G and GJ tubes: Managing the dressing and securement device and cutting the retention suture

 

 Managing G tube dressings

 

What are G and GJ tubes?

Gastrostomy tubes (G tubes) and gastrojujenostomy tubes (GJ tubes) are feeding devices. A G tube gives liquid nutrition, medication and other fluids directly into the stomach. A GJ tube gives liquid nutrition, medication and other fluids directly into the small intestine (the jejunum). Both G tubes and GJ tubes are placed in a surgical opening in your child’s tummy (abdomen) called the stoma. The tunnel from the outside into the stomach is called the tract.

Managing the dressing and securement device

It is very important that your child’s tube does not move around or get pulled out within the first two weeks after insertion. Accidentally pulling out the tube at this time can cause a very serious complication called peritonitis.

Peritonitis is the inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen. The peritoneum covers most of the abdominal organs, including the stomach, small and large intestines, and liver. Peritonitis can cause an infection that can spread throughout the body.

To prevent this from happening, your child’s image guidance inserted G or GJ tube will be secured to the abdominal wall with a dressing, securement device, and retention suture for 14 days after insertion.

Surgically inserted G tubes are secured with several sutures (stiches). Dissolvable sutures disappear on their own; non-dissolvable sutures need to be removed. Your child’s surgeon will discuss the plan for removing these sutures with you.

A dressing called Tegaderm™ IV Advanced will be used after your child’s image guidance tube insertion. The dressing will stay on for 14 days –being changed at day 7 or as needed if it gets soiled, wet, becomes loose, or there is excessive drainage or signs of infection. Your child cannot have a bath, shower or be submersed in water for the first 14 days. Sponge bathing is allowed. Bathing can resume only after the dressing is removed permanently.

The securement device is called a StatLock™. The securement device will stay on for 14 days or be changed as needed if it gets soiled, wet, becomes loose, the edges are lifting, or there is skin breakdown under the dressing.

If the StatLock™ needs to be replaced, you will need to change it to a GripLok™.

The retention suture that was placed into the stomach through the tract will stay in place until day 14. You can see it near the stoma attached to a gauze package. After 14 days, the retention suture will need to be cut as close to the stoma as possible. If your child is still in the hospital, your nurse may assist with this. If your child has gone home, you or one of your child’s other caregivers will need to cut it.

How to change your child’s dressing at day 7 (or as needed)

During the first 14 days, you may change your child’s dressing at day 7 or as needed. If the stoma appears very red, is leaking excessively, is soiled or showing signs of infection, you should change your child’s dressing.

​How to change your child’s dressing at day 7 (or as needed)
Step Instructions Notes
1 Gather all supplies
  • Clean washcloth
  • Warm tap water
  • Soap (mild, non-perfume)
  • Tegaderm™ IV Advanced
2 Explain the steps to your child. Consider giving pain medication such as acetaminophen or ibuprofen to your child before you begin.
3 Wash your hands and put on the gloves.
4 Remove existing Tegaderm™ IV Advanced. Pull low and slow from the edges toward the centre of the dressing. Be careful not to pull the tube out of the stoma or pull the retention suture. Consider having two people available to help with this.
5 Gently move the retention suture gauze package away from the stoma and clean the stoma with soap and water. Then rinse the skin with warm water. Dry the stoma thoroughly by patting or letting air dry.
6 Examine the skin for signs of infection, skin irritation or stoma leakage.
7 Return the retention suture gauze package to the original position. The retention suture may have discharge on it at this time. This is normal and the suture gauze package will remain like this until day 14.
8 Apply a new Tegaderm™ IV Advanced over the stoma. Use the extra piece of tape that comes with the Tegaderm™ IV Advanced to secure the tube further.
9 Wash your hands.
How to change your child’s StatLock™ to a GripLok™ (as needed)
Step Instructions Notes
1 Gather all supplies
  • Clean washcloth
  • Warm tap water
  • Soap (mild, non-perfume)
  • GripLok™
2 Explain the steps to your child. Consider giving pain medication such as acetaminophen or ibuprofen to your child before you begin.
3 Wash your hands and put on the gloves.
4 Remove the G or GJ tube from the StatLock™ by pressing the button on the clamp and opening it. Move the tube to the side.
5 Remove existing StatLock™. The dressing must be secured during this step to prevent tube dislodgement.
6 Clean the skin with soap and water. Then rinse with warm water. Dry thoroughly by patting or letting air dry.
7 Examine the skin for signs of infection, skin irritation or stoma leakage.
8 Apply the GripLok™ in the same area as the Stat Lock. Place the G or GJ tube in the sticky part of the GripLok™ and secure the Velcro in place. If there is skin breakdown (open skin), consider changing the area where you place the GripLok™.
9 Wash your hands.
​Removing the dressing and securement device, cutting the retention suture and securing the tube at day 14
Step Instructions Notes
1 Gather all supplies
  • Clean washcloth
  • Warm tap water
  • Soap (mild, non-perfume)
  • Hypafix™ tape
2 Explain the steps to your child. Consider giving pain medication such as acetaminophen or ibuprofen to your child before you begin.
3 Wash your hands and put on the gloves.
4 Remove the G or GJ tube from the securement device (StatLock™ or GripLok™). Move the tube to the side. If using a StatLock™, release the tube by pressing the button on the clamp and opening it.
5 Remove existing StatLock™. Be sure not to disrupt the dressing. The dressing must be secure during this step to prevent tube dislodgement.
6 Examine the skin for signs of infection, skin irritation or stoma leakage.
7 Remove existing Tegaderm™ IV Advanced. Be careful not to pull the tube out of the stoma or pull the retention suture.
8 Gently move the retention suture gauze package to the side and cut the string as close to the stoma as possible. Throw away the dirty retention suture gauze package. Consider having two people available to help with this. The small amount of string that is left on the outside of the stoma will get pulled into the stomach and passed in the stool.
9 Clean the skin with soap and water. Then rinse with warm water. Dry thoroughly by patting or letting air dry.
10 Rotate the position of the tube clockwise, by 90°. If you visualize the stoma as a clock, you will rotate the tube by 3 hours every day. For example, 12:00 to 3:00.* If there is a position that is uncomfortable or awkward (ie – in the diaper area), you may skip this spot when rotating daily.
11 Secure the tube with the Hypafix™. Be sure to tape the tube one finger width away from the stoma. Do not cover the stoma. The stoma is healthiest when dry, uncovered and open to the air.
12 Wash your hands.

*If your child has a G tube, you can rotate all the way (360°) around the stoma. If your child has a GJ tube, only rotate half way (180°) around the stoma, for example from 3:00-9:00.

Your daily care after the dressing and securement device are removed at day 14 will be:

  1. Clean with soap and water
  2. Rotate the position of the tube daily
  3. Secure the tube well with Hypafix tape

Key points

  • It is very important that your child’s tube does not move around or get pulled out during the first two weeks after insertion.
  • To prevent movement, your child’s image guidance-inserted G or GJ tube will be secured well with a dressing and securement device for 14 days after insertion.
  • After 7 days you will change your child’s dressing; after 14 days you will remove the dressing and securement device.
  • During the first 14 days, you may change the dressing as needed, if the stoma appears excessively red, is leaking excessively, soiled or showing signs of infection.

Holly Norgrove, RN, BScN

Silvana Oppedisano, RN(EC), MN

Mary Alicia Millar, RN

7/31/2017

At SickKids

If you are a SickKids patient, please contact the G tube resource nurse at 416-813-7177, with any questions or concerns.​​​

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