Gastrostomy Tube (G-Tube)

What Is a G-Tube?

Some kids have medical problems that prevent them from being able to take adequate nutrition by mouth. A gastrostomy tube (also called a G-tube) is a tube inserted through the abdomen that delivers nutrition directly to the stomach. It's one of the ways doctors can make sure kids with trouble eating get the fluid and calories they need to grow.

Who Needs a G-Tube?

Common conditions that might require a child to need a G-tube include:

• congenital (present at birth) problems of the mouth, esophagus, stomach, or intestines
• sucking and swallowing disorders, which are often related to prematurity, brain injury, developmental delay, or some neuromuscular conditions, like severe cerebral palsy
• failure to thrive, which is a general diagnosis that refers to a child's inability to gain weight and grow appropriately
• extreme difficulty taking medicines

Fortunately, a gastrostomy is a common procedure that takes only about 30 to 45 minutes. After spending 1 or 2 days in the hospital, kids who have had a gastrostomy can get back to their normal activities fairly quickly after the incision has healed.

Still, it helps to know some of the basics so you can feel confident about what's happening during the procedure and how you can support your child when the tube is in place.

What Happens Before G-Tube Insertion?

Several tests may be done before G-tube insertion. Most commonly, an X-ray of the upper gastrointestinal (GI) system is done so doctors can see a portion of the digestive system.

Your child's stomach must be empty on the day of the procedure. Gastrostomy in infants and children is usually performed either under general anesthesia (medicine that keeps the patient in a deep sleep-like state) or deep sedation (medicine that makes the patient unaware of the procedure but not as deeply sedated as with general anesthesia).

These medicines can suspend the body's normal reflexes, letting food be inhaled into the lungs if the child vomits during the procedure. So be sure to follow your doctor's instructions about when to have your child stop eating or drinking (for babies on breast milk only, this is usually 2 hours before the procedure; for toddlers and older kids, it may be up to 8 hours before).

The doctor will describe the procedure and answer any questions you might have. Be sure to ask the gastroenterologist (gastrointestinal doctor) or surgeon to explain anything you don't understand.

Then the anesthesiologist or CRNA will take your child back to the operating room to administer the anesthesia or sedation. You'll go to a waiting area and a hospital staff member will notify you when the procedure is over.

What Happens During G-Tube Insertion?

The three methods for inserting a G-tube are:

1. percutaneous (through the skin) endoscopic gastrostomy (PEG)
2. laparoscopic technique
3. an open surgical procedure

The laparoscopic technique can be used with the PEG approach or with another abdominal operation performed at the same time. All methods are fairly simple and take about 30 to 45 minutes to perform.

The PEG procedure, which is the most common technique, uses an endoscope (a thin, flexible tube with a tiny camera and light at the tip) inserted through the mouth and into the stomach to guide the doctor's positioning of the G-tube.

The laparascopic technique is done by making several small incisions in the abdomen and inserting a tiny telescope that helps surgeons see the stomach and surrounding organs.

Open surgery is a good approach for placing a gastrostomy tube but usually is reserved for cases where the child's anatomy won't allow for a PEG; if there is scar tissue from a previous surgery, procedure, or illness; or if the child requires another surgical procedure at the same time.

What Happens After G-Tube Insertion?

Your child will be taken to the recovery room, sometimes called the "post-op" (post-operative) room or PACU (post-anesthesia care unit), and will be closely watched by the medical team.

The doctor will let you know how the procedure went and how your child is doing. In most cases, parents can visit their child in the recovery room within a half hour after the procedure.

It usually takes about an hour for a child to completely wake up from the anesthesia. Your child might feel groggy, confused, chilly, nauseated, scared, or even sad when waking up. That is common and usually improves within 30 to 45 minutes.

Your child might feel a little bit of pain near the incision site. If so, be sure to tell the doctor because medications can be given to lessen discomfort. Antibiotics may continue for 24 to 48 hours after the procedure to prevent infection.

What Else Should I Know?

Your child probably will stay in the hospital for 1 or 2 days. Many hospitals let at least one parent stay with a child throughout the day and overnight. Much of that time will be spent learning about the care of your child's new G-tube.

The nurses will show you exactly how to care for the tube and the skin around it, keeping it clean and infection free. You'll also learn how to handle potential problems, such as the tube accidentally falling out. This is important because if the tube falls out of place, the hole can begin to close.

You'll also be taught how to give a feeding through the tube as well as what to feed. You might hear feedings referred to as "bolus" or "continuous." Bolus feedings are larger and less frequent (more like a regular meal). Continuous feedings, which often take place overnight, are delivered by a pump to kids who need smaller, slower feedings. A dietitian will help plan a specific diet and schedule based on your child's needs.

Kids who have a G-tube aren't necessarily unable to also eat by mouth. Although tube feedings can be used to replace all oral feedings, in some cases the tube supplements what a child eats by mouth. If your doctor decides that your child is physically able to eat, the medical team will help teach the skills needed for independent eating.

How Can Parents Help After G-Tube Insertion?

It's normal to feel a little bit nervous about the tube at first, but it's important that you feel comfortable taking care of it, so ask plenty of questions and get extra help if you need it.

By the time your child is ready to leave the hospital, you should have:

• detailed instructions on home care, including practical issues such as bathing, dressing, physical activity, giving medicines through the tube, and venting (releasing gas from) the tube
• a home health care nurse visit scheduled to make sure things are going smoothly
• follow-up visits scheduled with your doctor to check your child's weight as well as the placement and condition of the tube

Gastric tubes can last for more than a year before needing to be replaced. Replacing the G-tube is easily done by a parent or health care provider without another endoscopic or surgical procedure.

The gastrostomy site can be prone to infection and irritation, so it must be kept clean and dry, and frequent hand washing is a must.

When Should I Call the Doctor?

Call your doctor if you notice any of these problems:

• a dislodged tube
• a blocked or clogged tube
• any signs of infection (including redness, swelling, or warmth at the tube site; discharge that's yellow, green, or foul-smelling; fever)
• excessive bleeding or drainage from the tube site
• severe abdominal pain
• lasting vomiting or diarrhea
• trouble passing gas or having a bowel movement
• pink-red tissue (called granulation tissue) coming out from around the g-tube

Fortunately, most complications can be quickly and successfully treated when discovered early.

Looking Ahead

When the site is healed, kids have very few, if any, restrictions related to the tube. Some might worry about how the tube looks and how others might react. If this happens, ask your doctor to recommend a social worker who can help.

After a few months of healing, your doctor may recommend replacing the longer tube with a "button" — a device that is flatter and lies against the skin of the abdomen. This can often be done without surgery in the doctor's office, unless the doctor advises otherwise. The button can be opened for feedings and closed in between feedings or medications. For many families, moving to a button makes tube feedings and care easier and more convenient.

If and when the doctor decides that your child is able to take in enough nutrition by mouth, the G-tube or button may be removed. Removal takes only minutes and is usually done in the office by the doctor or nurse.

After the button or G-tube is out, a small hole will remain. It should be kept clean and covered with gauze until it closes on its own. In some cases, surgery is necessary to close the hole. Either way, the scar that remains will be small.

When your child is having any kind of surgery, it's understandable to be a little uneasy. But it helps to know that a gastrostomy is a brief, common procedure and complications are rare. However, as with most procedures, there are some risks, which your doctor will review with you. If you have any other questions or concerns, speak with your doctor.