Gastrostomy Tube Placement
What is a gastrostomy tube?
A gastrostomy tube, also known as “g-tube”, is a small feeding tube that is placed in the stomach for feeding or decompression. G-tubes are placed surgically or straight through the skin (percutaneously). Surgical placement is either laparoscopic or open and can accompany other procedures. G-tubes are placed in infants and children with conditions that affect their nutrition such as failure to thrive, malnutrition, feeding intolerance or swallowing difficulties. They can be temporary or permanent and, if needed, can be left in place for a long time.
Types of G-tubes/Placement:
Percutaneous endoscopic gastrostomy (PEG) tubes are most commonly performed in the operating room (OR) with a surgeon and/or a gastroenterologist. It requires that the infant or child be under general anesthesia. A lighted, flexible “scope” is passed down the mouth and into the stomach. The scope is aimed outward and the light at the end of the scope is visible from the outside of the abdomen. A small incision is made in the abdomen, over the light seen within stomach and the tube is threaded through the mouth and into the stomach with the external part outside and the internal part inside the stomach. This tube is usually left in place for at least 6-8 weeks before change can be considered. The removal and replacement of the low profile button can be done in clinic without any anesthesia in most children. In unusual cases where a child is not felt to be a good candidate for gastrostomy change in the clinic, a minor procedure in the operating room (under light anesthesia) can be arranged. Tubes placed using the PEG technique can be “low-profile” or longer tubes. Most tubes placed with this technique are held in place with a plastic “mushroom” that prevents inadvertent removal rather than having balloons to hold them in place.
Low profile button: These are placed in the OR using either open or laparoscopic techniques. The laparoscopic technique is performed using a camera to be able to see the procedure from inside the infant’s or child’s abdominal cavity. An opening is made in the stomach and the tube is placed into the opening and stitched in place. A common low profile button is known as the Mic-Key button although many brands are available. A low-profile button can be held in place with a balloon (as seen in the example below) or it can be a non-balloon button that has a mushroom or other anchor to hold it in place.
What will happen in the hospital?
- You will receive education on how to care for the g-tube.
- The g-tube should be cleaned 1-2 times/day with a mild soap (usually Dove) and warm water, around the g-tube site. It is important to thoroughly dry the area to prevent skin breakdown.
- The g-tube should be turned several times a day, also to prevent skin breakdown and causing a depression in one area.
- Your child will be started on feedings via the g-tube, slowly, and advanced as tolerated prior to discharge. The necessary pumps, etc. will be ordered for use at home.
When will my child be discharged?
- Infants and children who undergo g-tube placement are admitted after surgery and discharged 1-3 days post operatively unless other medical problems need to be managed. After you feel comfortable with the g-tube teaching and your child is able to tolerate the feedings without any complications, he/she can be discharged. If the tube is placed along with another major surgery, discharge will occur when appropriate. This should be discussed with your surgeon.
- Someone from a skilled nursing agency will come in to teach the parents how to use the feeding pumps at home.
What will be my child's recovery?
Each child has a different recovery, but for the most part children resume their normal/baseline activity level within 48-72 hours. Children will receive Tylenol and/or Motrin for pain or discomfort and should only need this for a few days.
What should I be looking out for after the operation?
Tube dislodgement: This is the most important problem to look for. If this were to happen, it is imperative that you bring your child to the Emergency Room as soon as possible. If you have been given instruction on how to replace the tube, this should be done but should not delay a trip to the hospital. The longer it takes to replace the tube, the faster the hole can close down, making it difficult to re-insert a new tube.
Leakage: This is a common problem and often self-limited. Too much leakage means your child is not getting the adequate nutrition provided. If you notice leakage, call the Pediatric Surgery office to speak to someone on staff. The feeds may need to be slowed down or the tube might be too loose.
Break in tube or plastic: Gastrostomy tubes are plastic and not indestructible. If the plastic is torn or if a connection appears broken, contact the Pediatric Surgery office to schedule an evaluation. It is likely that the tube will be changed. Please bring the spare tube with you if available.
Weight loss: If your child is losing weight, he/she may not be getting the correct amount of feeds, which can either be a nutrition problem or a mechanical problem associated with the g-tube.
Granulation tissue: Common complication with g-tubes. This is healthy tissue that comes out of the opening in an effort to close the hole. It is pink/red and fleshy in appearance. This is not an emergency. The child can be brought into clinic to have it evaluated and cared for with Silver Nitrate application.