Tube Talk

Frequently Asked Questions

This page will hopefully answer most frequently asked questions and explain associated terms. If you find it does not answer what you are seeking please contact us.

What is a Gastrostomy?

A gastrostomy is a tube is placed into the stomach via surgery, so that liquid formula (food), drinks and medication can be given.

Sometimes a gastrostomy or g-tube is called a PEG (Percutaneous Endoscopic Gastrostomy).It is called this because this term is the technique for placing a gastrostomy tube into the stomach. A PEG is a convenient, safe and cosmetically better alternative to a nasal/oesophageal tube. It is used for intermediate to long term nutritional support for people unable to eat an adequate diet. (PEG percutaneous endoscopic gastrostomy becomes link )

Why do I need a gastrostomy?

The main reason for needing a gastrostomy is due to dysphagia or difficulty with chewing and/or swallowing and thus a failure to thrive. It may be because food and drink is going into the lungs with a risk of aspiration pneumonia. A gastrostomy may be needed where there is a person is not able to eat or drink enough food and fluid to maintain a good nutritional and hydrated status. Some people may need total nutritional support via a tube (where no food/drink is taken orally) and other people may only need the tube to supplement their oral diet. (aspiration pneumonia becomes link)

Who makes the decision?

There are a number of professionals who may be involved in the decision making process to assist the person and the family make an informed choice. These may include:

• GP or local family doctor
• Speech pathologist
• Dietitian
• Gastroenterologist

How do I know if I need a gastrostomy?

Some investigations are usually carried out before a gastrostomy  is inserted. These include:

• video fluoroscopy, which shows a picture of a person's swallow mechanism and can usually give a clear indication as to whether the person is aspirating or not,
• lung X-ray which can give an indication as to the state of health of the lung blood tests to determine nutrient levels

How do they put the gastrostomy in?

The procedure is done in the operating theatre. It can sometimes be done as a day procedure but usually requires a few days in hospital. The procedure is simple and quick, usually with a fast recovery. The person is given a light anaesthetic for the procedure. An endoscope is passed through the mouth and into the stomach. The gastrostomy tube is then passed via the endoscope into the stomach and through the abdominal wall. (endoscope becomes link)

How is tube feeding different to regular eating?

Tube feeding is different to regular eating, because the nutritional formula or fluids go straight to the stomach or small  intestine through the tube. Therefore, the mouth and oesophagus are bypassed. The person will still get sensations of feeling ‘hungry’ and feeling ‘full’ but will not be required to bite, chew or swallow the food. When possible  it is important to maintain tastes for enjoyment. A small amount of liquid may be able to be put on the tongue for the person to taste – but this needs to be confirmed by the health team. Some people may be encouraged to eat orally but receive additional nutrition or medications through the tube.

What is the best position for me while having meals through the tube?

Several positions are safe and comfortable for tube feeding. You can be sitting upright in a chair, propped up in bed or on a couch, standing or even walking around. The most important thing to remember is to NOT lie flat during your meal. A minimum of 30 degrees elevation from horizontal is required. Wait for 1 hour after your meal before you lie down to avoid vomiting or coughing, which can be dangerous and lead to other complications.

When is the best time for tube feeding?

Depending on your needs, there are two different options for when tube feedings will take place. You can have: 

• Continuous feeding which means the formula slowly drips through the feeding tube continuously over several hours of the day and / or night
• Intermittent feeding which involves larger amounts of the formula being given 3 to 8 times a day.

What can go down the tube?

This needs to be discussed with the medical team. The main source of nutrition is a balanced formula which is called enteral nutrition. There are many brand names of enteral formulas and your dietitian can help you find the one which best suits you. The person may want to put coffee, tea, juices or alcohol down the tube and some on the tongue and mouth to experience the taste. This is usually possible for people but should first be confirmed by their health team.

What about my medications?

Medication given through the tube must be in an altered format. They may be suspensions, dissolved or crushed tablets or opened capsules. The pharmacist should be aware the person has a gastrostomy or jejunostomy to ensure the correct format and instructions are provided. 

How do I get the formula down the tube?

Your health team can help in advising the method that best suits you. It could be:

• Using  a taper tip syringe which is called a bolus feed and is the quickest way to deliver a meal,
• Gravity feeding using a container and tubing, which enables the rate to  be better controlled and slower.
• An enteral feeding pump which enables greater accuracy and consistency of the rate the meal is delivered.

Can I mix my own formulas?

Powder formulas are available but most formulas are pre-prepared now. Commercially produced formula is mixed carefully so that it contains certain amounts of nutrients to provide a balanced diet and to keep the person well nourished. Therefore, it is advised to stick with these formulas only.

Can I still swim with a gastrostomy?

Yes! After the stitches, if you have any, have been removed, you can still swim and take a bath or shower with a gastrostomy.

How do I care for my gastrostomy?

It is important to clean the site around the tube to avoid any infections. Wash around the area with warm soapy water and try to keep it dry at all times. You can use protective cream such as paw paw ointment around the stoma. (stoma becomes a link to stoma faq)

How should I prepare for mealtimes?

You should always wash your hands with soap and warm water,  gather all the equipment you need, prepare the formula, measure appropriate amount and deliver by the method suggested by your health team. Ensure all equipment is washed well after each meal.  Any unused formula should be placed in a clean container, covered and kept in the refrigerator.

What about oral care and hygiene for my mouth?

Even though you may not be eating and drinking orally, it is still most important to care for your mouth. Teeth cleaning should be done on a regular basis, cleaning all surfaces of your teeth, gums and tongue.

What happens if my tube gets clogged?

If your gastrostomy becomes blocked and the flow is slow or stops completely, you should insert a taper tip syringe into the end of the tube and try to withdraw fluid to remove the blockage. Insert approximately 10mL of warm water into the end of the tube. You should never use force when doing this. Move the plunger back and forth, putting a little water into the tube. If the tube does not clear, clamp the tube for 5-15 minutes, and try to flush the tube again with another 10mL of warm water. Repeat the procedure again, or call your health care professional if you are unable to clear the tube.

What happens if the tube comes partially out?

If the feeding tube looks like it has come part-way out of the tract, keep the tube in place by taping it to the skin. You should contact your health care professional. If they are not available, go to the Emergency Department of your nearest hospital.

What happens if the tube comes completely out?

If the tube comes out completely, cover your tube site with a small gauze dressing and tape to the skin. Then go quickly to the Emergency Department of your nearest hospital and take the tube with you. The gastrostomy tube must be replaced within two hours or the opening may begin to close.

What should I do to prepare myself for going home after having a gastrostomy tube inserted?

Before you leave the hospital, well before discharge, make sure you, your family and support people receive information about your gastrostomy. Ensure you all understand what your mealtimes and care require. Knowing about the availability of formula and equipment will make the first few days at home much easier. There is back up support available after discharge from hospital, from places such as the Royal District Nursing Service, the Gastrostomy Information and Support Society, or the Home Nutrition Service. Make sure you get phone numbers of people who can give you support if you should need it.