Placement and Care of Your Gastrostomy Tube
Your doctor has scheduled a percutaneous gastrostomy tube placement to be done by an Interventional Radiologist. Before the tube placement the staff will explain the procedure and ask for your consent.
What Is a Percutaneous Gastrostomy Tube?
It is a soft, narrow tube that enters the stomach through the skin in the upper part of the abdomen. It can be used to give food and medicines if you cannot swallow. It can also be used to drain fluids from the stomach. The tube can be left in place for a long time, but it must be changed every 3-6 months depending on the type of tube that is placed. A tube change is done in the Interventional Radiology Department and takes about ½ hour. This visit will be arranged for you.
How to Prepare for the Placement of Your G Tube
1. If you are taking any type of blood thinner (such as aspirin or Coumadin®), you will be told when to stop taking them, before the tube is placed.
2. You should have nothing by mouth after midnight on the night before the tube placement.
3. If there is a chance you may be pregnant, please tell the doctor.
4. Be sure to tell the doctor if you have any allergies to iodine, latex, contrast or medicines.
What Is the Procedure Like?
- The tube placement is done in the Interventional Radiology suite and often takes about 1 hour
- An IV will be started to give you medicine to help you relax.
- The nurse will be checking your blood pressure and pulse during the placement.
- Ultrasound and x-ray will be used to help locate the correct place for the tube.
- A nasogastric tube is placed through your nose and your stomach will be filled with air. This helps with tube placement. This will make you feel full but should not cause you pain.
- We will inject lidocaine into the skin over your stomach in order to numb the place where the tube will go into your abdomen.
- A small needle is advanced through the skin and into the stomach. This needle will then be exchanged for the soft tube. You may feel some pressure during the placement of the tube.
The tube will be secured in place with a skin suture.
After the Procedure
1. You will return to a hospital room where you will rest in bed for 2 – 4 hours.
2. The nursing staff will take your blood pressure and pulse often and check the tube site.
3. The tube will be attached to suction until the next morning.
4. You will not be able to eat or drink and the tube cannot be used until the next morning.
5. You should report any of these symptoms to your nurse:
- Increased or new abdominal pain, neck soreness, or shoulder pain
- Nausea or vomiting
- Feeling chills or fever
- Shortness of breath
- Increased pain at the tube site
6. Tube feedings are often started the next morning after a bolus test is performed and passed to ensure the GI tract is working properly.
Cleaning the Tube and Changing the Dressing
The G-tube needs to be cleaned daily to prevent infection. For the first 3 days after the tube is placed, clean the skin around the G tube with saline/water (see below) and then let air dry. After 3 days, you may simply shower, wash with soap and let the water run over the place where the tube enters your skin. If you can’t shower, keep using saline or water and swabs.
1. Gather all supplies needed: 4x4 split gauze, tape, cotton swabs, and saline/water.
2. Wash hands well with soap and water for 30 seconds.
3. Open the sterile 4x4 split gauze and sterile Q-tips®.
4. Remove the old dressing. Place the old dressing in a plastic bag and throw away.
5. Check the tube site for signs of infection. These may include:
- Increased tenderness or pain
- Increased redness or swelling
- Drainage that is green in color or smelly
- Sutures (stitches) at the skin site that come loose.
6. Moisten cotton swabs with saline/water and wipe around insrtion site. Let air dry.
7. Place the sterile split 4x4 soft wick dressing on the skin.
8. Secure the G tube with tape on your stomach. This helps prevent the tube from being pulled out.
Follow up Care:
1. The following activity restrictions are advised:
2. Lifting Restriction: 10 lbs x 72 hours post procedure
3. You may shower. Do not immerse tube in water such as in a bath, swimming pool, or hot tub.
4. Care of the gastrostomy tube: dressing to be changed prior to discharge from the hospital. On the day AFTER discharge, patient may remove dressing and thereafter cleanse site daily with soap and water (with washcloth or in shower). If patient wishes, he/she may keep site covered with 4x4 split gauze and then tape or tegaderm. Change this dressing every day or sooner if wet/soiled. Please refer to Health Facts for You # 5899, “Placement and Care of your Gastrosotmy Tube” for further information regarding care of the tube.
5. Take all medication as directed
6. Follow up with Interventional Radiology, G3/3 at UW Hospital: In 7-10 days post placement for routine post procedure clinic evaluation, or in 3 months for a routine change of the G tube. Do not eat or use the tube for 4 hours prior to this appointment.
