Gastrostomy feeding in Pediatrics

Gastrostomy feeding is a method of administration of fluid though the surgical opening into the stomach via the opening at abdominal wall.

Methods of Gastrostomy Feeding

• Continuous: Over an extended time period feeding is given by a pump at a slow rate, for example, 30 mL/24 h.
• Bolus: A large amount of feeding is given 3-6 times/day, sometimes given by a pump over a certain amount of time (1 hour) or simply allowed to run into the stomach by gravity using a roller clamp to slow down flow as necessary.
• Direct: Direct feeds are given with the feeding set hooked directly into the gastrostomy tube.
• Chimney: Chimney feeds are given by dripping the feeding into a vent that is attached to the gastrostomy tube.

Equipment Needed

• Feeding syringe (about 60-100 mL)
• Disposable gavage bag with tubing
• IV stand, measuring cup, formula, glass of
• Administration set
• Pair of gloves
• Stethoscope to auscultate the bowel sounds

Preparation

• Confirm the patient, instructions, and order.
• Explain the procedure to the child and parents as appropriate.
• Auscultate for bowel sounds
• Check the condition of gastrostomy site.
• Check if your formula is warm or at room temperature by putting a few drops on your wrist.

Procedure (Syringe method)

• Perform hand hygiene.
• Pour correct amount of formula into a clean measuring cup or clean baby bottle.
• Place the child in a comfortable position. If possible, place the child in a highchair or at the table during mealtime.
• Insert the syringe tip into the feeding tube or bolus extension set for the MIC-KEY or bard button.
• Flush tubing with 3-5 mL of water before starting the formula feeding.
• Slowly pour the formula into syringe.
• Unclamp the feeding tube. The feeding rate can be controlled by raising or lowering the syringe.
• The feeding should take about the same amount of time as it would take a child to drink the formula, about 15-20 minutes.
• When all the formula has been given, flush the tubing with water.
• Burp the child after each feeding if appropriate.
• Rinse the feeding supplies with warm water after each feeding and allow to air-dry.

Procedure (Drip Method)

• Connect the bag with tubing and fill the bag with feed.
• Hang it on the IV stand and expel air.
• Open the clamp so that the food fills with no air.
• Close the clamp.
• Insert the catheter tip into the G-tube
• On finishing, flush the tube with water.
• Clamp the G-tube
• Remove the feeding system.

Nurse’s Responsibility

• If the child cannot be fed by mouth, oral stimulation with a pacifier can be provided during the gastrostomy feeding. Encourage oral stimulation by blowing, kissing, etc.
• Give mouth care every 4 hours to prevent halitosis.
• Disconnect the feeding if the child becomes nauseated and shows signs of discomfort, abdominal distension, vomiting, or difficulty in breathing.
• Remember to flush the feeding tube with water between all feeding and medications.
• Care of the tube: In the first 2-3 days, the gastrostomy site should be cleaned 2-3 times/day with half-strength hydrogen peroxide. After 2-3 days, the site should be cleaned with mild soap and water.
• Take measure to prevent contamination of feed.
• Bathing: Sponging can be given for first 2-3 days to keep the child’s new gastrostomy site dry.
• Showering can be given after 2 days. Clean the site and pat dry after showering.
• Swimming is restricted until the stitch is removed.
• Venting the tube: Place a 60-cc syringe with the plunger removed into the end of the gastrostomy tube. If the tube is clamped, open the clamp.
• Hold the syringe above the child’s stomach for a few minutes. If gas is present, you can hear the gas bubbles up through the tube or sometimes even see stomach contents back up into the tube and syringe.
• Once the gas is removed, allow the formula to flow slowly back into the stomach.
• Make early referral to speech therapist for children requiring long-term feeding.

Accidental Tube Expulsion

• If tube comes out, cover the site with a clean, dry gauze pad or cloth.
• Once the tube is out, hole will begin to close and may close completely in 4-6 hours.
• So the child should be replaced with new gastrostomy tube immediately and should be checked under X-ray for proper placement.
• Balloon devices should be deflated and reinforced weekly to ensure that correct amount of fluid remains in the balloon.

Activity Restrictions

• Child should not lift anything heavier than 5 lb (4.4 kg) and should not participate in vigorous activity for 2 weeks after surgery.
• The school nurse/teacher needs instruction filled by the hospital and signed by doctor.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
4. Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
5. Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/

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