A Gastrostomy tube, commonly called a G-tube, is a medical device designed to provide a pathway directly into the stomach. This small, flexible tube is inserted through the abdominal wall to bypass the mouth and esophagus entirely. Its primary function is to deliver nutrition, fluids, and medications when a person cannot safely or adequately consume them orally. The term “gastrostomy” itself is a combination of “gastro,” referring to the stomach, and “ostomy,” meaning to create an opening, which describes the tube’s method of access.
Why Gastrostomy Tubes Are Necessary
G-tubes are placed to address situations where oral intake is insufficient. One of the most frequent indications is severe dysphagia, often caused by neurological conditions like stroke, Parkinson’s disease, or advanced dementia. When swallowing is impaired, there is a substantial risk of aspiration, where food or liquid enters the lungs instead of the stomach, potentially leading to pneumonia.
The tube is also necessary for individuals who cannot consume enough calories or nutrients by mouth to maintain their health and weight. This can include patients with severe malnutrition, failure to thrive, or chronic illnesses that increase metabolic demand, such as head and neck cancer or severe burns. Furthermore, G-tubes can be used for gastric decompression, which involves venting air or draining excess fluid from the stomach to relieve nausea and vomiting.
Overview of the Placement Procedure
The placement of a G-tube creates a tract, or stoma, from the outside skin directly into the stomach lining. The most common technique is the Percutaneous Endoscopic Gastrostomy (PEG) method, which often requires only conscious sedation rather than general anesthesia. During a PEG procedure, an endoscope is guided down the throat and into the stomach to help identify the precise insertion point on the abdominal wall.
A small incision is then made in the abdomen, and the G-tube is inserted using the endoscope as a guide, often employing a “pull-through” technique. Another method is surgical placement, which may be preferred in patients with altered anatomy, a history of previous abdominal surgery, or when endoscopic placement is contraindicated. Surgical placement, which includes open or laparoscopic techniques, typically requires general anesthesia and involves directly suturing the stomach to the abdominal wall to secure the tube.
Types of G-Tubes and How They Are Used
G-tubes are categorized into two variations: standard long tubes and low-profile devices, often called buttons. The standard long tube extends several inches from the abdomen and is often used immediately after placement. This type of tube is typically secured internally by an inflatable water-filled balloon and externally by a retention disc that rests against the skin.
Low-profile buttons are shorter devices that sit flush against the skin, making them more discreet and less likely to be accidentally pulled out. These buttons also use a water-filled balloon inside the stomach for retention, but require a detachable extension set to be connected for feeding or administering medications. Feeding can be administered in two ways: continuous feeding, where a pump delivers formula slowly over many hours, or bolus feeding, which uses a syringe to push a larger volume of formula over a short period, mimicking a meal. Medications must be crushed or dissolved in water before being flushed through the tube to prevent clogs.
Basic Care and Management
Management of a G-tube focuses on maintaining the stoma site and preventing the tube from clogging. The skin around the tube must be cleaned daily with mild soap and water to remove any drainage or crusting. This hygiene prevents skin irritation and reduces the risk of infection at the insertion site.
After the initial healing period, the tube should be gently rotated 360 degrees once a day to prevent it from adhering to the skin tract. Flushing the G-tube with water is required to keep the device clear and functional, and should be done before and after every use for feeding or medication. Caregivers must monitor the stoma for signs of complications, such as excessive redness, swelling, or thick drainage, which may indicate an infection or the formation of granulation tissue.