Introduction
A gastrostomy is a procedure to make opening in the stomach that will attach to a tube. This allows food and medication to be delivered directly into the stomach. Children who are unable to eat or drink enough or have trouble swallowing safely may need a gastrostomy inserted for tube feeding. It is commonly called a G-tube.
During the procedure
A gastrostomy procedure involves inserting a device into the stomach one of four ways:
- by doing an open operation
- endoscopically - using a flexible telescope called a gastroscope
- laparoscopically - through keyhole surgery
- in the x-ray department by interventional radiologists.
The device can be a balloon-type catheter, a non-balloon type catheter or a low-profile device, also called a button.
After the procedure
The new button or opening will be covered with a dressing for several days, which will then need to be removed by a nurse. Your child's doctor may also place a stich during the procedure to keep the button in place. The stitch can be removed by your local doctor 1 week after the procedure.
Your child’s stomach will be sore for a few days and their doctor will prescribe medication to help with this.
Your child will be in hospital for 3-5 days after the procedure. A nurse will show you and your child how to connect the right tubes to the button to give formula and medicine. A gastrostomy specialist nurse will also visit to help with the button and answer any questions you might have.
Your child’s gastrostomy device will be used to deliver small volumes of clear fluid and formula via a pump. A dietitian will tell you which formula is best to use and will help you develop a plan to slowly increase the amount of fluid or formula your child can have.
Your child’s treatment team will give you paperwork to help register your child with EnableNSW. This service provides an ongoing supply of gastrostomy buttons and feeding equipment. These forms can also be used to request a budget for gastrostomy equipment if you have a plan with the National Disability Insurance Agency (NDIS) for funding.
Management
Taking care of the gastrostomy device
To make sure the gastrostomy device works well, you will need to follow care instructions carefully.
Some tips to keep the gastrostomy device working well include:
- flushing the gastrostomy tubing after each use
- using barrier cream to protect the skin from irritation
- keeping the skin clean and dry and watch for redness or irritation
- turning the button 360 degrees once every day, once your child’s treatment team have said it is ok to do so
- checking the water level in the balloon every month, more often if the button feels loose
- for a non-balloon catheter, using a strap to stop it moving in front of the entrance to the small bowel which can block the outlet to the stomach
- checking the device to make sure it does not become dislodged.
Let your child's treatment team know as soon as possible if the gastrostomy device becomes dislodged. If a newly inserted device is dislodged too soon, it must be kept open with another button or catheter to prevent it from closing.
A device that has been in longer can usually be replaced without too much discomfort. Low profile devices can be replaced by a trained carer if they accidentally become dislodged.
Your child can swim and play normally with a gastrostomy device but contact sports should be avoided.
When to see your doctor
Having a gastrostomy inserted can sometimes make your child’s reflux or vomiting worse.
If your child’s button comes out and you can’t put it back in, call your local doctor immediately or present to your nearest emergency department for assistance. You should try to get help within 90 minutes, as a new gastrostomy opening will start to close within a few hours.
You should also see a doctor if:
- your child’s button appears loose after checking the water level in the balloon first
- the skin around the button is red and sore
- the skin around the gastrostomy hole becomes raised or starts to bleed.