This information will focus on surgically placed gastrostomy tubes, or gtubes, and will highlight the AMT MiniOne balloon button. This tube is most commonly used by the pediatric surgery team in the children's hospital at UCSF.
How do I care for the skin around the surgical gastrostomy tube?
- If there is a dressing from the surgery, this can be removed 3 days after surgery
- Once home, clean daily with mild soap and water
- Keep the skin around the gtube dry. You may place a dry split gauze under the gtube and change it at least every day or when moist or soiled
- Sponge baths are fine in the initial post-op period. Regular baths and swimming may resume 2 weeks after surgery
What emergency supplies do I need to keep with my child after the surgical tube is inserted?
- A spare gastrostomy tube of the same size
- Foley catheters 14 French (or the same size of the gastrostomy tube) and 12 French (or one size smaller)
- 5 ml syringe
- Lubricant jelly
- Blue clamp
When do I replace the gastrostomy tube?
The gtube must remain in place for at least 1 month to allow the tract to heal between the abdomen and the stomach.
The surgical team will change the gtube with you once the tract has healed between 4-8 weeks after the surgery. During this visit, you will learn how to do the change on your own. Do not check the water balloon or try to remove the gtube prior to that time.
If the gtube accidentally falls out, follow the instructions for replacement and present to the emergency department if this occurs in the first month after surgery or if there is difficulty placing the tube.
After the first change with pediatric surgery, it is recommended to exchange the gtube at home every 3 months or sooner, if needed. The balloon can become weak or develop a leak if it remains in the stomach for longer periods of time.
How do I replace the gastrostomy tube?
1. Check the water balloon of the new gtube by inflating the balloon with 4ml of water (unless otherwise specified) and then deflating it
2. Dip the gtube in lubricating jelly
3. Place the gtube in the hole (use a straight down motion)
4. Hold it in place, insert the syringe into the "BAL" or balloon port of the gtube
5. Fill the balloon with 4ml of water (unless otherwise specified) to hold the gtube in place
General Information about all gastrostomy tubes
The diameter or width of the tube is measured in French (Fr) and the length in centimeters (cm). This is marked directly on top of the tube. Knowing the type and size of your child's gtube will help you when reordering supplies and talking with your child's doctors and nurses.
Use of the Gtube
- Give medications and feedings as directed by your medical team.
- Flush the extension tube and gtube with 5-10ml of water after each feed or medication to prevent clogging of the tube. 3ml of water may be used for infants.
- Change the extension set weekly. Remove the extension set between each feeding and rinse with warm water.
- Do not check the water balloon until cleared to do so. After the first gtube change with your child's provider, you may check the volume of water in the balloon if the tube is loose or leaking. Refill with water to maintain the recommended volume of water in the balloon
Assess the site daily and contact your provider with concerns. Keep an eye out for the following:
If the skin around the gtube becomes tender, red, warm or has pus, contact your child's medical provider.
If the tube gets bumped, or is rubbed, there may be a small amount of bleeding from the skin around the tube. Applying pressure for up to ten minutes should stop the bleeding. If the bleeding does not stop, contact your child's provider.
Granulation tissue is pinkish/red scar like tissue that can form around the gtube site. Granulation tissue is common and not dangerous but can produce exudate, moisture, and can bleed at times. Contact your provider if you notice this to discuss treatment options. Medication can be prescribed to treat the granulation tissue.
Leaking or crust around the tube
A small amount of drainage can be normal. Drainage that dries around the gtube is called crust. You can remove crust and drainage by cleaning around the gtube site with warm water. If more significant leaking is present, contact your child's provider.
If your child has a fever, call your pediatrician.
Not tolerating feedings
If your child has vomiting and/or diarrhea and is not tolerating feedings, contact your pediatrician and the pediatric GI provider following your child for advice.
- Supplies will be ordered by the hospital discharge coordinator from a homecare supply company.
- Equipment and supplies will be delivered to your home or the hospital when your child is discharged.
- If ordered, you be taught to use a pump by a representative of the homecare company.
- Each month, supplies will be mailed to your home. Keep your homecare company name and phone number readily available. You will need to call the company monthly to reorder more supplies. We recommend placing your order when you have about a week of supplies left. Do not wait until you are out of supplies.
- If you are missing something or your order is incorrect, contact to homecare company directly. If you cannot solve the problem, contact your child's GI or surgical provider. Sometimes a new prescription is required.
Recap of important tips
- Clean the gtube site daily or more often if any drainage is present.
- Switch out the feeding extension tubing weekly
- The first gtube exchange will be performed with the pediatric surgery team about a month after surgery. Then exchange the gtube at home every 3 months.
- Do not remove or refill the water from the water balloon until cleared by the pediatric surgery team after the first gtube exchange as this could cause accidental dislodgement.
- If the gtube accidentally falls out, follow the instructions for replacement and present to the emergency department if this occurs in the first month after surgery or if there is difficulty placing the tube.
- Keep a spare gtube kit and emergency kit with you at all times.
For additional resources on the AMT MiniOne balloon button click below: