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Care and Feeding of Enteral Tubes

Care and Feeding of Enteral Tubes. Jeffrey C. Fahl, M.D. Professor of Pediatrics Children’s Hospital of New Mexico University of New Mexico. What is a Gastrostomy?. An “ostomy” is a connection between an organ and the skin.

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Care and Feeding of Enteral Tubes

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  1. Care and Feeding of Enteral Tubes Jeffrey C. Fahl, M.D. Professor of Pediatrics Children’s Hospital of New Mexico University of New Mexico

  2. What is a Gastrostomy? • An “ostomy” is a connection between an organ and the skin. • Therefore a “gastro” meaning stomach and “ostomy” is a connection between the stomach and the skin. • A Tube is needed to keep the ostomy open.

  3. How do you create a Gastrostomy? • There are two techniques: • Surgical • PEG

  4. Creating a PEG • General Anesthesia • Upper Endoscopy • Placement of Gastrostomy • Incision • Delivery of Guide wire or string • Attachment of the tube • Pushing or pulling the tube into place

  5. Jejunostomy Tube • Usually created surgically • Principally used to by-pass the stomach because of slow gastric emptying or gastroesophageal reflux that is inoperable or has failed operation • Uses the same devices as a gastrostomy to keep the connection open

  6. Indications • Inability to eat • Aspiration • Poor oral intake • Inadequate caloric intake • May be combined with a fundoplication

  7. Evaluation • History • Growth • Cough • Emesis • UGI and/or Swallow Study • pH probe

  8. Fundoplication

  9. Are Fundoplications always the best answer? • Relatively high failure rate. • High complication rate. • Re-doing the surgery is difficult at best. • Fundoplications tend to loosen as the child grows.

  10. Gastrosotomy Devices • Catheter Devices • Button Devices

  11. Catheter Devices • Foley • Mallecott • MIC Tube • PEG Tube • Usually the first tube inserted in a new gastrostomy

  12. Button Devices • MIC-KEY • Bard • Genie • Used for long term management. • Converted or inserted in one to three months

  13. Nourishing G-tubes • Bolus Feeding • Continuous Feeding

  14. Bolus Feeding • Simple • Fast • Requires minimal equipment • Useful for feeding children at school

  15. Problems with Bolus Feeding • Often precipitates vomiting if delivered too fast. • Night feeds are not possible, unless the parents want to get up.

  16. Continuous Feedings • Great for delivering feeds while asleep • Good for getting around slow gastric emptying • Great for supplementing daily oral intake

  17. Problems with Continuous Feeds • Requires more equipment • Difficult to use at school • Often makes the children too full to eat a morning meal

  18. So what tube does the patient have? • Check to end of the tube • Check the skin level device

  19. Caring for a Gtube • Daily washing with soap and water • Rotate the tube while cleaning • Apply dressing if necessary • Ointment only if it is inflamed.

  20. Do they ever get infected? • This is a rare phenomenon • The puss that you see is more likely to be mucus (Please don’t culture) • Infections are not superficial. • Superficial redness is due to moisture or gastric acid • There is always swelling and tenderness with infection

  21. Granulomas • Very common. • Usually associated with increased tube movement • Granulomas are gastric tissue which has been pulled to the surface by tube movement • Treatment is best done with silver nitrate and decreasing the tube movement.

  22. Emergency Techniques • Primary goal is to keep the ostomy open. • Push the old tube back in or clamp tube. Then tape in place. • Or - use any object to keep ostomy open. • Replace with the proper tube as soon as possible. (most families have spares) • ERs don’t always know what to do. • When in doubt, put in a Foley catheter!

  23. Summary • Gtube and PEG are not different in function • Bolus vs. Continuous Feeds are determined by patient needs • The type of tube can be determined either by the end of the tube or how it looks at skin level.

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