g tube care guide!

- 2 - When should I call for help? Call the doctor if: • redness, pus-like drainage, or bad smell around the stoma • temperature higher than 101°F • continued upset stomach, vomiting, or gas • diarrhea for longer than 24 hours • constipation (hard, painful bowel movements) • bleeding around stoma • fussiness, hard to console • coughing that does not stop • continued increase in abdomen size • residuals are more than the recommended amount for 2 feedings in a row • blood in the residual • tube is accidentally pulled out and you don’t know how to replace it • tube breaks off or is cut off • trouble inserting the tube • tube is too short or too long and you cannot adjust it • leaking around stoma (more than a quarter-sized amount between cleanings) • tube is clogged and you cannot unclog it • trouble breathing - Call 911 • rash or irritated skin around the gastrostomy site • increase in granulation tissue around stoma Phone numbers Primary doctor _____________________________ Gastroenterologist ___________________________ Surgeon ___________________________________ Dietitian___________________________________ Emergency room____________________________ Feeding clinic_______________________________ Home care nurse ____________________________ Medical equipment company___________________ Occupational therapist ________________________ Speech-language pathologist ___________________ Resources Family Resource Centers Minneapolis campus Phone: (612) 813-6816 St. Paul campus Phone: (651) 220-6368 National Digestive Diseases Information Clearinghouse • www.digestive.nddk.nih.gov Oley Foundation • www.oley.org Others: ____________________________________________ ________________________________________ _______________________________________ _________________________________________ Who to contact

- 5 - Cleaning the gastrostomy site The stoma, or opening in the skin, heals very slowly. It may take several months. Stabilizing the tube can help healing. Careful skin care is essential. Until the site is healed, the skin around your child’s stoma needs to be cleaned twice a day, such as with the bath, before a feeding, and as needed if drainage occurs. Once the site is healed, it can be cleaned once a day, and as needed. 1. Wash your hands well with soap, using friction. 2. Have all supplies together, ready to use: • cotton swabs such as Q-Tips® • mild, pH-balanced soap and water • washcloth and dry towel • gauze drainage sponges (if applicable) 3. Remove the old gauze, if present. 4. Check for drainage. A smear of blood or a bit of clear yellow drainage is normal. If drainage has increased, is cloudy, yellow or green, or smells bad, call the doctor. 5. Gently clean around the gastrostomy site with water and mild, pH- balanced soap, rolling a cotton swab around it to remove any drainage. Clean the stabilizer and the G-tube, too. Rinse and dry the area well. 6. Check the skin around the stoma. If there is increased redness or skin growth, call the doctor. 7. If there is a little bleeding or drainage at the site, place gauze under the bumper. Change it as needed to keep the site dry. 8. Clean the feeding port by vigorously swishing it in warm soapy water. Rinse with clean water. 9. To keep the tube from being pulled, wrap a piece of tape around tube, leaving a tape tag. Use a safety pin to pin the tag to the child’s clothing. Wrap a piece of tape around the clasp of the safety pin to keep it from popping open. (Your child’s health care team may recommend another type of tube stabilizer.) Gastrostomy site care Protecting the gastrostomy site It is important to keep the tube stable so it does not shift. Movement prevents healing, and can lead to leaking or tube slippage too far into the body. Some tubes have a stabilizer that rests on the skin to keep the tube from sliding in and out of the opening. If your child’s tube does not have one, a separate stabilizer can be used, such as Flexi-Trak®. The stabilizer may be used for the first 4 weeks after the tube is placed to promote healing. It may also be used if your child develops problems such as skin redness or drainage. The replacement feeding tube and the skin-level device have their own stabilizing devices and you will be shown how these work. Changing a stabilizer Do this once a week, or sooner if it is coming off. 1. Wash your hands well with soap, using friction. 2. Have all supplies together, ready to use: • supplies for cleaning the site (see left) • stabilizer • gauze drainage sponges, if applicable 3. Remove the old stabilizer, and gauze if present. 4. Open the stabilizer package and have it ready. 5. Clean the gastrostomy site (shown on left). 6. Pull gently on the tube to snug the bumper against the stomach wall. 7. Apply the stabilizer, following package directions. There should be no pulling on the tube. To give your child a tub bath with the stabilizer in place, you may want to use waterproof tape to secure the edges.

- 8 - Bolus feedings are given over a short period of time. Refer to this section only if you have been told to give your child bolus feedings. 1. If your child has a skin-level device, connect the extension set. 2. If recommended, check the residual (amount of stomach contents left over from the last feeding). To do this, insert a syringe into the feeding port and pull back on the plunger to bring stomach contents into the syringe. Keep pulling back until no more fluid comes out. Measure the amount, record it, and then gently push the contents back into the stomach. 3. Put the syringe (without plunger) into feeding port. 4. Pour part of feeding into the syringe. 5. Unclamp the tube. 6. A gentle push of the plunger may be needed to start the flow. Try to start the feeding when the child is calm. • A pacifier may help calm an infant. • For older children, use activities to distract them, or involve the child with the feeding, such as holding the syringe. 7. Allow the feeding to flow by gravity. Do not force it. • During the feeding, the bottom of the syringe should never be held higher than 6 inches above the child’s stomach. • Lower the syringe at times to allow air bubbles to escape, or to slow the feeding. • If your child is crying, you may need to repeat the gentle push with the plunger several times. 8. Continue adding formula to the syringe until the entire amount is given. 9. When the last part of the feeding is in the syringe tip, flush it with ___ ml warm water to keep it from clogging (refer to amount on page 1). After the bolus feeding • If directed by your doctor, allow air to escape by venting (leaving the tube open to air). Tape a piece of gauze over the syringe to keep fluids from splashing out. Vent for ________min. (see page 1). • Plug or clamp the tube. • Burp your child, unless a nissen fundoplication has been done. The upper body should stay raised for at least 30 minutes after feedings, whether your child is sleeping or awake. Bolus feedings (Note: Conventional G-tubes do not have the extension set - the feeding port is directly connected to the tube.)

