Gastrostomy Feeding Tube Placement

What is gastrostomy feeding tube placement?

Gastrostomy feeding tube placement is a procedure for putting a feeding tube directly into the stomach through the abdominal wall.

When is it used?

This procedure may be done to feed you if you are unable to eat normally. For example, you may need a gastrostomy if:

• You cannot swallow because you have cancer of the mouth or throat or have had a stroke.
• You have another problem with swallowing.
• You are receiving medical treatment, such as chemotherapy or radiation therapy, that is temporarily making it hard for you to eat enough to get good nutrition.
• You are very malnourished.

Most temporary feeding tubes are passed through the nose into the stomach. A gastrostomy tube is usually placed to allow removal of a nose tube, so that feeding can continue with greater comfort. It is also an alternative to getting nutrition through your veins (IV).

How do I prepare for gastrostomy feeding tube placement?

Plan for your care and recovery after the operation. Find someone to drive you home after the procedure. Allow for time to rest and try to find people to help you with your day-to-day duties. Follow any instructions your healthcare provider may give you.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before the procedure.

If you need a minor pain reliever in the week before the procedure, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. Aspirin, ibuprofen, or naproxen can cause extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your procedure.

Follow any other instructions your provider gives you.

What happens during the procedure?

The procedure can be done in a number of ways:

• open gastrostomy tube placement or laparoscopic tube placement by a surgeon
• percutaneous endoscopic gastrostomy (PEG) tube placement by a medical doctor called a gastroenterologist at an endoscopy clinic or hospital
• percutaneous fluoroscopic gastrostomy tube placement guided by X-rays and done by a radiologist.

For open or laparoscopic gastrostomy tube placement, you will receive a general anesthetic. It will relax your muscles and put you to sleep. It will keep you from feeling pain during the operation.

The surgeon will either make a cut in your skin and the abdominal wall and then a cut through the wall of the stomach (called open surgery) or make smaller cuts through which a camera and small instruments are passed (laparoscopy). The open procedure may be necessary if you have scarring that prevents the use of the smaller instruments. The surgeon will place a tube through a cut into the stomach. Sometimes the tube will be threaded further into the duodenum, which is the first part of the intestines. This may require a smaller tube, which can get plugged more easily but it lowers the risk of vomiting. The surgeon will sew the tube to the abdominal wall and close the cut.

For percutaneous endoscopic gastrostomy (PEG) tube placement you will probably be given a sedative and a local anesthetic to keep you from feeling pain. The doctor will guide an endoscope through your mouth and into your stomach. An endoscope is a thin, flexible tube with a tiny camera. It lets your doctor look into the inside of your stomach during the procedure. Your doctor will fill your stomach with air to make it bigger and push the stomach wall closer to the abdominal wall. The doctor will guide a needle and wire through your skin and abdominal wall and into your stomach. The endoscope allows the doctor to see and grasp the wire inside the stomach. The wire is then pulled back through your mouth. A plastic tube is attached to the wire and pulled through your mouth and back along the wire's path into your stomach.

The doctor will secure the tube inside the stomach and to your skin. The short piece of the rubber tube visible through the abdominal wall is easily covered with normal clothing.

Placement of a feeding tube with percutaneous fluoroscopic gastrostomy uses X-rays rather than a scope to guide the feeding tube placement. First a small tube is placed through your nose into your stomach to fill your stomach with air. The radiologist then takes some X-rays to make sure nothing is in the way between the stomach and the abdominal wall. Some stitches (sutures) are placed in the stomach to bring it close to the wall of your abdomen. After numbing your skin with a local anesthetic, the doctor places the gastrostomy tube through a small cut in the abdominal wall and into the stomach over a guide wire. The tube in your nose is then removed.

With each procedure, a balloon or rubber cap keeps the tube in place in the stomach.

Talk to your provider about which procedure best fits your needs.

What happens after the procedure?

You will be taken back to a hospital or recovery room. You may stay in the hospital for 1 to 3 days, based on your condition. If you have a percutaneous tube, you usually will leave the day of the procedure. You will be taught how to use and care for the feeding tube before you leave the hospital. It can usually be used within 12 to 24 hours after the procedure.

The formula for tube feedings may be passed through the tube into the stomach with a special syringe. In some cases a pump is used. The pump may be connected to the tube all the time so that the formula goes in a little at a time. Or the pump may be used at night for feedings during sleep. If the tube is needed for a long time, it may later need to be replaced with a new tube. Replacing the tube is a fairly simple outpatient procedure that can be done in your healthcare provider's office.

Discuss your medicines with your healthcare provider. Most liquid medicines can be given to you through the feeding tube with a syringe. Many medicines available as tablets may also be available in liquid form. It may also be possible to dissolve crushed tablets in water so they can be given to you through the feeding tube. Substitute medicines may be available if none of these solutions work. Always flush the feeding tube with water after putting medicines or food in it to prevent clogging the tube.

You may have changes in your bowel movements. Your bowel movements may be looser, or you may have constipation.

Your healthcare provider will tell you when you can go back to your normal activities. You will usually be told to avoid lifting for 6 weeks after open surgery but there are fewer restrictions after PEG tube placement. Make sure that the feeding tube is carefully secured under clothing. A cummerbund (or girdle) made of cloth or BandNet (an elastic, netlike material) can help to secure the feeding tube. A feeding tube should not keep you from returning to work or most activities. If you have questions about this, ask your healthcare provider.

Ask your healthcare provider what steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

You will be able to get enough nutrition without having a tube through your nose into the stomach.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. In older adults, mild to severe confusion can occur. Discuss these risks with your healthcare provider.
• The colon or other organs in your abdomen may be injured during the procedure, which could require surgery for repair.
• The area around the tube may become infected after the procedure.
• You may have bleeding.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• The tube comes out. It's dangerous if the tube comes out within 2 to 3 weeks after the procedure. It's not dangerous after that, but the opening can close very quickly, so a new tube needs to be placed before this happens. Be sure to call your healthcare provider for instructions if your feeding tube accidentally comes out.
• The tube is becoming blocked.
• You are unable to take food through the tube.
• You have a lot of drainage around the tube.
• You have a fever of 100°F (37.8°C) or higher.
• You have nausea or vomiting after feedings.
• You have pain with feedings.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.

For information on support groups, diet, equipment, and other problems, contact:

The United Ostomy Associations of America
Phone: 800-826-0826
Web site: http://www.ostomy.org/