Education & Services

Tubes and their counterparts

At Jude’s Totally Tubular Packages, our top priority is to ensure that our Tubie Tribe is well equipped with the knowledge needed to be successful in caring for their tubies safely, efficiently, and with access to the most up to date information. We know that our success depends on a collaborative effort between both JTT and our tribe, so we ask that if you have any further questions please don't hesitate to reach out. Our information does not replace the advice of your physicians, please always follow the recommendations set forth by your providers first and foremost.

G-Tubes

What is a g-tube:

A gastrostomy tube is a surgically inserted tube into the abdomen to give nutrients to children who otherwise are unable to receive enough. There are a few types of gastrostomy tubes such as peg tubes, mic-key buttons & mini-buttons and their placement can vary such as with GJ tubes and J tubes. Each surgery varies slightly in how it is performed, but all are performed under anesthesia. 



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Benefits

Benefits of switching to a g-tube: 1. The g-tube is more comfortable for children once healed 2. It's pulled out less often than the NG tube 3. Less allergic reactions for children with adhesive sensitivities 4. Tube changes occur less often and are less traumatic for children 5. G-tubes are often more comfortable on the stomach because they can be vented allowing excess gas to escape 6. No tape on the face!

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Common Issues


Leakage:

Small amounts of leakage around the g-tube can be a common occurrence for a variety of reasons. Chronic and heavy leakage are not normal and need to be addressed immediately by your GI team. Long term leakage can cause

  • skin breakdown


  • cracking of the tube


  • infection


  • granulation tissue


  • enlarged stoma    


  • increased pressure in the stomach


​Tube Dislodgement:

First of all, don't panic! It's going to be ok. Your doctor should have advised you before you went home to either cover the opening with gauze and tape to protect the site, or to insert a tube into the g tube site (Our surgeon sent us home with a red rubber catheter we are supposed to cut a pinky finger length). If your practitioner wants you to insert a tube, you will have been taught how and given a replacement tube. Your practitioner will also have advised you to proceed to the emergency department or clinic. Ask your practitioner what you should do in the event the tube becomes dislodged and follow those instructions, it is important that you don't attempt to resume feedings until the tube has been confirmed to be back in place when your tube is new. It’s important that you know and always have a photo with you of the type, size and length of yours child’s tube as well as knowing the volume their balloon contains. 


Granulation Tissue:

This is the most common problem we all face, the dreaded granulation tissue! Granulation tissue is new tissue that forms during wound healing. It excess skin that appears to be growing around the tube, it is often bumpy or swollen looking, pink to dark red, shiny and/or wet looking, and can bleed easily and often grows rapidly. Granulation tissues happens due to:

  • Movement of an improper fit tube

  • The site isn't staying clean and dry

  • Too much pressure on the stoma, potentially from a too tight fit, the tube has accidentally been pulled out, or a recent tube change

  • Trauma to the stoma

How to Treat & Prevent

Treatment:

  • Hypertonic Salt water soaks


  • Granulotion


  • Your doctor may prescribe Triamcinolone (Kenalog) ointment or do a silver nitrate treatment. 


  • Calmoseptine ointment 


  • Alum spice/calmoseptine mix


  • Antimicrobial dressing


Prevention:

  • Keep stoma clean and dry


  • Stabilize tube and/or extension with tape, cinch or other securement device.


  • Address leakage issues right away


  • Use tubie pads/gauze


 

NG/NJ/ND Tubes

A nasogastric (NG) tube is a flexible tube of rubber or plastic that is passed through the nose, down through the esophagus, and into the stomach. The tube is placed into your digestive system in order to deliver or remove substances to and from the stomach. A NJ/ND tube goes past the stomach into the small intestines. 

 

Considerations

Benefits

  • Non surgical

  • Temporary

  • Helpful in determining if a longer term solution is needed

  •  Short term use

  • Easily changed by caregiver

Disadvantages

  • Have to be taped to face

  • Little hands can easily reach

  • Can cause increased nasal congestion

  • Very visable

  • Short term solution

Questions to ask:

  • What type of tube will it be?

  • Will we leave the hospital with this tube?

  • What should I do if the tube is pulled out?

  • How long will this tube be in place?

  • How often do we need to replace it?

  • How do we replace it?

  • At what point do we need to consider a more permanent tube, such as a G-tube?

  • Do I need to check placement before feeding or giving medication?

  • How do I check the placement?

  • How do I get more supplies?

  • How do I feed through the tube?

  • How do I give medications? 

 

Pumps and Parts

Feeding by pump can often be an intimidating and daunting task, but doesn't have to be! Please review the following guidelines on both the Infinity pump and the Kangaroo (Joey) pump.

 

Feeding Bags

  • Most supply companies will give you 30 days worth at a time.

  • You should use one new bag each day. 

  • Between feedings you can store the bag in the fridge or in an insulated bag cover with ice packs.

  • You should prime the bag before use with either formula or water to prevent filling your child’s belly with air. You can do this using the Prime button on your pump, or by hand.

  • If you are feeding a Blended Diet, consider modifying the set to avoid clogs.

Syringes

The good news is that syringes can be used at home and can be washed with hot soapy water. The bad news is that some medical supply companies do not supply syringes. All the same, I will cover the types.
Enfit:
There are a series of Enfit syringes that are wonderful and fit specifically to the enfit extension sets and come in various sizes. Jude's Prilosec is actually compounded at our local Children's hospital and we receive an enfit syringe with each prescription, so some pharmacies will supply them as well if your MD writes the prescription indicating that your child has a tube with Enfit connection. 
Luer tip/Slip tip:
These classic syringes will fit into the legacy style extension sets, and you will also require and/or have been given a slip tip syringe in order to check the ballon level on your child's button.

Extension sets

Button style feeding tubes require extension sets in order to use them. You should always remove the extension sets when not actively feeding. There are 3 parts to each extension set:

  1. The connector which comes in 2 styles either enfit or legacy

  2. the tip which connects into the button and comes in 2 styles either right angled or straight. 

  3. the clamp which closes off any fluids from leaving the extension set. 

 

Tips and Tricks

Clogs

  • warm water flush

  • carbonated soda 

  • push/pull techinique

  • MD may prescribe Clog Zapper.

Pump alarms

No flow- check for kinks in line, is the clamp open? press run again
No food- make sure there is food in the bag, no kinks in line. press run again
Low battery- plug in battery. press run again
door open- make sure door is closed tightly. press hold. press run again
Dose done/feeding complete- turn off pump
Chek *infinity pump*- your settings are incorrect. Reprogram and press run again
Press run to feed/hold error- you've left hold on too long- press hold again if you still need to hold or press run to continue feeding
ER##, System error #- Turn pump off and back on, verify pump settings and continue feeding

Dosing Rate Calculator

Feeding pump dosing rate calculator.