, blot the area with a clean cloth and warm water, dry well and repeat as needed to keep the area clean and dry.
- Bathing: Once a day, wash around the G-tube with a wash cloth, warm water, and mild soap. Be sure to rinse all of the soap off. Dry the skin well. It is okay to shower or bathe on the day after the tube was placed unless it was placed in surgery. If your child's G-tube was placed in surgery, follow the instructions of the surgeon. No special creams or soaps are recommended for routine care.
- Rotate the tube: For the first week after the tub is placed, rotate the tube one-quarter turn several times per day, unless the tube is sutured in place. If you find that the tube swivels back to its original position, try tucking the tube in your child's diaper or put a piece of tape around the tube and pin it to your child's clothing. Do not put tape on your child's skin. After the first week, continue to rotate the tube once per day.
- Check the tube's position: Check the position of the G-tube every day by measuring its length with a measuring tape. This will be helpful if you develop problems down the road.
- Flush the tube: Always flush the G-tube with 5-15 CCs of water before and after use. Contact your doctor if you are unable to flush the tube.
After 6-8 weeks with the G-tube, your doctor may change the tube to a low profile gastrostomy device, also known as a Mic-key or Button.
What to do if the G-tube comes out
Do your best to keep the G-tube from getting yanked or caught on something. If the G-tube gets tugged, it might come out. The opening in the skin (stoma) can close up very quickly (within two hours). If the G-tube comes out, you can replace with a Foley catheter. You should receive a Foley catheter before you leave the hospital. Always have a Foley catheter available.
If the G-tube comes out, use this procedure to replace it with the foley catheter:
- Do not panic.
- Wash your hands.
- Lubricate the end of the foley catheter. If you are unable to find lubricant just wet the end of the catheter's tube.
- Slide the foley about three inches into the hole. Tape the catheter to your child's skin so that it won't fall out. Once you have the foley in the hole, you are in good shape.
- Call your doctor. If your doctor is not available, go to the emergency room. Note: Do not use the tube for medications or feedings until it is checked by medical personnel.
Feeding with the G-tube
- Before you feed with the G-tube, gather the equipment you will need:
- Formula
- Water to rinse the tubing
- Syringe or feeding pump and bag
-
Wash your hands
-
Flush the G-tube with 5-15 CCs of water before and after use.
-
Image
Fill the syringe with the measured amount of formula.
-
Attach the pump or the syringe to the G-tube.
-
Unclamp the G-tube.
-
Image
A gentle push with the plunger of the syringe may be necessary to start the flow of formula; then remove the plunger and allow gravity to take over.
-
Hold the syringe at the height necessary to flow at the desired speed. Do not feed too fast. Most feedings take about 20 minutes.
-
Continue adding formula to the syringe until all the desired amount has been fed.
-
Add a small amount of water before all the formula has flowed out of the syringe to flush the tube.
-
Clamp the G-tube and close the little cap.
Frequently asked Questions
How will the hole for the G-tube look?
The opening from the abdominal skin into the stomach is not a "natural opening" and will be "oozy" for weeks to months. Eventually, the skin will grow down into the hole and it will look completely healed.
How will the hole look if it is infected?
Serious infections at the G-tube site occur only during the first few days after insertion. If there is an infection, your child will have a fever and the tube site will get swollen. Pus may come out of the G-tube hole. The crosspiece around the G-tube will be very tight. This needs treatment and you need to call us right away.
After the first week, if there is an infection, it will be a minor one. The skin will be red and moist. You may apply an over-the-counter antibacterial cream such as Bacitracin or Neosporin. If the cream is helping, the skin will look better within two days. Sometimes the infection is fungal, and you can try a cream such as Micotin or Lotrimin. This should also work within two days. If neither of these creams helps, your child should be seen by us or your local doctor's office.
The most common reason for redness or crustiness at an old G-tube site (older than six months) is the that the G-tube is too loose or too tight. Mild skin infections can also occur. If over-the-counter creams do not heal the rash, please call our office.
As the G-tube tract is healing, granulation tissue often forms. It can be lumpy and red and can ooze small amounts of bloody yellow fluid. This is the body's healing response working too hard. Sometimes applying over-the-counter hydrocortisone cream makes it go away. If not, your local nurse or doctor or our group can apply special treatments that help.
Is there anything special I should be doing with the G-tube?
When the G-tube is placed the crosspiece is kept tight for the first days. Your doctor may decide this needs to be loosened at the end of the first week. The skin will look pink and raw where the crosspiece touches it. During the first week, be sure to rotate the crosspiece every few hours when your child is awake so the pressure is not always on the same spot.
How do I clean the area around the G-tube?
Your child may bathe the day after the tube is placed. The tube site may get crusty throughout the day. Clean the site with warm water as needed. A washcloth will work fine. Once a day, use bath soap to clean the site. Rinse well afterwards.
What should I do if the G-tube comes out accidentally?
If the G-tube comes out, the hole may close over within a few hours, so something needs to be back in the hole as soon as possible. If you are uncomfortable dealing with this problem, take your Foley catheter to a nearby emergency room or your doctor's office. If that is not a choice, you must try to place it yourself. For instructions for placing the Foley catheter, see "If the G-tube comes out," above.
Do not use the Foley tube for medications or feedings until it is checked by medical personnel. If the G-tube comes out too soon, the stomach wall may not have sealed to the abdominal wall. This means the end of the Foley tube could be inside the abdominal cavity and not in the stomach. You do not want to put formula into the abdominal cavity. If the G-tube has come out too early or anyone has difficulty re-inserting a tube, we must make sure the tube is inside the stomach. This can be done by seeing stomach juices come back out of the tube or by an X-ray.
What should I do if the G-tube gets clogged?
If the tube is clogged, try flushing it with cranberry juice or Coke. Put as much of the fluid into the tube as you can. Then clamp the tube and leave it for two hours. Then try flushing the tube again. Call your doctor if you are unable to unclog the tube. Never put anything rigid into the tube.
Page reviewed on: Sep 28, 2004