After 5 hours of varied classroom discussion the level IV students will be able to: 1. Define the following 1.1 Gastrostomy 1.2 Gastrostomy tube 1.3 Gastrostomy feeding 1.4 Feeding tube 1.5 Irrigation 1.6 Total enteral nutrition 1.7 PEG 1.8 Low profile Gastrostomy 2. State the following: 2.1 Purpose 2.2 Indication and contraindication 2.3 Advantages and Disadvantages

3. Enumerate the following: 3.1 Types of Gastrostomy 3.2 Types of formula feeding 3.3 Site Gastrostomy tube insertion 4. Discuss the following: 4.1 Guidelines involved in Gastrostomy 4.2 Complication of Gastrostomy Feeding 4.3 Nursing responsibilities before, during and after 5 Demonstrate beginning skills in Gastrostomy

3 Gastrostomy feeding is the introduction of liquid food through a tube or catheter which the surgeons has introduced it into the stomach through the abdominal wall 1. 1.5 Irrigation the washing of a cavity or wound with a stream of water. . an operation performed to create an opening into the stomach for the purpose of administering food and fluids.4 Feeding tube a medical device used to provide nutrition to the patient who cannot obtain nutrition by swallowing. 1. 1. Definition of terms 1.8 Low profile Gastrostomy Device an alternative to the PEG device is the low profile gastrostomy device or LPGD. 1.Percutaneous Endoscopic Gastrostomy a flexible polyurethane tube that is passed down through the throat and into the stomach using an endoscope while the patient is under general anesthesia.1.7 PEG.1 Gastrostomy an artificial opening through the abdomen into the abdomen into the stomach can be performed surgically.6 Total Enteral Nutrition nutritional formula feedings introduced through a tube directly into the gastrointestinal tract. 1. laparoscopically or endoscopically.2 Gastrostomy tube a Tube that is inserted through the opening of the stomach 1. It may be inserted 3 to 6 months after after initial gastrostomy tube placement.

b) Act as drainage tube to bypass obstruction from tumors and scarring c) Provide drainage for the stomach when it is necessary to bypass a long standing obstruction of the stomach outlet into the intestine d) Provides fluid and nutrition directly into the stomach.During swallowing food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach. Gastrostomy feeding is preferred over NGT feeding in patients who is comatose because the gastroesphageal sphincters are still intact. . Gastrostomy feeding is the introduction of liquid food through a tube or catheter which the surgeons has introduced it into the stomach through the abdominal wall 2. b) Cancer of the esophagus.1 Purpose a) To feed a person who is unable to swallow to provide proper nutritionProvides a route for tube feeding when it is needed for weeks of longer since the incidence of regurgitation is lower. State the following: 2.2 Indication and contraindication Indication: a) Tumors in the upper alimentary tractPatients with dysphagia secondary to tumor are indicated for gastrostomy to allow maintainance of adequate nutrition.the most common symptoms of esophageal cancer are dysphagia (difficulty swallowing) and odynophagia (painful swallowing) gastrostomy feeding provides patients with esophageal cancer maintenance of adequate nutrition. d) Preferred for prolonged enteral nutrition support greater than 3-4 weeksFor example elderly of debilitated patients.2. c) Stricture of the esophagus caused by poison. When esophagus becomes constricted because of poison food cannot pass to the stomach. Regurgitation and aspiration are less likely to occur with NG feeding.

