G-Tube Protocol

A gastrostomy tube, or G-tube, is a thin plastic tube inserted surgically into the stomach of a person who cannot swallow or eat by mouth. The G-tube can be a temporary measure, often removed within one to two years of placement, or it can be a relatively safe lifelong alternative to feeding by mouth.

Types

• There are several types of G-tubes. The PEG variety is inserted endoscopically and has a mushroom-shaped tip at the end that prevents the tube from falling out on a regular basis. A regular G-tube is inserted in the OR in a typical surgical procedure and has a long tip. You may hear these referred to as MIC-Key, which refers to the button that is flush against the skin. Both come with an extension set that allows caretakers to hook up an external feeding apparatus, such as a feeding pump or gravity bag.

After Surgery

• After surgery, the site will be secured with gauze and medical tape to prevent the tube from shifting. The friction from a shifting tube can cause infection and granuloma (when excess tissue forms under the button). A doctor will let the caretaker know when is best to remove the tape and bathe normally. It usually takes three months for the stomach to build a proper tunnel for the tube, so in that time, should the tube fall out, the patient will need immediate medical attention to ensure that the hole into the stomach does not close.

Site Care

• A G-tube site presents many challenges in terms of hygiene. In terms of cleaning, the site must be cleaned daily, if not after every feed, to avoid residue or excess tissue growth. A caretaker should always wash his hands before caring for or administering tube feeds, as bacteria or germs from the hands can easily enter a patient's stomach through the tube.

Considerations

• In order to keep the tube clean, caretakers should flush the tube with between 5-10 mL of water before and after administering a feed, before and after giving a medication, and prior to removing the extension set. Tubes should also be replaced by a doctor every three months, as the stomach juices will erode the internal mechanism, rendering the tube unusable.

Removal

• Once patients no longer have a need for a feeding tube, a doctor will decide if the tube should be removed. Tube removal may need to be done by a doctor or by the caretaker, depending on the type of tube that is inserted. Healing of the site may take a few months up to a few years, with some patients having a permanent "hole" at the former site of the tube. These holes can be fixed with plastic surgery.