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A primary consideration in the care of these patients is their acceptance of the gastrostomy as a substitute for eating. There are many social and emotional factors associated with eating and sharing a meal with others. Health care providers must be sensitive to the problems these patients will encounter in their adjustment to the changes a gastrostomy may bring to their lives. Whenever possible patients are taught self care in preparation of food, the feeding procedure, and peristomal skin care. It is important that they have privacy while doing this and that they be encouraged to ask questions and seek assistance from the members of the health care team.
The skin around the opening must be protected from irritation by the gastric juices, which may leak from the opening and act as a corrosive on the skin. In some cases the gastrostomy tube can be removed after each feeding. A device called the Barnes-Redo prosthesis is available for use by patients with a permanent gastrostomy; it is designed so that a cap can be fitted over a nylon tube permanently installed in the opening. When food or liquids are to be given the cap is unscrewed and a catheter is passed into the nylon tube. After feeding is completed the catheter is removed and the cap is screwed tightly over the nylon tube.
Feedings for a gastrostomy patient are gradually increased according to tolerance. At first, water and glucose are given at regular intervals. If there is no leakage and the patient has no difficulty with these liquids, other liquids and puréed foods are gradually added until a full meal can be tolerated.
In order to stimulate gastric secretions and aid digestion, these patients should see, smell, and taste small amounts of food before each feeding. It is recommended that they be allowed to chew small bits of food even though they cannot swallow them. This allows for proper stimulation of the gums and teeth and helps promote the health of the mouth and teeth.
Feedings should be warmed before they are given through the tube. Although commercially prepared liquid feedings are more convenient, they often cause diarrhea and are not as nutritionally adequate as regular meals. The foods to be given through the tube should be cooked until they are soft and then puréed in an electric blender. They can be diluted with the water in which they have been cooked, so that no vitamins are lost. A clinic dietitian usually must work very closely with the patient and family, instructing them in the planning and preparation of the patient's meals and offering suggestions for a variety of foods that will provide a well-balanced diet.
gastrostomyA surgically created opening in the anterior wall of the stomach, which allows feeding while bypassing the oesophagogastric junction.
gastrostomyGI disease A surgical opening into the stomach which can be used for feeding usually via a gastrostomy tube. See PEG tube.
The skin around the tube is inspected for signs of irritation or excoriation and kept clean, dry, and protected from excoriating gastric secretions. Tension on the tube that may cause the incision to widen and allow spillage of gastric secretions on the skin or into surrounding tissues is prevented.
Before the patient is fed, tube patency and position are assessed, and the volume of the remaining stomach contents is measured by aspirating the stomach. If the volume is greater than the amount permitted by protocol or the physician's direction, feeding is withheld. The patient should be placed in high Fowler’s position during feedings, and the blenderized food or formula administered slowly by gravity in the prescribed amount (200 to 500 ml). Encouraging the patient to chew prior to enteral feeding promotes gastric secretions to aid digestion. After feedings and after introduction of medications, the tube is flushed with an adequate amount of water (at least 60 ml). Fluid intake and output (which includes aspirated feeding) should be monitored and recorded.
Assistance is provided with oral hygiene at intervals throughout the day to prevent dryness and parotitis. Both patient and family are taught correct techniques for tube and skin care and for feeding through the gastrostomy tube, for keeping track of intake and output, and concerns to be reported to the primary care provider.