2. 2. which is the space between the layers of tissue that line the belly's wall and the abdominal organs (such as the liver. Contraindication a) Complete intestinal Obstruction and Malignant small bowel obstruction Digestion is the process whereby nutrients are reduced to appropriate form for intestinal absorption. Decrease the risk of pulmonary aspiration-. spleen. . Regurgitation and aspiration are less likely to occur with NG feeding.e) Comatose patients – Gastrostomy feeding is preferred over NGT feeding in patients who is comatose because the gastroesphageal sphincters are still intact. c) Severe Gastroesophageal Reflux Patients with sever gastroesophageal reflux are at risk for aspiration pneumonia and therefore are not candidates of gastrostomy. Intestinal absorption transports nutrients across the mucousa to the portal blood when there is complete intestinal obstruction there is inability of nutrients to be readily catabolized and transported. b) Ascites In Ascites there is extra fluid in the peritoneal cavity.Patients with dysphagia secondary to tumor are indicated for gastrostomy to allow maintenance of adequate nutrition. gall bladder and stomach).3 Advantages and Disadvantages Advantage 1. Regurgitation and aspiration are less likely to occur with NG feeding. Provides alternative passage of food and medicine in cases of obstruction. Gastrostomy feeding is preferred over NGT feeding in patients who is comatose because the gastroesphageal sphincters are still intact.

there are opportunistic bacteria that when given a chance enters into the tissues and causes infection. red.3. Infection. A device that is secured by a deflatable balloon than one secured by internal bumper or disc. Gastric distention-There is distortion of the anatomy of the stomach and interference of the normal peristaltic movements of the stomach musculature. Left untreated the skin may become macerated. Leakage and Skin Irritation. Tube is easy to replace Tube placement is much simpler. 3 . Disadvantage A. The end of the PEG tube is then brought to a small incision into the abdomen to allow smell access for feeding and is secured in place inside the stomach and held against the skin by a fixation device. Bleeding.The skin surrounding the a gastrostomy requires special care because it may become irritated from enzymatic action of the gastric juices that leak around the tube. C. .Bleeding from the insertion site of the stomach may occur. Percutaneous Endoscopic Gastrostomy (PEG) tube a flexible polyurethane tube that is passed down through the throat and into the stomach using an endoscopic while the patient is under general anesthesia.Infection of the stoma site since there is a break in the continuity of the skin. B. D. requiring less much manipulation. Gastrostomy tubes and buttons requires less frequent changes than nasogastric tubes. raw and painful.Enumerate the following: 3. almost any type of diet can be used.1 Types of Gastrostomy Tube a.

The main difference is that the section of the tube or catheter that is in the stomach is held place by an inflatable silicone balloon and may need to be temporarily secured with sutures to the skin.Advantage:   can be utilized for feeding within 24 hours of insertion. but it has a wider diameter. Balloon Gastrostomy Tube Is a flexible surgically placed catheter that is inserted through an incision in the abdomen. it is similar to the PEG tube in that it has a long external extension tube. . Disadvantage:    Invasive Need minor surgical Procedure to insert them. These tubes are more suited to long term usage and can stay in place for many months. The tube may be temporarily for the first 6-8 weeks and can be then replaced by a balloon device. Subsequent proximal displacement Picture: b.

Low Profile Gastrostomy Tube Also known as balloon retention low profile gastrotomy tube is a much shorter tube. the exterior of this device sits flush with the skin.Advantage:   Surgery is not necessary when removing or changing this tube Low risk of migration and dislodgement Disadvantage:   More difficult and painful to replace Malfunctions more often Picture: c. the device is a silicone shaped end that sits inside the stomach and is cosmetically pleasing. Advantage:      Simplified care Decrease skin irritation Low risk of migration and dislodgement Comfortable wear-no bulk under clothing Cosmetically pleasing .

the difference being that a seromuscular tunnel will be made a distance of five to eight centimeters from the insertion site. Janeway Gastrostomy is similar to Stamm gastrotomy with a difference that a gastric flap will be created to cover the tract to the skin. and the site of insertion will be sutured to the abdominal wall with three or four interrupted sutures.Disadvantage:     Limited sizes The requirement of a mature stoma tract Expense greater to traditional tubes Possible of pressure necrosis due to inappropriate sizing Picture: SURGICAL GASTROSTOMY INSERTIONS  Stamm Gastrostomy is the insertion of the gastrostomy tube through a small incision in the midline or subcostal area. The tube is inserted in the stomach through a purse-string suture. This type of gastrostomy is permanent. and removal of tube does not cause spontaneous closure of the gastrostomy site.   . Witzel Gastrostomy is similar to Stamm gastrostomy.

