Steps for cleaning the feeding equipment:

1. Wash your child’s feeding equipment by hand with liquid dish soap and warm water. If it becomes sticky or looks cloudy, clean it with three parts water and one part white vinegar.
2. Rinse well with clear water.
3. Air-dry between feedings.

Tips:

• With proper care and cleaning, you can reuse feeding equipment many times.
• Before cleaning the equipment, rinse the extension set in cool water. One way to loosen the formula from the tube is to partly close the clamp. Then slide it up and down the tubing.
• Be sure to carry all extra feeding supplies when away from home with your child.

Flushing the tube after feedings and medicines helps prevent clogs and keeps it working right. Your child’s doctor or nurse will tell you how much water to flush, based on what your child can tolerate.

Flushing guidelines:

• After each feeding: Flush with 5-10 milliliters of water.
• After each medicine: Flush with 5-10 milliliters of water.

If your child has a GJ-tube:

• J-port: Flush with 10 milliliters of water at least twice a day.
• G-port: If sluggish, flush daily with 5-10 milliliters of water. Do this only if your child can tolerate it.
• After medicine: Flush the J-port after every medicine.
• If there are no feeding breaks: Pause the feeding twice a day to flush the J-port.
• If there are feeding breaks: Always flush after a feeding break.

Ask your nurse for a printed flushing guide to take home.

To clean the skin around the tube, you’ll need:

• Soap and water
• Washcloth or cotton-tipped swabs

Steps for cleaning the skin around the tube:

1. Wash your hands with soap and water.
2. Use a wet washcloth or cotton swabs with soap and water to gently clean the skin around the tube. Bath time is a good time for this care.
3. Rinse the area with clean water and gently dry.
4. Gently spin the tube once each day during cleaning (unless your child has a GJ-tube or stitches). This helps keep the skin from sticking to the tube.

Do not spin the tube if your child has:

• A GJ-tube
• Stitches at the tube site

If there is crust or drainage:

1. Soak a clean washcloth or gauze pad in warm water.
2. Place it around the tube to loosen the crust.
3. Gently wipe away any drainage.

Removing crust or buildup helps the skin heal.

Bathing and swimming guidelines:

• Your child can take a bath one week after tube placement.
• Your child can go swimming one month after tube placement.

Medicine safety basics:

• Know the names of your child’s medicines.
• Always give medicines exactly as prescribed. Don’t skip, change, or give extra doses unless told to by your doctor or nurse.
• Store medicines in their original containers to keep them fresh and properly labeled.
• Keep all medicines out of kids’ reach. If a child takes medicine by mistake, call Poison Control at (800) 222-1222.
• Bring medicines or a list of them to all clinic visits.
• Store medicine in a cool, dry place unless advised to refrigerate.
• When traveling, carry medicines with you (not in a trunk or checked luggage).
• Call your doctor or nurse if your child has side effects, misses a dose, or vomits. Don’t give extra unless advised to do so.

General tips:

• Liquid medicine is easiest to give through the tube.
• If using pills, ask if you can crush them and mix them with water or thinned baby food.
• Ask your care team if you should give medicine before or during a feeding.

If your child has a medicine port:

1. Wash your hands.
2. Gather supplies: syringes, medicine, water, and an extension set (if needed).
3. Make sure to close the feeding port (the larger opening) when using the medicine port.
4. If your child has a button-type tube, attach the extension set. Pause the feeding (if in progress).
5. Clamp the tube.
6. Open the medicine port and insert the medicine syringe.
7. Unclamp the tube and push in the medicine.
8. Clamp the tube and remove the syringe.
9. Draw up 5-10 milliliters of water into a syringe unless advised otherwise by your care team.
10. Attach the syringe of water to the medicine port.
11. Unclamp the tube and push the water through.
12. Clamp the tube again and close the medicine port.
13. Remove the extension set if your child has a button-type tube.

If your child does not have a medicine port:

1. Wash your hands.
2. Gather supplies: syringes, medicine, water, and an extension set (if needed).
3. Clamp the tube.
4. Insert a larger empty syringe without a plunger into the tubing.
5. Pour the exact dose of medicine into the syringe.
6. Unclamp the tube to let the medicine flow in. If needed, gently squeeze the tube or give a slight push with the plunger.
7. Draw up 5-10 milliliters of water into a syringe to flush the tube. Your care team will instruct you on the amount of water.
8. Clamp the tube after flushing is complete.

