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Tube Talk
Frequently Asked Questions

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

What is a Gastrostomy?
A gastrostomy is a tube is placed into the stomach through a surgical opening, so that liquid formula (food) can be given via the tube. 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 ideal for intermediate to long term nutritional support for people unable to eat an adequate diet.

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 an inability 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) where as other people may only need the tube to supplement their oral diet.

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
Gastro-Enterologist
Very often, this can be a difficult decision for the family to make and extra support can be offered by:
Gastrostomy Information Support Society (GISS )
Home Nutrition Service (HNS )
Another person with a gastrostomy

How do I know if I need a gastrostomy?
Some investigations are usually carried out before a g-tube 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.

How is tube feeding different to regular eating?
Tube feeding is different to regular eating, because the food goes straight to the stomach or small intestine via 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. For quality of life issues, it may be important for the person to still ‘taste’ these foods or drinks. 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 medical team. Some people may be encouraged to eat orally but receive additional nutrition or medications via 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. Your head should always be raised at least 30 degrees. The most important thing to remember is to NOT lie flat during your meal. 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 either:
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 complete and 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 medical team.

What about my medications?
Medication given via 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 to ensure the correct format and instructions are provided.

How do I get the formula down the tube?
Your medical team can help in advising the method that best suits you. It could be :
via a 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.

What types of formulas are available?
Formulas come in two types.
Powder which you mix with water to make a liquid meal
Ready-to-use formulas, which are already in a liquid form. They are available in cans or prefilled containers (Ready to Hang) that are made especially for tube feeding. The dietitian will be able to provide the best information about the most appropriate formula.

Can I mix my own formulas?
This is not recommended. 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 some protective cream such as paw paw ointment around the stoma.

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 decided by your medical 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 are not eating and drinking, 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. Mouth sprays are usually a good idea to keep it smelling fresh and clean. Sometimes you may get dry lips, so a lip balm or mouth moisturiser can be beneficial.

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 withdraw as much fluid as possible. Then 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 tube site, do not put anything down the tube. 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 Accident and 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 Accident and 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.

Is there a life after gastrostomy?
Yes! Having a gastrostomy should make life better for you. As it is hidden under your clothes, it will not be obvious to people that you have a gastrostomy. There may be social issues with not eating and drinking for the person with a gastrostomy and their family and it can be particularly difficult at social gatherings. It is normal to feel anger, fear, grief and isolation after an illness and surgery. The changes to your body image are obvious to you but not to others.
There are many strategies that can be utilised to help people maintain their normal lifestyle. Pumps can be carried in a backpack or on a pole on a wheelchair.
Don't hesitate to ask any questions you may have and explore better options of management. Having contact with other people with gastrostomies can also be beneficial, particularly families who have children with gastrostomies. You can also explore the internet for information and tips. People who have a gastrostomy often find the benefits outweigh the difficulties as they no longer need to be so focussed on their nutrition and, or, safe swallowing.

Different names given to gastrostomy tubes:
Gastrostomy tube
Feeding Tube
G-tube
PEG
Low Profile Gastrostomy Tube Short tube which sits close to the abdomen
Mic-Key type of low profile tube
Button type of low profile tube
Jejunostomy Tube, J-tube, PEJG Feeding tube placed into the section of small intestine known as the jejunum.
Feeding tube A tube in the stomach or intestine through which the formula passes.
Gastrostomy tube (G-tube) A feeding tube that goes into the stomach at the gastrostomy site.

Terms Associated with Gastrostomies

Aspiration - food or fluids entering the lungs by accident.

Aspiration Pneumonia Inflammation or infection of the lungs caused by food or fluid entering the lungs.

Balloon Bumper A bumper which like a balloon is inflated , with water, and then holds the tube in place

Bolus Meal A meal sized quantity of formula delivered over a short time, usually about 15-20 minutes via a syringe connected to the gastrostomy tube.

Bumper The part of the gastrostomy tube which holds the tube in place. It sits gently against the inside wall of the stomach.

Continuous Feeding- Formula that slowly drips through the feeding tube over several hours.

Dietitian Allied health professional specialising in nutritional health.

Endoscope An instrument that has a camera and a light attached to it which is inserted through the mouth to enable the doctor to see inside the stomach.

Formula A nutritionally balanced product that has the same nutrients as regular foods. Formula can come in a liquid or powder form which is then mixed with water.

Flush Cleaning the tube before and after formula and medication by delivering water down the tube.

Gastro-Enterologist A doctor who specialises in conditions of the gastro intestinal tract.

Gastro- oesophageal Reflux (GOR) When stomach contents travel back up the oesophagus.

Gastrostomy A surgical opening into the stomach.

Gastrostomy tube (G-tube) A feeding tube that goes into the stomach at the gastrostomy site.

Gravity drip Set Tubing that goes from the feeding container and connects directly to the feeding tube to enable an enteral meal to be delivered.

Intermittent feeding Formula given 3 to 8 times a day.

Jejunum The second part of the small intestine

Jejunostomy A surgical opening into the small intestine known as the jejunum

Jejunostomy tube (j-tube) Feeding tube that goes into the jejunostomy site.

Low profile gastrostomy tube Gastrostomy tube which sits close to the abdomen.

Nutrients Protein, carbohydrate, fat, vitamins, minerals and water.

Percutaneous Endoscopic Gastrostomy(PEG) Procedure for putting a feeding tube in the stomach.

Pump Small machine that controls the amount of formula going into the feeding tube.

Speech Pathologist Allied health professional specialising in conditions affecting the mechanics of the mouth and swallowing.

Stoma The opening in the stomach or small intestine through which the feeding tube enters the body.

Syringe A hollow plastic tube with a plunger, used to draw in fluid or insert fluid into a feeding tube.

Video Fluoroscopy Diagnostic test involving swallowing radio opaque substances of varied consistency. This process is video recorded and then assessed to determine the safety and quality of the persons swallow.