2 Types of formula feeding 1.g liver failure.0 Kcal/ml) -commercially prepared for specific indications or situations (e. Lactose free formulas 3.0 Kcal/ml) -include milk based blenderized foods prepared by hospital dietary staff or in the client’s home. Polymeric (1.0 to 2.0 Kcal/ml) -contains predigested nutrients that are easier for a partially dysfunctional G. Special formulas (1. pulmonary disease. 2. polymer or lipids) preparation but are not nutritionally complete. 5.8 to 4. -includes commercially prepared whole nutritional formulas -For this formula to be effective.0 Kcal/ml) -are single macronutrient (e. the clients G. HIV infection) .I tract must be able to absorb whole nutrients.3. Elemental diets (1. -Formula added to another food for meeting the client’s individual nutritional needs.g protein. Modular diets (3.I tract to absorb 4.0 to 2. glucose.0 to 3.

Continuous Pump Infusion-is the preferred method of delivering enteral nutrition in the critically ill patients.TUBE FEEDING ADMINISTRATION METHODS 1. A peristaltic pump can be used to provide continues infusion of the formula at a precisely controlled flow rate. largevolume (60ml) syringe. Given by bottle or bag. Syringe bolus – The bolus is usually delivered with the aid of a catheter tipped . Hooked to a feeding tube set and is administer at specific times of the day 2. which decreases problems with infection and diarrhea. . 3. Intermittent gravity drip-administering tube feeding into the stomach.

3.3 Site Gastrostomy tube insertion .


the common cause of GI bleeding is gastric ulceration beneath the internal bolster .1 Guidelines involved in Gastrostomy a. vomitus and stool for evidence of bleeding -avoid dark color foods .Excessive handling and manipulation of tube -can increase risk for ulceration and subsequent infection.wash the area around the tube with soap and water daily.this could also lead to peritonitis Intervention: . loosen the tube retainer device so that there is 1/8-inch distance between the skin and the reatainer disc or triangle.4. Once the stoma heals and drainage ceases.proper cleaning of the site and change dressings daily.can also occur as a result of frictional abrasion which can lead to pressure necrosis. d. remove any encrustation with saline solution. c. .Patients are at increased risk for infection if they are: diabetic.2 Complication of Gastrostomy Feeding  Wound Infection. b. and pat it dry. if the tube does not twist easily. give tube a twist to ensure that the tube is not too tight against the abdominal wall. 4. Abdominal wall abscess .keep the dressing dry and protect the skin from moisture with alcohol-free skin sealants or ointments . obese. once the gastrostomy site has healed (usually 2 to 3 weeks after surgery) NO DRESSINGS are needed at the site e. cleanse around the gastrostomy site with mild soap and water. Cellulitis. when a patient puts tension on a G-tube. watch for any signs of irritation or leakage at the gastrostomy site and report these immediately to a supervisor f.internal part of the tube is too tight against the abdominal wall . a dressing is not required.  GI bleeding . on chronic corticosteroids or immunosupressed . pat dry. the tube should be stabilized with a mesh netting or wrap to prevent discoloration of the tube or tissue breakdown. . Intervention: -monitor the patient’s vital signs and observes all drainage from the operative site. Discuss the following: 4. rinse the area well with water.

consider the use of an external stabilizing device • Verify leakage has ceased . • If balloon catheter. hypertonicity/spasticity o Inability to decompress gastric content (i.e.-avoid caffeinated drinks -check the characteristics of stools  Premature dislodgement of the tube -tube displacement -inadequate tube stabilization Intervention: -allow sufficient length of tubing to prevent tension or pulling on the tube. pull back the fluid in the balloon. check tube for proper inflation of balloon o Verify tube type and proper amount of fluid in the balloon as recommended by manufacturer o Using a syringe attached to the port.  Leakage around gastrostomy tube -Tube displacement -Improper balloon inflation -Inadequate tube stabilization -Increased abdominal pressure related to: o Cough. constipation. • Stabilize the tube o Gently pull up on the tube until the internal anchoring device or balloon is against the wall of the stomach o If unable to stabilize in this manner or there is no anchoring device. -gastrostomy tube must be held in place by a thin strip of adhesive tape that is first placed around the tube and then firmly attached to the abdomen. A slip-tip syringe may be necessary for certain low-profile tubes o If insufficient fluid is present in the balloon. Routinely check the position of markings on the tube to determine if slippage has occurred. re-inflate with the correct amount of sterile water o Balloon volume should be checked weekly. burp) Intervention: Use proper hand washing technique before and after all nursing interventions.

