QUICK GUIDE TO GASTROSTOMY FEEDING TUBES AND DEVICES

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

Oesophagus

Stomach

Gastrostomy tube

Skin

Cross-section: non-ballooned tube

Clamp External Flange

Skin Fat Muscle

Internal Bumper

Stomach

Photo: A Kennedy Photo: M Sutherland

Patient with a ballooned gastrostomy tube insitu

Patient lying down with a non-ballooned 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

ml/cc ml/cc

Ballooned Gastrostomy Tube With side port

Balloon Port (X ml/cc)

Feeding Port (Enteral Dispenser and Feed Bag connect here)

Side Port

External Flange

FR

French (size) [For example:16/18/20]

cm markings

Ballooned Gastrostomy Tube Without side port

Balloon Port (X ml/cc)

Feeding Port (Enteral Dispenser and Feed Bag connect here)

French (size) [For example:16/18/20]

FR

External Flange

cm markings

Balloon

Balloon

Non-ballooned Gastrostomy Tube with collapsible internal bumper

Feeding Port (Enteral Dispenser and Feed Bag connect here)

Side Port

French (size) [For example:16/18/20]

Non-ballooned Gastrostomy Tube With rigid internal bumper

NOTE: this tube must be removed endoscopically

Feeding Port (Enteral Dispenser and Feed Bag connect here)

Side Port

French (size) [For example:16/18/20]

FR

FR

TRACTION REMOVAL

Clamp

Internal Bumper

External Flange

cm markings

Clamp

Internal Bumper

External Flange

cm markings

8 A Clinician's Guide: Caring for people with gastrostomy tubes and devices

Low Profile (skin level) Gastrostomy Device With a balloon

Used with compatible extension tubes - see below.

Feeding Port (extension tube connects here)

Low Profile (skin level) Gastrostomy Device Non-ballooned (obturator or traction removal)

Used with compatible extension tubes - see below.

Feeding Port (extension tube connects here)

x ml cc

Balloon Port (x ml cc)

Feeding

Port cover

Length of the device varies and depends on tract length

(see page 10)

Balloon

Length of the

device varies and

depends on tract length

(see page 10)

Feeding Port cover

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 extension tube

Feeding Port

Side Port

Extension tube with right-angled connector (different lengths are available)

Clamp Connector

Specialised tubes and devices

Example: Selfretaining (loop) Gastrostomy Tube or "pig-tail catheter"

String to hold loop in formation (cut or unlock to release before removing)

Feeding holes

Feeding Port

External Flange (some times present)

NOTE: New international design standards for medical device tubing connectors are anticipated to be released in 2014/2015 as part of a phased patient safety improvement initiative called "Stay Connected". The new design standard impacts connectors within the entire enteral feeding system, for example - the way a feeding tube or an extension set connects with the giving set.

For the most current information, visit:

A Clinician's Guide: Caring for people with gastrostomy tubes and devices 9

The initial gastrostomy tube or device may be placed endoscopically, surgically or radiologically.

The insertion of a gastrostomy tube or device is considered a relatively safe procedure for adults and children, depending on the underlying medical condition of the patient. The rates of complication with the formation of gastrostomy are estimated in the range of 8-30% depending how a complication is defined. (6-10) The rate of acute and severe complications such as perforation, serious abdominal haemorrhage or peritonitis requiring significant surgical intervention is less than 0.5%.14-18 Consideration should also be given to the risks associated with sedation and anaesthesia.

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.

Measuring the length of a stoma tract

? The length of the gastrostomy tract can be measured using the existing gastrostomy tube or a special "stoma measuring device" that is inserted into the stomach via the stoma.

? The length of the gastrostomy tract is the distance from the internal retention device to skin level (as measured by the centimetre markings) when the tube or measuring device is pulled gently to ensure the internal retention device is against the stomach wall.

See photos below

PHOTOS: A Kennedy

Measuring the length of the stoma tract

Post measurement ? low profile gastrostomy device in situ

10 A Clinician's Guide: Caring for people with gastrostomy tubes and devices

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