Health Library
Percutaneous Gastrostomy Tube Care

How Do You Care for a Percutaneous Gastrostomy (PEG) Tube?

How to care for percutaneous gastrostomy tube. A gastrostomy tube -- commonly abbreviated as "G-tube" -- is a tube that is placed into your child's stomach. The word "gastrostomy" comes from two Latin root words for "stomach" (gastr) and "new opening" (stoma). This tube is used to give your child an alternate way to get their fluid, nutrition, and / or medications. It may also be used to vent your child's stomach for air.

The tube stays in your child's stomach because there is a bumper at the end of the tube inside the stomach, and there is a plastic piece around the tube outside the child's body. These keep the tube from sliding in and out of the opening. The plastic piece should not slide around on the tube. The tube should be able to move in and out of the child's stomach just slightly. The plastic bar should be snug against the skin (about the depth of a dime), but it should not cause pressure. You may need to loosen or tighten the plastic piece if your child gains or loses weight.

At the end of the tube there is a feeding adaptor and medicine port. These connect to a syringe or feeding set to deliver nutrition and / or medications. The adaptors close at the end when you aren't using the tube.

Supplies

Soap and water
35-60 mL catheter tip syringe
10 mL syringe for meds and flushes
Water for flushing PEG tube

Cleaning and Dressing the Wound

Wash your hands with soap and water.
Remove the old dressing. Look at the area where the tube enters the skin. Check for pain, tenderness, redness, swelling, green or yellow liquid drainage, or excess skin growing around the tube. A small amount of clear or tan liquid drainage is normal. See the "problem solving" list below for what to do if you notice any of these things.
Clean the skin under the plastic bar around the tube with soap and water or during bath or shower. Then rinse the skin using clean tap water and cotton swabs. Dry thoroughly.
If there is any drainage at the disc, use one split 2x2 gauze piece and place it around the tube under the plastic piece. Do not use more than one 2x2 under the disc.
Secure the tube.
Do not use ointments around the tube site unless directed by your child's doctor or nurse.

Flushing the G-Tube

Use an appropriate syringe and slowly push ___mLs of warm clean tap water into the tube. Flush the tube after every feeding and after all medications are given to keep the tube open and clean. This syringe may be washed in warm water and reused.

Giving Medication or Feeding

Before feeding or giving medication, check to make sure the tube is clear by slowly pushing ____ mLs of water through the tube with a syringe.
Instructions for giving medications through your child's tube will be given to you by your child's doctor or nurse.

Protecting the Tube

Keep your child from pulling on his / her tube. There are several different ways of securing a G-tube. Your child's doctor or nurse will discuss these with you. Here are some suggestions:

Keep the tube taped or pinned to the diaper or shirt.
Keep the child's T-shirt over the tube. One-piece, snap T-shirts work best for infants and toddlers.
An alternate way to cover the tube is to use an ACE wrap or stretchy gauze over it.
Most children get used to the tube after a while, but until they do, they may need to wear elbow splints if necessary.
Be sure to keep the end of the tube closed as directed.

Problem Solving

The following is an emergency problem that can occur with a G-tube. For an emergency, take your child to the emergency room.

Emergency Problem	What to Do Before Coming to the Emergency Room
G-tube is forcefully pulled out.	If bleeding occurs, cover the site with a clean, soft cloth. The opening of the tube may close within hours, so it is important not to wait before coming to the emergency room. If your team has provided you with a foley catheter to insert in the case of accidental dislodgement, please insert is as instructed into the stoma.

The following are nonemergency problems that can occur with your child's G-tube. Remember to notify your child's doctor if your child will miss a feeding because of a problem with his / her G-tube.

Problem	What to Do
G-tube site is red, sore and has increased drainage.	Clean per instructions. Call your child's doctor or nurse. If your child also has a fever, this is an emergency. Call your child's doctor immediately.
G-tube site is leaking large amounts of clear and / or mucus-like liquid. (Large amounts = soaks a 4 x 4 gauze three or more times a day.)	Call your child's doctor or nurse.
Skin or scar appears to be growing where tube enters skin.	Clean per instructions. Call your child's doctor or nurse.
G-tube is clogged.	Try to slowly push warm water into the tube with a syringe. Use slow, easy pushing. Never try to push any object into the tube to unclog it. If you are unable to unclog the tube, call your child's doctor or nurse.
Leaking occurs where the feeding set and adapter meet.	Check to see if the feeding set fits tightly into the G-tube. If the fit is loose, try to push the feeding set a little further down into the adapter. If it still leaks, call your child's doctor or nurse. The adapter can be replaced.