Tanta University

Faculty of Nursing

Intended Learning Outcome

At the end of this procedure the student will be able to :-
A) knowledge and intellectual skill
A.1.Define gastrostomy correctly
A.2- List purpose of gastrostomy feeding
B) Intellectual capabilities
B.1.Illustrate the condition that require gastrostomy feeding
B.2. Differentiate between normal stoma and infected stoma
C) Professional and Practical Skills
C.1. Demonstrate feeding child through gastrostomy.
C.2. Perform care of gastrostomy after feeding of child
D) General and Transferable Skills
D.1. Conduct proper communication and education for nurse's students
about proper performance of gastrostomy feeding.
E) Attitude
E.1. Appreciate the role of nurses' students in providing feeding of child
through gastrostomy feeding tube
Tanta University
Faculty of Nursing

Gastrostomy Feeding
Definitions:

The term “ostomy” comes from the Greek “stoma” and means “mouth.”
Stoma ostomy:- refers to a surgically created opening of a hollow
organ on the surface of the body to enable excretion of waste products

Gastrostomy :- is the creation of an artificial external opening into the

stomach for nutritional support or gastrointestinal compression , this
operation may include child epigastrium as a part of operation.

Gastrostomy feeding: - is a mean of providing nourishment and fluid via

a tube that has been inserted by a stab wound through abdominal wall
directly into the stomach .

A gastrostomy feeding tube is a small feeding tube which is inserted

directly into the stomach so that you can receive feed, fluid and
medication without swallowing. It will provide you with a safe and long-
term method of obtaining nutrition.

Purposes:

1. To provide a method of nutrition and fluids that require minimal

effort when the child unable to suck or swallow for long period of
time
2. To allow better gastric decompression of stomach
3. For requiring prolonged artificial feeding
4. To provide a safe method of feeding a child with esophageal
stricture or child cannot tolerate alternative feeding
5. To provide a route that allow adequate fluid and caloric intake in
Tanta University
Faculty of Nursing

child with chronic lung disease who unable to receive it by other

method

Indication

1. The primary indication for gastrostomy in infants and children is

the need for long-term more than 3-6 months either primary or
supplemental enteral feeding .
2. In children with severe dysphagia associated with neurologic
dysfunction that impairs normal swallowing. Such as GI mal
absorption, malignancy, trauma, chronic lung disease, and
congenital heart disease.
3. Gastrostomy feeding may also be considered in patients with
pulmonary disease due to frequent aspiration of oral feeds.
4. Children with primary GI abnormalities, gastrostomy placement
may be a preferred means of gastric decompression
5. Impaired in swallowing or sucking with increase a risk of choking
and aspiration (food enters not only the esophagus and stomach,
but also the lungs)
6. If a child has difficulty to take enough food by mouth to meet their
nutritional needs and failure to thrive

Difference Between Normal ( Healthy) Stoma and Infected Stoma

Items Healthy or normal stoma Infected or abnormal stoma

Stoma pink/red/warm to touch – black, dusky, pale, sloughy

color
Tanta University
Faculty of Nursing

Skin Skin surrounding the stoma Any soreness- ulceration,

condition should be intact inflammation or broken skin.

edema In the post-operative period Any sudden or unexplained

(swelling) the stoma can be quite swelling of the stoma
swollen. It may reduce in
size for about 6 weeks after
surgery.

Bleeding A slight smear of blood on Excessive bleeding when

from the wipe when washing or cleaning the stoma/blood in the
Stoma drying the stoma. pouch/bleeding from inside the
stoma.

Steps Rational

I. Preparation:
A. Equipment:
1. 50ml syringe to aspirate gastric
content
2. Water for flushing
3. Measuring cup to measure the
food
4. Mackintosh with towel to avoid
soiling of bed and clothes of pa-
tient .
5. Gauze piece in bowel to clean the
skin if wet
6. Kidney tray and paper bag to dis-
card the wastes
7. Medication powder to be given
8. Enteral pump if administration
feed with pump
Tanta University
Faculty of Nursing
B. Environment:
1. Maintain privacy
2. Select the proper time for the
procedure
3. Maintain good lightening.
4. Put down side rails.
5. Close curtains around the bed area
if in a four bedded bay
C. Patient:
1. Identify the patient
2. Introduce yourself to the child/ 
mother  Encourages participation, allays
3. Explain the procedure to the
child/mother
4. Place child d in comfortable posi- 
tion such as flat position with
head slightly elevated
5. Spread the mackintosh over child 
chest
II. Implementation
1. Visually check the gastrostomy 
site for signs of redness, swelling
or leakage of fluid and report to
the medical staff before
commencing feed if observed.
2. Clean the stoma and surrounding 
skin with warm water and dry the
skin well
3. Aspirate the gastric content and  To monitor for appropriate fluid
see the residual volume.
 To maintain child dignity
 Encourages participation, allays
anxiety, and ensures accurate
measurements.
 To avoid fall of child during
procedure
 To maintain privacy and dignity
 To establish trust relationship with
child
For good communication.
anxiety, and ensures accurate
measurements.
Keeping child relax and comfortable
allow feeding fluid to flow more
easily into stomach
To avoid contamination of child
clothes
To check sign of infection
Wet skin increase risk of skin break-
down and soreness , stoma itself re-
main wet
intake , digestion time and over
Tanta University
Faculty of Nursing
4. Flushing the tube with 5-10 ml 
water
5. Attached reservoir syringe to tube 
and fill it with feeding fluid be-
fore open the clamp
6. Elevate the tube and reservoir to 
10-12 cm above the abdominal
wall , don’t apply any pressure to
start feeding
7. Feeding slowly within 20-45 
minute
8. When feeding is complete, instill 
10-30ml of clear water , apply
clamp before water reach the end
of reservoir
9. Check dressing and skin around 
point of tube entry for wetness
10. Clean the skin around stoma and 
apply skin barrier
11. Leave the child dry and comfort- 
able , place child in right side or
fowler position
12. Discard all equipment
III. Documentation:
1. Amount and time of feeding
2. Amount and characteristic of resid-
ual
3. Child response
feeding which caused abdominal
distention
To ensure patency of feeding tube and
avoid blockage
To prevent air from enter the tube
which may cause distention
This elevation level allow flow of
fluid by effect of gravity , pressure
may cause backflow of fluid into
esophagus.
Too rapid feeding interfere with
peristalsis and cause abdominal
distention.
To rinse the tube and prevent
clogging, clamping the tube prevent
air enter the stomach and avoid
abdominal distention
Break down of skin is caused by
continues exposure of stomach
content that may be leaking out
around the tube causing excoriation
and infection
To prevent skin break down and
infection
To promote relaxation and improve
digestion of feeding

Tanta University
Faculty of Nursing

4. Stoma condition

Fig. (1) Equipment

“ Pictures

”
Gloves Sterile water Apron

syringe Figure (2): placement of tube in the stom-

ach

Figure (3): Normal stoma Abnormal stoma

Tanta University
Faculty of Nursing

References:
1. Correia C . Pediatric Nursing Procedure Principle and Practice . 1st
ed . , New Delhi: CBS publisher &distribution ., 2017:75-80
2. Trigg E , Mohammed T . Practice in Children's Nursing : Guideline
for Hospital and Community. 2nd ed., China: Elsevier ., 2105;173-
185.