7. If you have questions or concerns including bleeding at the site, severe pain or nausea, call the Interventional Radiology Nurse Coordinator at 608-265-0308
After hours, call the on call Interventional Radiology Resident at 608-262-2122
G Tube Feedings
What to Feed:
Formula Name_____________________________________________________
Names of EquivalentProduct__________________________________________
Name of Manufacturer_______________________________________________
Total amount of formula per day_______________________________________
Total amount of water per day:________________________________________
Additional Vitamins/Minerals/Supplements:______________________________
When to Feed:
Give______can/ml of____________every_____hours or_______ times per day.
Flush the tube with_______________ml water after each feeding.
Pig Tail Type Tube
Method: Syringe Feeding Bag Feeding Bag and Pump
In order for the stopcock not to leak, there needs to be a red adapter from the G Tube to the stopcock.
When to delay feeding:
If you are having an increased feeling of fullness or nausea, the tube does not flush freely, try again in one hour. If this continues, call your local doctor.
| What to Do | Why |
| 1. Wash hands with soap and warm water for 30 seconds. | Helps remove germs and prevent infection. |
| 2. Make yourself comfortable. Sitting up or lying on your right side with head raised 30-45° is best. | This position helps the stomach empty and prevents reflux. |
| 3. Attach the connector tubing and open stopcock. | Flushing before feeding helps you check to be sure the tube is open. |
| 4. Flush the tube with 30-60 mL tap water. | |
| 5. Give the new feeding at room temperature. | Cold feedings can cause stomach cramps. |
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|
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Prevents extra air from entering stomach with feeding. |
| 6. Clamp or cap tube. Connector tubes and feeding bags are reusable. | The caps can be reused. They should be changed or washed with liquid detergent and rinsed whenever they look dirty. |
| 7. Clean your supplies by rinsing the syringe and bag with cool water. Then swish with warm water and a small amount of liquid dishwashing soap. Rinse thoroughly. Hang to dry. Replace the feeding bag every 3 days and the syringe once a week. | Some people handle their feedings better if the tube is vented (left open and suspended) for 1/2 to 1 hour after feeding to let out excess air. It's best done if lying down with head up 30-45º and the tube held straight up. Be sure to have a towel handy in case fluid is released. Recap once the air is out and fluid starts to come out |
| 8. NOTE: If the plunger cannot be easily inserted into the syringe, lubricate it with vegetable oil. Never use Vaseline®. |
CTU Tubing (extension tubing) should continue to be used until visibly soiled, cracked, or leaking.
Giving Medicines
Medicine can be given with a syringe through the G-tube. Be sure to crush pills in water until dissolved so that they do not clog the tube. You may want to ask your doctor about getting the pills in liquid form. Never crush enteric-coated or time-release capsules. Flush the tube with 30-60 mL of water before and after giving medicines to be sure that it enters the stomach and to prevent clogging the tube.
Common Problems
1. Blocked tube
2. Excessive leakage around the tube
3. Redness around the tube
4. Bleeding around tube
5. Stitches come loose or tube falls out
6. Tube is punctured or torn
7. Internal Bleeding
8. Vomiting
9. Diarrhea
10. Dehydration
11. Constipation
12. Gas, bloating, cramping
1. Blocked Tube
- Gently flush the tube using 15 mL of warm water.
- Prevent blockage by always flushing tube with 30-60 mL water after feedings, before and after medicines.
2. Excessive leakage around the tube
- Call your nurse or doctor.
3. Redness around the tube
- Keep the skin around the tube clean and dry. Some redness is normal, but moisture can irritate the skin and lead to an infection.
- Clean the skin around the site more often using plain water.
- Keep iinflamed areas open to air if you can.
- Ask a nurse about other ways to fasten the tube in place.
- Call the nurse or doctor if you see signs of infection (redness, swelling, rash, greenish drainage).
4. Bleeding Around the Tube
- If you notice more than a few drops of blood, call your doctor or nurse.
- Keep the tube taped tightly to your skin to prevent pulls that might cause injury.
5. Stitches come loose or tube falls out
- If the tube falls out partly, or all the way, do not try to push it back into the opening. If you can, secure the tube with tape. You must call the Interventional Radiology Department at UW Hospital, for the tube to be replaced. This must be done within 12 hours after the tube has fallen out. Call 608-263-9729 option #3. 8:00am - 4:30pm Mon - Fri; or 608-262-2122 after hours and on weekends and ask for the Angio Resident on- call.
6. Tube is punctured or torn
- Clamp the tube close to your abdomen and call the phone numbers listed above.
