A percutaneous feeding tube (PFT), such as a gastrostomy (G-tube) or jejunostomy (J-tube), is a device placed through the skin into the gastrointestinal tract, typically the stomach or small intestine. Its function is to provide long-term nutritional support, fluids, and medication when a person cannot safely meet their needs by mouth. The tube bypasses the mouth and throat, allowing for nourishment while preserving the body’s natural digestive processes. Consistent assessment of the patient and the tube system is necessary to ensure the feeding regimen is safe and effective.
Assessment of the Tube and Insertion Site
The area where the tube enters the body, known as the stoma, requires routine inspection for normal healing and maintenance. Expected findings include a pink, dry, and intact skin surface around the tube. It is common to see a small amount of clear or yellowish drainage, which should be minimal and manageable with routine cleaning.
The tube itself must be secure and patent to function correctly. The external retention device, such as a bumper or disc, should sit lightly against the skin, holding the tube in place without causing excessive pressure or blanching of the surrounding tissue. Proper positioning is confirmed by checking the tube’s external markings against the established baseline measurement. The tube should also flush easily with water, confirming patency and ensuring there is no internal blockage.
Expected Systemic and Gastrointestinal Findings
When the body tolerates the tube feeding regimen, the patient’s overall health status should reflect adequate nutrition and hydration. Weight should be stable or show appropriate gain or loss, depending on the care goals established by the healthcare team. Signs of good hydration include moist mucous membranes, resilient skin turgor, and consistent, adequate urine output.
Gastrointestinal function should remain comfortable and predictable. An expected finding is a soft, non-distended abdomen with normal, active bowel sounds upon listening. While the consistency of stool may be softer than usual due to the liquid diet, regular bowel movements are anticipated.
Gastric residual volume (GRV) refers to the amount of formula remaining in the stomach before the next feeding, and a small amount is expected. Monitoring GRV is common practice, but a single high volume is often less concerning than a persistent pattern of high volumes, especially when other symptoms of intolerance are absent. For many patients, GRV measurements below 250–500 mL are considered within a tolerable range, depending on facility protocol and the patient’s condition.
Recognizing Findings Requiring Immediate Intervention
Certain assessment findings indicate a serious complication and require prompt medical attention. Any indication of a stoma site infection, such as significant purulent discharge, a foul odor, warmth, or spreading redness that extends more than a couple of centimeters from the site, should be addressed urgently. A fever above 101°F occurring alongside these local symptoms suggests a systemic infection that needs immediate medical evaluation.
A dislodged or fully removed tube is a time-sensitive emergency, particularly if the PFT was placed recently, because the tract can begin to close within hours. If the tube cannot be flushed, is completely blocked, or if the external length has changed significantly, the system integrity is compromised, and feeding must stop immediately. Another mechanical issue is Buried Bumper Syndrome, where the internal retention device becomes embedded in the stomach wall, often presenting as severe pain, inability to move the tube, or significant leakage around the site.
Gastrointestinal symptoms also signal potential danger when they are severe or persistent. Persistent, high gastric residual volumes accompanied by vomiting, abdominal distention, or intractable nausea are signs of feeding intolerance or delayed gastric emptying that can lead to aspiration. Coughing or difficulty breathing that occurs during or immediately after a feeding is a sign of aspiration, where formula enters the lungs, and requires prompt intervention. Systemic distress, such as a rapid heart rate, low blood pressure, or a sudden change in mental status, suggests a complication like peritonitis or septic shock and necessitates urgent medical care.