Gastrotomy tubes are placed to feed pediatric and elderly patients most of the time. Caring for such patients in a safe manner is essential to preserving the life and wellbeing of thees patients. This plastic patient is not likely to flourish on this feed of colored water.
A gastronomy is an opening in the wall of the stomach on the outside to the stomach on the inside the abdominal cavity. This opening or gastronomy is usually made in the operating theater. A feeding tube is then inserted into the gastronomy. This tube is then hooked up to a bag containing the “food” in liquid form. In some places, where technology and resources exist, a mechanical devise known as a Kangaroo Pump can be used to deliver a fixed amount of feed can be given over a specified period. E.g. 83mls per hour.
When commencing a feed always insure that the tube is in the right place. This is done by aspirating the contents of the stomach and checking the pH value of these contents. Gastric contents are acidic in nature. A blue litmus paper should turn red. If it does not the tube is not in the right place and the Registered Nurse should be notified for follow-up.
Picture – Patient with a gastronomy tube connected to feeding bag via a Kangaroo Pump.
Water flushes of 30 to 40 mls should be used be administered pre and post feed and also before and after the administration of medications. Most feeds are milk based and they curdle when the pH is changed or the lactic acid bacterial count is high.
If the tube becomes blocked then water or soda water should be used to unblock it. Milking the tube breaks up the curdles which are causing the blockage. I have successfully used the milking effort and clean water to open up many blocked tubes in the ICU and in the High Dependency Unit. A smaller syringe generates more pressure to unblock the tube. Excessive pressures should not be used.
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Blue Litmus paper + gastric contents => Litmus paper turns red.
Skin around the stoma should be assessed four hourly initially and then once each day. Observe for redness, leakage around the stoma and irritation.
Always have feeds at room temperature for patient comfort. Amount of feed to be administered is determined by the Doctor, Dietitian or Registered Nurse. This must be done in accordance with local policies and procedures.
When feeding by gravity or with a syringe do not use the plunger (piston of the syringe) to force the feeds into the patient. Shaking the syringe gently is acceptable to speed up feeding. Generally, thick feeds will go down slowly but thin fluids will run down quickly.
When feeding is completed do not forget to clamp the feeding tube. Some tubes are fitted with bungs. Clamping prevents the entry of air into the stomach and keeps stomach contents in.
Clean area around stoma with soapy warm water daily. Aim to keep the skin clean and dry to prevent infection.
If there is redness due to contact with discharge of gastric contents then a barrier cream should be applied. A gauze swab may be used to protect the skin.
Avoid excessive tagging (pull) on the gastronomy tube.
If a tube is pulled out accidentally a new tube is inserted by a doctor. All the protocol for a new tube (check placement with x-ray) apply.