QUICK GUIDE TO GASTROSTOMY FEEDING TUBES AND DEVICES A gastrostomy feeding tube or device is one which has been inserted directly through the abdominal wall into the stomach. It is secured by an internal retention device (either a balloon or a soft disc known as a “bumper”) on the inside and a firm external retention device (known as a “flange”) on the outside.11 Placement of a ballooned gastrostomy tube Cross-section: non-ballooned tube Oesophagus Stomach Clamp External Flange Gastrostomy tube Skin Fat Muscle Skin Internal Bumper Stomach Photo: APhoto: Kennedy Photo: MPhoto: Sutherland Patient with a ballooned gastrostomy Patient lying down with a non-ballooned tube insitu gastrostomy tube in situ See page 8 and 9 for a summary of the different types of tubes and devices you might see. A Clinician’s Guide: Caring for people with gastrostomy tubes and devices 7 Common features of gastrostomy feeding tubes and devices include, but are not limited to: Refer to manufacturer’s guidelines for advice on brand specific tube and device features Ballooned Gastrostomy Tube Ballooned Gastrostomy Tube With side port Without side port Feeding Port Feeding Port (Enteral Dispenser (Enteral Dispenser and Feed Bag and Feed Bag connect here) connect here) ml/cc Balloon Port Balloon Port ml/cc Side Port (X ml/cc) (X ml/cc) French (size) [For example:16/18/20] French (size) [For example:16/18/20] FR FR cm markings cm markings External External Flange Flange Balloon Balloon Non-ballooned Gastrostomy Tube Non-ballooned Gastrostomy Tube with collapsible internal bumper With rigid internal bumper Feeding Port NOTE: this tube Feeding Port (Enteral Dispenser (Enteral Dispenser and Feed Bag must be removed and Feed Bag connect here) endoscopically connect here) Side Port Side Port French (size) French (size) [For example:16/18/20] [For example:16/18/20] FR FR REMOVAL TRACTION Clamp Clamp External External Flange Flange Internal Internal cm markings Bumper cm markings Bumper 8 A Clinician’s Guide: Caring for people with gastrostomy tubes and devices Low Profile (skin level) Gastrostomy Device Low Profile (skin level) Gastrostomy Device With a balloon Non-ballooned (obturator or traction removal) Used with compatible extension tubes - see below. Used with compatible extension tubes - see below. Feeding Feeding Port Port (extension tube (extension tube connects here) connects here) x ml cc Balloon Feeding Feeding Port Port cover Port cover (x ml cc) Length of the Length of the device device varies and varies and depends on depends on tract length tract length (see page 10) (see page 10) Balloon Internal bumper NOTE: The design/shape of the Internal bumper will vary according to the manufacturer Examples of extension tubes (used with compatible low profile device) Bolus Feeding Port Extension tube with extension tube right-angled connector Side (different lengths are Port available) Clamp Connector Specialised tubes and devices NOTE: New international design standards for medical device tubing Example: Self- Feeding connectors are anticipated to be retaining (loop) Port Gastrostomy Tube or released in 2014/2015 as part of a “pig-tail catheter” phased patient safety improvement initiative called “Stay Connected”. String to hold loop in formation The new design standard impacts (cut or unlock to release connectors within the entire enteral before removing) feeding system, for example - the way a feeding tube or an extension set External connects with the giving set. Flange (some times present) For the most current information, visit: www.StayConnected2014.org Feeding holes A Clinician’s Guide: Caring for people with gastrostomy tubes and devices 9 The initial gastrostomy tube or device may be placed Measuring the length of a endoscopically, surgically or radiologically. stoma tract The insertion of a gastrostomy tube or device is considered a relatively safe procedure for adults and children, • The length of the gastrostomy tract can be measured depending on the underlying medical condition of the using the existing gastrostomy tube or a special “stoma patient. The rates of complication with the formation measuring device” that is inserted into the stomach via of gastrostomy are estimated in the range of 8-30% the stoma. depending how a complication is defined. (6-10) The rate • The length of the gastrostomy tract is the distance from of acute and severe complications such as perforation, the internal retention device to skin level (as measured serious abdominal haemorrhage or peritonitis requiring by the centimetre markings) when the tube or significant surgical intervention is less than 0.5%.14-18 measuring device is pulled gently to ensure the internal Consideration should also be given to the risks associated retention device is against the stomach wall. with sedation and anaesthesia. See photos below Health care organisations providing care to patients with a gastrostomy tube or device should have local policies and guidelines in place to ensure best practice across the continuum of care including:19 • patient selection • selection process for optimal access route where options available i.e. percutaneous endoscopic gastrostomy (PEG), laparoscopic or open gastrostomy or radiologically inserted gastrostomy (RIG) • immediate pre and post gastrostomy tube/device placement guidelines (i.e. prophylactic antibiotics, oral care and wound care) • education pre and post insertion • systems for routine monitoring and review • transition from paediatric to adult services • termination of tube feeding. PHOTOS: A Kennedy PHOTOS: Measuring the length of the Post measurement – low profile stoma tract gastrostomy device in situ 10 A Clinician’s Guide: Caring for people with gastrostomy tubes and devices .