including disturbances in the gastric reservoir and transporting function.pressure at the PEG’s external and internal bolsters Interventions: .  Dumping syndrome Dumping is the effect of alteration in the motor functions of the stomach. but Carbohydrate intake should be kept in low -Antispasmodics. Skin Irritation . -Cover with dry gauze under stabilizer to wick minor drainage until the skin irritation is resolved. as prescribed. Avoid tape if possible. the patient should lie down for 20-30 minutes to delay stomach emptying -Fluids are discouraged with meals but may given up to an hour before mealtime or one hour following mealtime -Fat may be given to tolerance. Intervention : -patient should be positioned in a semi-recumbent position during mealtime. Gastrointestinal hormones play an important role in dumping by mediating responses to surgical must be kept clean with frequent use of soap and water and should be kept dry.leakage of gastric secretions around the tube . may aid in delaying the emptying of the stomach. a protective ointment such as Zinc oxide or Petrolatum gauze may be applied around the tube. . Ensure there is adequate space for the foam dressing below the bumper/stabilizer so the tube is not under excessive tension. Following the meal.

3 Nursing responsibilities before. attach the syringe • do lavage (if content is more than or equal to 100cc withhold the feeding) • hold the tube upright above the level of the stomach During: • fill the aseptosyringe with the feeding solution • release the kink tubing to allow the solution to flow • allow the syringe to empty gradually by gravity • refill the syringe until the prescribed amount is introduce to the client • flush 30mL of water • kink the proximal end of the tube before disconnecting the syringe • cover the end of the tube with a cap • allow patient to remain in semi-fowler's position for 30 minutes After: • • • do after care rinse all reusable materials with water and let it dry Documentation comes next 5. Demonstrate beginning skills in Gastrostomy .4. during and after Before: • explain the procedure to the patient and to the significant others • perform medical handwashing • gather all the materials needed and bring to the patinet's bedside • position patient in sem-fowler's position • inspect the site for any unsual reaction • check the placement of the tubing • auscultate the bowel sound • assess for bowel distention • open the sterile materials asepticallys • rink the distal end of the tube to present air from coming in.

Fecal & urinary diversions: management principles .Lippincott William and wilkins:Singapore. Fundamentals of Nursing . Teplick .Nonsurgical Therapies for the Gut and Abdominal Cavity . Elsevier:Singapore.1000 Janice Colwell et.38 Meera Kaur . Clinical pediatric dietetics . Pearson:Singapore.8th edition. p. Bogden.305 Medical Surgical Nursing by Susan Smeltzer.Medical Foods from Natural Sources.Medical Surgical Nursing.INFORMATION SOURCES: Thresyamma . Kozier and Erb’s fundamentals of Nursing.p.6th edition.44 Susan Smeltzer .Clarissa . p.355 Patricia Potter and Perry.Feeding Problems in Children: A Practical Guide .Abrams' angiography: interventional radiology p. Missouri: Elsevier.10th edition. Abrams . .p. Acute and chronic wounds: current management concepts .p.Margaret.522 John D.Anne Griffin.p.1231 . Fundamentals of nursing.p.p.602 Vanessa Shaw and Lawson.10th edition.22 Herbert L.10 Angela Southal and Martin. 357-359 Ruth A. Denise. p.998) Steven K. Clinical nutrition of the essential trace elements and minerals: the guide for health professionals.1314 Audrey Berman. Bryant and Nix.

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