Gastrostomy feeding overview

A gastrostomy is a surgically formed artificial opening into the stomach known as a stoma. They are commonly surgically inserted endoscopically through the abdominal wall, and held in place by an internal balloon or bumper and external fixator. Gastrostomy feeding is a successful method of enteral feeding providing daily nutritional requirements in specialist liquid form directly into a patient’s stomach via a flexible tube.

It is a method that should be considered in patients likely to need long-term (4 weeks or more) enteral tube feeding. The decision concerning the placement of a gastrostomy is usually dependent on the estimated length of therapy, and the needs of the parent and caregivers.

The tubes come in a variety of types and are referred to according to the type inserted. The commonest types are percutaneous endoscopic gastrostomy (PEG) tubes and low-profile gastrostomy tubes, e.g. Mic-key button™.

When it is decided that a patient requires gastrostomy feeding, the type of feed they receive will differ according to their individual requirements in consultation with a dietician and consultant.

There are two main methods of feeding via a gastrostomy as detailed below:

• Bolus feeding: A volume of liquid feed given usually via a gravity set over a short duration, e.g. 15–20 minutes.
  
• Continuous feed: This is a feed given via an electronic feeding pump, which allows clinicians and home caregivers to deliver set amounts of enteral formula in a consistent manner, over a desired duration of time.

Preparation and equipment

Before administration of feed, preparation is paramount, therefore simple steps should be adopted as detailed below:

• Collect the appropriate equipment, e.g. syringes (20–50 ml), gravity feeding set, pump, pump feeding set, gloves, apron, water for flush.
  
• Make feed or use appropriate pre-made feed.
  
• Check the expiry date of the feed.
  
• Gain informed consent from patient or parent prior to administration of feed.

Procedure for bolus feed

• Wash hands in accordance with local hand hygiene policy.
  
• Put on gloves and apron.
  
• Ensure the patient is sitting up or elevated as much as their condition dictates, to help prevent vomiting and aspiration during the feed and for a period of time after the feed is completed.
  
• Flush the gastrostomy with approx. 10 ml of water to confirm the patency of the tube.
  
• Open the gravity feeding pack, which should consist of:
  
  
  
  • 60 ml open-ended syringe;
    
  • extension tubing with a roller clamp system;
    
  • Luer lock connector end, with purple and clear capped end.
  
  
• Taking the tubing, ensure the clamp is rolled in a downward position, connect the bladder tip syringe on to the open end of the tubing.
  
• Take your feed, pour enough feed into the syringe to cover the stretch of the tubing and a little bit more approx. 15 ml.
  
• Over the sink, roll the clamp slowly into the upward position and gradually prime the tubing till it reaches the Luer lock end.
  
• Ensure the clamp is in the downward position.
  
• Attach the Luer lock end to the appropriate enteral feeding port on the gastrostomy.
  
• Unclamp, then clamp on the gastrostomy tube.
  
• Hold the syringe with the feed up and gradually release the clamp until fully open. Reducing the height of where the syringe is held will slow down the speed at which the feed is administered.
  
• Once the volume of feed is delivered, clamp down on the administration tube before the milk reaches the end, and close the clamp on the gastrostomy extension.
  
• Remove the giving set and flush the gastrostomy using an oral 20 ml syringe filled with a minimum of 10 ml water (sterile or cooled boiled water for children under the age of one).

Procedure for a pump feed

• Collect all the relevant equipment required for the feed as per the bolus feed, including the feeding pump.
  
• Wash hands in accordance with local hand hygiene policy.
  
• Put on gloves and apron.
  
• Ensure the patient is sitting up or elevated as much as their condition dictates, to help prevent vomiting and aspiration during the feed and for a period of time after the feed is completed.
  
• Flush the gastrostomy with approx. 10 ml of water to confirm the patency of the tube.
  
• Take the feed and the feeding set.
  
• The tubing extension will have a purple screw top, with a sharp pointed skewer, a length of tubing with a plastic chamber below the cap and a purple kite-shaped junction half-way down the tubing with a squeezable priming attachment.
  
• The feed will either need to be decanted into a plastic bottle that will be provided with the extension or will come in a pre-made bottle with a foil seal.
  
• Connect the tubing onto the feed.
  
• Half-fill the plastic chamber with milk by squeezing the sides.
  
• Hold the milk up in the air, and using the squeezable primer, push until the tubing is fully purged of air and full of milk, ensuring to stop just after the junction.
  
• In accordance with the manufacturer’s guidelines for the pump, attach the bottle/bag to the pump and set the rate and the total volume of feed to be delivered. Ensure the pump is set to hold.
  
• Attach the Luer lock end to the appropriate enteral feeding port on the gastrostomy.
  
• Unclamp, then clamp on the gastrostomy tube.
  
• Ensure the clamp is released on the gastrostomy extension if relevant, and turn the pump dial to run.
  
• Once the volume of feed is delivered, close the clamp on the gastrostomy extension and detach from the pump.
  
• Remove the giving set and flush the gastrostomy using an oral 20 ml syringe filled with a minimum of 10 ml water (sterile or cooled boiled water for children under the age of one).