Gastrostomy Tubes (G-Tubes)
Introduction
Gastrostomy tubes are feeding devices inserted through the abdominal wall into the stomach, providing direct access for nutrition, hydration, and medication administration in pediatric patients unable to meet their nutritional needs orally.
Key Indications
- Chronic feeding difficulties
- Neurological impairment affecting swallowing
- Congenital anomalies
- Failure to thrive
- Extended NPO requirements
- Chronic aspiration risk
Types of G-Tubes
1. Initial Placement Tubes
- PEG (Percutaneous Endoscopic Gastrostomy) Tube
- Length: 15-20cm
- Sizes: 12-24 Fr
- Duration: 3-6 months before replacement
2. Replacement Tubes
- Balloon G-Tubes
- Most common replacement option
- Sizes: 12-24 Fr
- Balloon volume: 3-10mL
- Replace every 3-6 months
- Non-Balloon G-Tubes
- Mushroom-tipped
- Longer lasting (6-12 months)
- Requires endoscopic replacement
Placement & Insertion Techniques
Initial Placement Methods
- Endoscopic (PEG)
- Gold standard for initial placement
- Requires endoscopic guidance
- Local anesthesia with sedation
- Surgical
- Open gastrostomy
- Laparoscopic approach
- Required for complex anatomical cases
- Radiologic
- Fluoroscopy-guided
- Alternative when endoscopy contraindicated
Care & Maintenance
Daily Care Requirements
- Site cleaning with soap and water
- Skin assessment for irritation/infection
- Tube rotation 360° daily
- Checking balloon volume weekly
- Flushing before/after feeds/medications
Troubleshooting
- Tube displacement
- Assess balloon integrity
- Check external marker position
- Verify placement before use
- Leakage around tube
- Check balloon volume
- Assess tube size appropriateness
- Evaluate for site infection
- Tube blockage
- Attempt flush with warm water
- Use declogging enzyme solutions
- Replace if unsuccessful
Common Complications
- Early Complications (≤30 days)
- Bleeding
- Site infection
- Tube dislodgement
- Peritonitis
- Late Complications
- Granulation tissue
- Buried bumper syndrome
- Site leakage
- Tube deterioration
Emergency Considerations
- Accidental removal
- Replace within 2-4 hours
- Verify placement before use
- Consider x-ray confirmation
- Severe site infection
- Culture wound
- Consider systemic antibiotics
- Monitor for peritonitis
