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Thursday, December 4, 2008

Gastrostomy tubes and feedings: A parent's guide

Gastrostomy care

Flushing after feedings and medications

At the end of each feeding and after every medication the tube must be flushed or rinsed with 5 to 10ml of water. This prevents the tube from becoming clogged with formula or medication.

NOTE: When possible have your physician order the medications that you will be giving through the tube, in liquid form. Some pills can be crushed, mixed with water, and given through the tube. However, when capsules are opened, they will clump together in the tube and may clog it.

Venting the gastrostomy tube

Children with reflux who have a fundoplication may have difficulty with gas pain. To relieve this, attach a 30cc or 60cc syringe, without the plunger, to the tube for 10 to 15 minutes after each feeding — this will allow air to escape. Children who are receiving continuous feedings may have their feeding interrupted for 10 minutes every 3 to 4 hours for venting.

Baths

Children can take a bath 4 days after the operation. Change the dressing after the bath if it is wet or loose and no longer stabilizing the tube.

Tummy time

After gastrostomy surgery, avoid placing your child on his stomach for at least 2 weeks. It is ok if the child rolls unassisted onto his stomach and seems to tolerate the position. Your child may resume physical therapy one week after the operation but should not be placed on his stomach or on a ball during therapy for 3 weeks.

Dressings and skin care

Cleaning around the gastrostomy tube

  • Clean the skin around the tube daily with a wash cloth, gauze or a cotton swab moistened with water.
  • Do not use hydrogen peroxide or alcohol around the tube.
  • Ointments such as Bacitracin or Neosporin are not necessary and are generally discouraged.

Dressings or bandages: securing the tube

There are several dressings used to secure the gastrostomy after surgery. The dressing is very important because it:

  • Holds the tube in place allowing the gastrostomy site to heal.
  • Decreases the chance that the tube will be pulled out accidentally.
Malecot or de Pezzar tube

Malecot or de Pezzar tube

Malecot tube dressing changes

General information

  • Use the Hollister drain tube attachment device.
  • Change every 5 to 7 days or sooner if it has come loose from the skin.
  • Between changes, clean around tube with cotton tip applicator (Q-tip).

To remove old tube holder

  • Squeeze top of holder and push strap back through slot OR unclip the clip.
  • Gently remove holder from skin and throw away.
  • Wash skin with water, or soap and water.

To apply new holder: See pictures in the packaging of the dressing

  • Remove paper from inner area of holder. Leave outer paper ring in place.
  • Split tube along pre-cut line.
  • Place on skin around tube.
  • Wrap strap around tube and insert into slot.
  • Pull gently on strap until it squeezes the tube slightly.

NOTE: Push down gently on tube as the strap is tightened to prevent the tube from being pulled up too tightly against stomach wall.

  • Tuck extra strap into slot.
  • Remove outer paper from paper tape and tape to skin.

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