Do not let anyone other than the Interventional Radiologist remove this tube. The doctors feel it is very important that they remove it for you, since they placed it.
7. Internal Bleeding
- If you cough up blood, see 50 cent-size blood clots coming from the G tube, or see blood in your stool, call your doctor.
8. Vomiting
- Because frequent vomiting causes the loss of body fluids, salts, and nutrients, call the doctor or nurse if it doesn't stop.
- Do the feeding sitting up or with the head of the bed raised 45°.
- Try smaller feedings more often. Make sure total amount for the day is the same. The strength of the formula or the contents may need to be changed.
- Infection may cause vomiting. Be sure the supplies are cleaned well and rinsed between feedings. Wash your hands after contact with persons who are ill.
- Other causes might include food intolerance, side effects of medicine, feeding too much at one time, giving the feeding too fast, or reflux.
9. Diarrhea
Diarrhea means frequent, loose, watery stools. Looser stools may be normal, depending on the formula being used. A few loose stools in a 24-hour period are not a problem.
| Causes | Ways to prevent |
| Too much formula at one time | Avoid formula hanging for longer than 6-8 hours |
| Feeding too fast | Give the tube feeding more slowly |
| Infection | Give more water after each feeding to replace water lost in the diarrhea |
| Bacteria getting into the feedings and/or supplies | If the diarrhea does not stop after 2 or 3 days, call your doctor |
| Tube out of place | |
| Side effects of medicine | |
| Not enough fiber | |
| Intestinal blockage |
10. Dehydration
Vomiting, diarrhea, a fever and sweating cause the body to lose fluid. You may not get thirsty so you must be very careful to note the signs of dehydration and call your doctor. They will tell you what kind of extra fluid to give. Symptoms may include:
- Decreased urine or more concentrated (darker) urine
- Crying with no tears
- Dry skin that has no recoil when squeezed
- Fatigue or irritability
- Weight loss
- Feeling dizzy
- Dry mouth and lips
- Sunken eyes
- Headache
11. Constipation
- Constipation may be due to not enough fluids, too little fiber in the diet or a side effect of medicine.
- This is common in the elderly or those who are less active. Giving extra water or fruit juice (such as prune or apple juice) between feedings may help.
- If you have chronic constipation, call your nurse or doctor. Your formula may need to be changed.
12. Gas, Bloating, Cramping
See above tips on diarrhea. Also, try to get rid of all air from the tubing before connecting the feeding tube. You may open the G-tube while it's raised to allow extra air to escape. It's best done if lying down with head up 30-45º and the tube held straight up. Be sure to have a towel handy in case fluid is released. Recap once the air is out and fluid starts to come out.
Common Questions and Answers
What happens when I no longer need the gastrostomy tube?
Your doctor can explain the reasons you need the tube and when it is no longer needed. It will be removed in the Interventional Radiology Department. Most often after the tube is removed, the holes close over in a few days. Sometimes it may take a few weeks to close. Surgery is not needed in most cases.
What should I know before I travel?
Remember to take all the supplies needed for feeding: syringe, formula, tubing, bottled water, tape, etc. Opened formula can be stored in a cooler in the summer to prevent spoilage. Some families have a small canvas bag that is always filled with supplies needed for travel.
Can I sleep on my stomach?
Yes. After the tube site has healed, most people are quite comfortable on their stomachs.
Home Supplies List
Tube Feeding Formula: ______________________________________
- 60 mL catheter tip syringes (change every week)
- Feeding bags (change every 3 days)
- IV pole
- Connecting Tube, with stopcock (CS# 2200257)
- Blue caps, to cover stopcock (CS# 2227088)
- Pastic adhesive tape, 1
- Cotton swabs and bottle of normal saline for cleaning the tube site, if unable to shower
- 4x4 drain sponges
- Catheter tip syringes for medicine
Additional supplies for pump feedings:
- Pump & IV pole
- Feeding bags
The inpatient unit will provide a three day supply. To get future supplies, you need to contact your home care provide. They will also supply you with the pump and pole.
Phone Numbers
Please call if you have concerns or questions.
Doctor:________________________ Phone Number:_____________________
Local Doctor:___________________ Phone Number:____________________
Nurse:_________________________ Phone Number:____________________
Dietician:_______________________ PhoneNumber:_____________________
Vendor:________________________ Phone Number: ___________________
Interventional Radiology: Phone Number: (608) 263-9729 option #3
The Spanish version of this Health Facts for You is #7043.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 05/15/2013
Copyright © 05/15/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5899
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