- 11 - Problem solving What if the gastrostomy tube comes out? The stoma will not close up right away, but a new tube should be put in within 2 to 3 hours. 1. Place a diaper or cloth over the stoma to absorb any fluid. Some stomach contents might ooze out of the opening, and the site may bleed a very small amount, especially if the tube was accidentally pulled out. Apply gentle pressure to stop the bleeding. 2. If this is the first time the tube has come out, or you have not been taught how to replace the tube, call the doctor’s office. You will be instructed to take your child to the office or emergency room to have a new tube put in. Bring along your gastrostomy travel kit with a new gastrostomy tube. If you do not have a new tube, bring the one that came out. The doctor will need to know the type and size your child uses. How do I replace the gastrostomy tube? Once the gastrostomy site has healed, the doctor or nurse may teach you to replace the tube or skin level device at home. Change the tube if: · it is plugged and you cannot unclog it. · the tube comes out. · your child has pulled the tube out. To replace the gastrostomy tube: 1. Wash your hands well with soap; rub to create friction. 2. Have all supplies together, ready to use: r extra gastrostomy tube r clamp or plug, if used r lubricant, if desired r stabilizing device, if used r 5-ml syringe r tape r 2 clean cloths r water 3. Measure the new G-tube against the old one. Put a mark at the same level with a permanent marking pen. (This step is not needed with a skin-level device.) 4. Check the new gastrostomy tube by filling the balloon with 5 ml water. Be sure it does not leak. 5. Remove the water from the balloon. 6. Wet the tip of the tube in tap water or lubricant. 7. Put the tip into the stoma. 8. Gently push tube into the stomach until the mark is at skin level. 9. Fill the balloon with the correct amount of water (see balloon volume on page 1). 10. Gently pull tube to position the balloon against the wall of stomach. Pulling the tube too tightly will cause the opening to enlarge and formula may leak out around the tube. 11. Clamp or plug the tube. 12. Apply stabilizing device. 13. Check the tube for correct placement. For a skin- level device, insert an extension set and listen for air and check for residual stomach contents.

- 14 - General Care Activity Your child should be able to do normal activities. Be sure to protect the tube from being pulled out. Children may enjoy being in a swimming pool once the site has healed. Be sure to dry the site well afterwards. Mouth care Whether or not your child is eating by mouth, the mouth needs to be cleaned. The mouth may become dry and sore, or mucus may pool in it. You can wipe out and moisten the mouth with a washcloth and plain water. Use lip balm as directed to keep the lips moist. If your child has teeth, clean them with water or a soft toothbrush. No toothpaste is needed for children younger than one year of age. If your child does not like a toothbrush, begin with a wet washcloth over your finger. Work toward your child getting used to a variety of textures in the mouth. Begin regular dental checkups as you would for any child. Bathing Children can take a tub bath once the gastrostomy is healed, about 14 days after a G-tube has been placed. Until tub baths are allowed, sponge baths may be given. Be sure to dry the skin around the G-tube well after the bath. Clothing Your child can wear almost any kind of clothing. Infant outfits that have snaps or fasteners all the way down the front give easier access to the gastrostomy site. As babies get older, they sometimes like to play with the G-tube. If your child does this, you may want to use one-piece outfits and shirts that tuck into pants. You can tuck the tube under the shirt or under an elastic waistband. If your child does not see the tube, there will be less temptation to play with it. Babysitters All caregivers should be trained in gastrostomy care. The hospital or home care staff can help you teach other caregivers how to care for your child. Be sure to provide the babysitter with emergency phone numbers and enough extra supplies. Safety Keep sharp objects away from the gastrostomy tube. Protect the tube from being pulled on. Do not put anything in the tube that has not been approved by the health care team. Siblings It is important to help other children in the family understand why and how the child is fed through a G-tube. It may be helpful to involve brothers or sisters in small tasks, such as distracting the child (singing, looking at books, talking), getting or holding things, or helping to clean the equipment. Be sure to watch children so they do not put anything into the gastrostomy tube, or pull it out. Travel Take a gastrostomy travel kit everywhere you take your child. The kit should contain: r clamp or gastrostomy plug, if used r clog zapper, if used r cotton-tipped applicators r gastrostomy tube r extension set (for skin-level devices only) r feeding supplies r gauze or clean cloths r lubricant, if desired r measuring container with pouring spout r mild, pH-balanced soap r stabilizers, if used r syringes r wipes or waterless cleanser r Y-adapter repair kit, if used