Gastrostomy Tubes in Pediatric Patients:

Gastrostomy Tubes in Pediatric Patients: Gastrostomy tubes are tubes that are specifically designed to help children and pediatric patients in feeding. The placement of this tube is performed for two major reasons which are to either help in gastric decompression following gastrointestinal and abdominal operations or for feeding in patients that can't take food by their mouths. In order for these gastrostomy tubes to be inserted in a patient, they require a general anaesthetic.

The tubes will stay in the patient's body to the point that a replacement is necessary or the child no longer needs a gastrostomy because he/she is eating adequately. As earlier mentioned, there are two major reasons why pediatric patients get gastrostomy tubes with the first being to help the child's nutritional needs if he/she is not swallowing enough to foster his/her proper growth.

The second reason why these patients get gastrostomy tubes is in cases where the child's oesophageal atresia is not joined up for him/her to swallow totally. These tubes are placed directly into a child's stomach through the outside of his/her tummy with the surgical opening of the abdominal wall where the tube is placed being known as the stoma. This opening in the skin is red in color with its size being compared to the size of a very tiny sultana (Sexton & Holden, n.d.).

How Are Gastrostomy Tubes Placed? While all gastrostomy tubes are made from a soft material known as silicone, there are various tubes and skin-level devices or buttons that are in use. Nonetheless, the most appropriate gastrostomy tube for a pediatric patient is usually determined by the doctor or nursing staff. Given that there are three major categories of gastrostomy tubes, there are also three major ways within which the tubes are placed. In fact, the difference in placement of the tubes is dependent on the category of the tube.

These three categories are: Surgical Gastrostomy Tube: This is the type of gastrostomy tube that is placed in the process of an operation under general anaesthetic. Surgical gastrostomy tubes are surgically placed in pediatric patients by pediatric surgeons while in the operation room. This kind of tube has either a balloon or cross bar at one end that sits inside in the stomach and enables the tube not to fall out.

However, at the other end of the tube, there may be one or more openings that are used for tube caring purposes. To place the surgical tube, the pediatric surgeon has to both create an incision or laparoscopic incisions in the tummy area and also create an opening into the stomach. The pediatric surgeon will then insert the tube through the belly opening into the stomach and stitch up the tube in its appropriate position.

These surgical tubes may necessitate the use of a primary inserted button which is a temporary tube that needs a Hollister dressing until the replacement of the tube. For pediatric patients who require surgery, the gastrostomy tube is inserted during the surgery. The surgical placed gastrostomy tube is usually for a short-term use and is always replaced easily by the medical staff. The period of time within which the surgical tube stays in place is usually discussed between the patient and the doctor.

Percutaneous Endoscopic Gastrostomy (PEG) Tube: Similar to the surgical gastrostomy tube, the percutaneous endoscopic gastrostomy tube is also inserted under a general anaesthetic though an elastic telescopic endoscope is employed for the purpose of helping to position the tube. The PEG tube usually consists of either a disc or cross bar that helps in stopping the tube from accidental falling. This kind of tube is placed by a radiologist who performs this duty when the patient is asleep in the interventional radiology section.

The radiologist however inserts the tube into the stomach by an incision in the abdomen through threading the tube through the patient's mouth into the esophagus and the stomach ("Gastrostomy Tubes," 2008). Then, the PEG tube will then exit the stomach through the incision in the abdomen and be stitched up in its appropriate position. In some cases, only a few patients are unable to go through this procedure and will therefore need a surgically placed gastrostomy tube.

The most appropriate procedure for this tube placement is usually determined by the radiologist. Unlike the surgically placed gastrostomy tubes, the PEG tubes are usually appropriate for long-term use and can stay in the appropriate position for a number of months. Currently, due to their design, they necessitate an endoscopic removal for a patient under general anaesthetic for the initial replacement or removal.

Skin Tubes: The final category of gastrostomy tubes are the skin tubes that are usually shorter than any other category of the tubes and sit flush with the skin. The skin gastrostomy tubes consist of a mushroom-shaped or balloon end which rests inside the belly and prevents them from falling out. The skin gastrostomy tube are widely considered as the low profile category of gastrostomy tubes with the advantage that there are minimal chances of them being pulled out and are easily covered under clothing.

Given the appropriate care, skin gastrostomy tubes have a high chance of staying in place for several months and are sometimes used instead of surgical or PEG gastrostomy tubes. Maintaining Gastrostomy Tubes: In order to maintain the effective use of gastrostomy tubes, the feeds that are put through the tubes have special formulations that are originally provided and prescribed by a dietician and doctor respectively.

The dietician usually begins feeding the patient with tiny and frequent amounts of feeds with the volume of the feed increasing as the patient familiarizes him/herself with the technique. In most cases, if the patient's stomach is too full, feed may start leaking around the child's stoma site. Maintenance of the gastrostomy tube is also enhanced when one learns about the most appropriate way of feeding the child by the time they leave the hospital.

While some feeds are given overnight using an exceptional pump, other feeds are usually administered by bolus. Further measures that help in maintaining the tubes include giving feeds when the patient is in a comfortable position with the best position being the sitting position. Notifying the nurses, doctors and dietician of any problems that one encounter, supervising the patient's feeding and other measures of daily.