What is gastrostomy?
A gastrostomy is performed to insert a tube directly into the stomach or small intestine of a person who cannot take food or medicine by mouth. Gastrostomy can be done surgically, or through an interventional radiology (IR) technique called “percutaneous gastrostomy,” which requires only a tiny incision in the skin. Percutaneous gastrostomy can be performed safely in adults or children. Generally, this is an outpatient procedure or may involve a short hospital stay.
Why is a gastrostomy tube placed?
Gastrostomy tube placement is performed for a variety of reasons. Some gastrostomies are performed to provide a route for feeding in people who are unable to eat and swallow normally. Gastrostomies may also be advised for people with chronic bowel obstruction who cannot tolerate a nasogastric tube (a tube inserted through the nose into the stomach). Your physician will explain the reason for your gastrostomy.
How can I arrange for an interventional radiologist to perform my percutaneous gastrostomy?
Evaluation may require blood tests and a consultation with a clinical nutritionist who can explain all about percutaneous gastrostomy feedings. You will be informed about the benefits and risks of having the procedure, and any questions you may have will be answered.
How should I prepare for a percutaneous gastrostomy?
You must not eat, drink or receive nasogastric tube feedings for at least six hours before the percutaneous gastrostomy procedure. However, you may take routine medications by mouth with small sips of liquid, or medications may be given through a nasogastric tube. More detailed instructions, based on your individual needs, will be given to you by your interventional radiologist when your procedure is scheduled.
What happens on the day of the procedure?
You will change into a hospital gown and go to the interventional radiology suite where the procedure will be performed. Usually, the procedure is performed using a mild sedative and local anesthesia. In rare cases, general anesthesia is required and an anesthesiologis will work with the interventional radiologist to monitor you during the procedure.
Once you are in the interventional radiology suite, the following steps will be taken to perform the gastrostomy procedure:
- An intravenous line will be placed in your arm to deliver the anesthetic or sedative, analgesics (medication to prevent pain), and an antibiotic (medication to prevent infection), if needed.
- An ultrasound scan of the stomach area may be performed to assist your interventional radiologist in selecting the correct placement of the gastrostomy tube – usually below the rib cage.
- Your stomach will be inflated with air. The air is usually delivered to the stomach through a nasogastric tube that is inserted through the nose and into the stomach.
- The skin over the stomach area will be cleansed with an antiseptic solution and draped with sterile covers. A local anesthetic will be injected in the skin to numb the area where the tube will be placed. In some situations, the stomach is first fastened to the abdominal wall by inserting small devices through the skin. These are later removed.
- The tube will be inserted by the interventional radiologist through a very tiny incision in the skin – about five millimeters long (approximately 1/4 inch).
- Typically, percutaneous gastrostomy is performed in less than an hour. The procedure is painless, but there might be some mild discomfort related to the temporary expansion of your stomach and placement of the gastrostomy tube. Immediately after the procedure, you will be transferred to a recovery unit where you will be monitored.
What will happen after the gastrostomy? Can I go home?
Most adult patients and some older children may be discharged to go home the same day as the procedure, and arrangements are generally made for a home care nurse to visit during the first 24 to 48 hours. Most young children will be admitted to the hospital following gastrostomy. If the interventional radiologist has used fastening devices to insert the tube, you will be instructed to return to your interventional radiologist at five to seven days for a simple outpatient removal of these tiny fasteners. You will be given written instructions before you go home about gastrostomy tube care, feeding, warning signs of possible problems and telephone numbers to call in case you have questions.
Feeding guidelines for gastrostomy tubes
The following guidelines may be helpful for your feedings after percutaneous gastrostomy, although your interventional radiologist and clinical nutritionist may have more specific recommendations for you.
- Maintain an upright position during your feeding and for 30 to 60 minutes after feeding. Lying on your right side also may help the food or liquid formula enter your body through the tube.
- Make sure the food or formula is not too cold. It is helpful to warm formula to room temperature before administering.
- Make sure the formula has not expired or has not been open more than 24 to 48 hours. To prevent spoilage, keep all open formula in the refrigerator until it is used.
- Make sure equipment is very clean.
- Usually, patients are instructed to have water between feedings or immediately following a feeding to prevent dehydration. Also, flushing the tube with water after each feeding will keep it from becoming clogged. The volume of water that can be safely given variesaccording to your weight. Check with your physician, nurse or clinical nutritionist to determine the most appropriate amount of water for you.
- Medication may also clog tubes. Consult with your physician or pharmacist about your medications if gastrostomy tube clogging becomes a problem.
- If you have any problems with your gastrostomy, call your interventional radiologist.