Care of a Patient with a Gastrostomy Tube

The use of nasogastric tubes and gastrostomy tubes to feed patients who are unable to eat is becoming increasingly frequent in hospitals. This article outlines the safe care of NG and gastrostomy tubes. This knowledge is essential to care for patients safely.

Prior to commencement of any feed the placement of the tube must be checked by aspirating a small amount of gastric fluid and confirming it with litmus paper. Since the contents of the stomach are acidic blue litmus paper will turn red. If the litmus does not turn red then the tube is probably in the lungs and must be removed and reinserted.

“Feeding” a patient whose tube is in the lungs will result in the patient suffocating to death. The food will enter the patients lungs! If uncertain, do not feed, it is safer. Notify your superior and treating physician.

Picture 1. Cross-Section of Human body to show correct placement of nasogatric tube (fine bore). Picture by Shergill.

Water flushes of 30 to 40 mls must be given before and after feed and medication. This practice will prevent blockage of the tube.

If a blockage occurs a water flush should be attempted prior to rushing the patient to the emergency department of a hospital. Some institutions encourage the use of sodium bicarbonate solution to unblock the tube.

Skin around the stoma should be assessed daily. Check for redness, leakage or evidence of irritation.

Skin around the stoma should be washed with warm soapy water and barrier cream applied if the patient is no t allergic to it.

Keep the skin dry to prevent infection.

If irritation occurs then it may be advisable to use a gauze swab to shield the skin from friction with the tube.

Key points about feeding via tubes.

Be certain that the tip of the tube is in the stomach.

Some tubes are not suitable for medication administration and may not be used to aspirate gastric contents. Generally: tubes which smaller are not suitable for feeding or aspirating gastric contents. Larger tubes can be used for medication administration and for aspirating gastric contents.

The appropriate amount of feed is placed in the bag. The feeding bag is then connected to a Kangaroo pump or allowed to drain by gravity into the patient. Kangaroo pumps are more accurate and should be used whenever they are available. When the feeding is completed flush the bag and tube with the prescribed amount of water. As stated earlier this procedure will keep the line patent longer.

Always secure the tube to the patient’s skin so that it is not tagged or pulled out by accident. Some gastrostomy tubes may be sutured in place.

Picture 2. Nasogastric tube with wire. Note that the end is black. It has metal beads in it to weigh it down. This is a small bore feeding tube. Picture by Shergill.