Nursing Care and Management of Gastrostomy and Gastojejunostomy Tubes in the Pediatric Population

Abstract

P ediatric surgical nurses care for children with enteral feeding devices, which include nasogastric (NG), orogastric (OG), gastrostomy (G-tube), gastrojejunostomy (G-J tube), and jejunostomy tubes (J-tube), on a daily basis. The purpose of this article is to provide updated information regarding care and management specifically for G-tubes and G-J tubes.Eating is instinctual; feeding is learned. The skills necessary to eat successfully are fully acquired by the age of 3 years (Edwards et al., 2016). However, these skills may be impaired by several conditions including but not limited to prematurity, pulmonary disease, congenital anomalies, cerebral palsy, genetic syndromes, neoplastic conditions, or trauma. If the child cannot take enough nutrition or fluids by mouth, the feeding tube may be used to supplement and provide fluids or medications as well as decompress the stomach and gastrointestinal tract. Children with severe neurological impairment often have failure to thrive and aspiration because of dysphagia and gastroesophageal reflux; conditions that may lead to acute and chronic lung disease. These children are often offered either fundoplication with G-tube or feedings with a G-J tube (Stone et al., 2017).A parent(s) decision to have an enteral device-G-tube or G-J tube-placed in their child is difficult. A study done by Craig and Scrambler (2006) described conflict with mothers' expectations of "good mothering" and the ideal child. Sleigh (2005) reported descriptions of oral feedings as central for mothers and their relationship to the child. Mothers spend an enormous amount of time struggling with feedings; however, Wilken (2012) describes relief felt by mothers after tube insertion.

The Pediatric Emergency Department Nurse and Gastrostomy Tube Replacement

“…6 Beyond the postsurgical period, complications associated with g-tube replacement include disruption of a fistula tract, incorrect tube size, pneumoperitoneum, peritonitis, bleeding or irritation around the stoma site, skin and stoma infection, and obstruction from an overinflated balloon. 3,7 Not surprisingly, caution should always be applied among parents and providers when replacing a g-tube. At our institution, parental education and a replacement kit (g-tube) are often given to parents before discharge or at the first g-tube replacement.…”

“…The first percutaneous endoscopic gastrostomy (PEG) placement was performed in 1979 and was followed by laparoscopic gastrostomies in the early 1990s 6 . Beyond the postsurgical period, complications associated with g-tube replacement include disruption of a fistula tract, incorrect tube size, pneumoperitoneum, peritonitis, bleeding or irritation around the stoma site, skin and stoma infection, and obstruction from an overinflated balloon 3,7 . Not surprisingly, caution should always be applied among parents and providers when replacing a g-tube.…”