General

Open gastrostomy

PEG

Laparoscopic gastrostomy

G-tube care

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PERI- AND POSTOPERATIVE CARE

When a new (<2 month old) G-tube is dislodged, a Foley catheter needs to be placed promptly into the gastro-cutaneous tract to maintain patency of the tract. Generally, this will be a Foley of smaller French size than the catheter that was in previously. Avoid excessive force in placing the catheter as this may push the stomach away from the anterior abdominal wall and result in a gastric leak into the peritoneal cavity. (We do not replace the Malekot or Pezzar catheter, since this requires undue traction on the stomach.)

If there is any difficulty in replacing the gastrostomy tube, or the gastrostomy was created within the past month, then a contrast study should be obtained to verify correct placement of the tube.

Place the catheter into the stomach for a sufficient length to avoid inflating the balloon in the subcutaneous tract. (Judge this by the thickness of the child’s abdominal wall). To avoid the other extreme, take care not to push the foley so far, that it passes through the pylorus and is inflated in the duodenum. This will result in gastric outlet obstruction, and also has the potential for rupturing the duodenum. The pylorus is frequently within 2-3 inches of the site where the tube enters the stomach (usually at the incisura).

This also is the basis for evaluation feeding difficulties in a child with a Foley for a feeding tube. If not properly secured to the skin, the stomach will propel the balloon forward and through the pylorus as if it were a bolus of food, resulting in a very proximal small bowel obstruction (emesis may or may not be bilious, usually there is gastric, but no diffuse abdominal distension). These kids usually present with the problem of excessive leakage from around the g-tube site! You can make the diagnosis by examining how much tube is protruding from the site, and fix the problem by deflating the balloon, pulling the catheter out and replacing it to the proper depth and then securing it appropriately with tape. The best solution is a Button G-tube, since this can’t get sucked in.

In evaluating a patient for a gastrostomy button, the primary tube should not be removed prior to 6-8 weeks postoperatively. The length and width of the button need to be determined with a specific measuring device to avoid opening an inappropriate size button (each box approx. $200. -). In addition to MIC-key buttons there is another brand of G-tube button called the BARD button. It does not have a balloon and is removed by placing a blunt metal stent through the valve to stretch the button as it is pulled or inserted. If you have never dealt with this button, please ask for help.

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