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Complications From Feeding Tubes

Types of feeding tubes

The image below shows various types of feeding tubes that your child might need to use.

Gastrostomy Tubes (G-tubes)
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When the feeding tube moves out of place

You should know how long the tube is outside your child’s body. If you find that the feeding tube has moved, gently pull it back into position and tape it to your child’s skin. Here are some ways to measure your child’s tube:

  • You can put a mark on the outside part of your child’s feeding tube where it meets your child’s stomach. Use a marker with ink that does not wash off.
  • You can measure how long the outside part of your child’s feeding tube is. Measure one fingernail width from the hole (stoma).

You must always tape the feeding tube to your child’s stomach so that it does not move around.

If the feeding tube falls out

The G-tube team will instruct you on what to do if your child’s feeding tube falls out. This is not an emergency. However, you must replace the tube with another G-tube or a Foley catheter to prevent the hole (stoma) from closing. Anything that your child has just eaten or that has just gone through the feeding tube may come out of the hole where the feeding tube was. Follow the directions from your treatment team before you start feeding again.

  • If the stoma is less than eight weeks old, insert a foley catheter that is one size smaller than the size of the G-tube. Insert it about two to three inches or the length of your index finger.
  • If the tube is less than eight weeks old, it cannot be used yet for feeding. Do not inflate the balloon with water. Tape it to the skin to hold it in place.
  • If the stoma is more than eight weeks old, insert a foley catheter that is one size smaller than the size of the G-tube. Insert it about two to three inches. You may inflate the balloon on the tube (catheter) using 3 mL of water. Pull the catheter back until you start to feel resistance. If you see stomach contents or formula leak out of this tube, you may start feeding again through this tube. If your child seems uncomfortable, stop feeding immediately and contact the G-tube team. If it is a weekend or after hours, please go to your pediatrician or nearest emergency department.

Blocked feeding tubes

Your child’s feeding tube may get blocked if there is any formula or medicine left in it. You can prevent your child’s feeding tube from getting blocked by flushing it with at least 5 mL of water after every feed, and after giving your child medicine through the tube. If the tube is blocked, you will need to follow the instructions from your G-tube team. If you cannot unblock the tube, the tube may need to be changed. Please see specific instructions listed in the Enteral Tube Feeding Booklet.

Diarrhea or vomiting

Diarrhea or vomiting may be caused by a number of reasons.

Do not let the formula sit out for too long. Clean the feeding set after each feed with dish soap and warm water. Rinse well. For continuous tube feeds, it is suggested that the feeding set is rinsed at set time periods during the feed. Please see the Enteral Tube Feeding Booklet for more information. Replace the feeding set twice per week.

Make sure your child does not get dehydrated if he has diarrhea or vomiting. Signs of dehydration are:

  • dry linings of the nose, mouth, and throat
  • dry skin
  • loss of weight
  • less urine, or pee, than usual
  • dark urine
  • a greyish sunken look around the eyes

If you notice signs of dehydration in your child, contact your pediatrician or go to your nearest emergency department.

Problems digesting the feeding

Your child may have problems digesting the feeding at certain times. Digesting means the body breaks food down and uses it. This problem can happen when you increase feeding amounts, change formulas, or if your child feels ill. Some of the symptoms are:

  • a swollen or bloated stomach (the stomach looks bigger and feels harder than usual)
  • watery bowel movements (diarrhea)
  • cramping
  • upset stomach
  • looking uncomfortable

Skin problems associated with G tubes:

Granulation tissue

Your child may have problems with granulation tissue. Granulation tissue is extra tissue made of new skin growing around the feeding tube. This is the body’s normal reaction to a wound. The extra tissue looks dark pink and may bleed easily.

You can reduce your child’s chances of getting granulation tissue by keeping your child’s feeding tube taped down so that it does not move. Move the tube to a new position each day and tape it securely to your child’s abdomen. The feeding tube rubbing on the skin can cause extra tissue to grow. If your child has an infection around the tube, contact the G-tube team.

How can you treat problems with your child’s skin?

If your child has problems with the skin, you can use a warm salt water soak to dry out and soothe the area around the feeding tube. If your child has an infection around the tube, contact the G-tube team.

To make a saltwater soak, follow these steps:

  • Measure one cup of warm water and two teaspoons of table salt.
  • Stir the salt into the warm water until the salt disappears.
  • Wet a piece of gauze or a strip of clean cotton cloth in the warm salt water.
  • Place the wet gauze or cotton cloth around the feeding tube on the skin of your child’s stomach for three to five minutes, repeat three times per day for seven days.

If you think your child has an allergy to the tape that you use on the feeding tube, try using a different kind of tape.

Infection

Your child may have an infection if you see any of these signs. Call the G-tube team.

  • redness of the skin around the feeding tube
  • a change in the colour and thickness of the liquid leaking around the feeding tube
  • a change in the smell of the liquid leaking around the feeding tube
  • pain or swelling, or a feeling of warmth around your child’s feeding tube
  • a fever

Coughing often around feeding time

If your child tends to cough often around feeding time, she may be getting food or liquid into her lungs by mistake. This can happen while she is eating, if she throws up, or when food comes up the throat from the stomach (reflux). Call the your pediatrician if this is happening regularly. Your child may need to be started on a special medication to help control the reflux such as ranitidine or omeprazole.

Mary Barron, MSc, RD

Ute Bartels, MD

Kim Milbury, MN, RN(EC)

8/14/2009




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