After G-tube placement, the tract takes about two weeks to heal. During this time, it's vital to keep the tube stable. A loose or pulled tube can lead to problems or even fall out.

Keeping the tube stable helps:

• The tract to heal properly
• Prevent irritation, leaking, or granulation tissue
• Prevent it from being pulled out, which would require another procedure to replace it
• Keep the internal balloon or bumper snug against the stomach wall
• Reduce movement that can widen the tract and cause leaking

How To Keep the Tube Stable

It’s vital always to keep the tube stable. There are many ways to do so.

For long tubes, use a tension loop made with tape.

For long tubes or buttons, use one or more of these methods:

• A belly holder or band
• A one-piece bodysuit with snaps, or an adult stretch headband
• Tucked-in T-shirts or bodysuits
• Run the tube under clothing and out of the leg of pants

Using a Tension Loop

A tension loop helps keep the tube from pulling, twisting, or moving too much. A child who is vented or receives continuous feedings always needs this. Rotate where you place the loop on your child’s belly every one to three days to protect the skin and stoma site.

There are two ways to make a tension loop. One uses a pin and one does not.

Tension loop without a pin:

1. Cut a 1-by-4-inch piece of tape (or thinner for smaller kids).
2. Fold it around the tube so both ends meet.
3. Pinch the tape where it meets.
4. Stick the ends of the tape onto your child’s skin.

The loop can be closer or farther from the tube site, based on your child’s size and type of tube.

Tension loop with a pin (use only if your child won’t tamper with it):

1. Tear two 1-inch pieces of tape, about 3 inches long.
2. Fold both ends of one piece to make tabs. Wrap this around the tube, 3-5 inches from the site.
3. On the second piece, pinch the center to make a tab, and place it on your child’s belly, 3 inches from the tube site.
4. Use a safety pin to connect the two tabs and keep the tube straight.

There are three main types of dressings for tube care. Each has a specific purpose. Some help absorb drainage, while others help keep the tube stable.

Split 2-By-2 Gauze Dressing

Use when there is drainage at the G-tube site. If there is no drainage, leave the site open to the air.

Supplies:

• One split 2-by-2-inch gauze pad (pre-cut or homemade)
• Washcloth or cotton-tipped swabs
• Soap and water
• Small piece of tape (optional)

Steps:

1. Wash your hands with soap and water.
2. Remove the old dressing.
3. Clean the skin (see daily care instructions).
4. Place the split gauze around the button or stabilization device.
5. Use a small piece of tape to hold it in place if needed.
6. Change the dressing daily or more often if it becomes wet or dirty.

Bolster Dressing

Use with long indwelling tubes without a stabilization bar or disc, such as Pezzer or Foley tubes.

Often used:

• When new tubes are placed
• To support healing skin
• When no stabilization disc is present

Supplies:

• Two 3-by-3-inch gauze pads
• Washcloth or cotton-tipped swabs
• Soap and water
• Three ½-by-4-inch tape strips
• 1-inch tape for tension loop

Steps:

1. Wash your hands with soap and water.
2. Fold and roll two 3-by-3-inch gauze pads into a bolster. Tape to secure.
3. Remove the old dressing.
4. Clean the skin if not already done that day.
5. Place the bolster next to the G-tube while holding the tube straight up. If stitches are out, gently pull the tube until the balloon (mushroom) is snug against the stomach wall.
6. Lay the G-tube over the bolster so it forms a 90-degree angle.
7. Secure with three ½-by-4-inch tape strips in the same direction.
8. Create a tension loop for extra security.
9. If there is drainage, place gauze next to the bolster and tape it in place. Change when wet or dirty.

Change the bolster dressing only when soiled or loose. Change the location of the bolster at least every three days.

Gauze and Tape Dressing

Use for long indwelling tubes without a stabilization bar or disc. Often used when new tubes are placed and to help with skin healing.

Supplies:

• Two 2-by-2-inch split gauze pads (or pre-cut)
• Two 6-inch pieces of 1-inch tape, split halfway lengthwise
• Washcloth or cotton-tipped swabs
• Soap and water

Steps:

1. Wash your hands with soap and water.
2. Remove the old dressing.
3. Clean the skin.
4. If stitches are removed, gently push the tube inward and twist. Then pull back until the internal bumper is snug against the stomach wall.
5. Place split gauze around the tube.
6. Take one split piece of tape. Fold ends to make tabs.
7. Position the tape so the tube sits at the split.
8. Hold the tube straight, gently pulling to ensure proper placement.
9. Use the second piece of split tape in the opposite direction.
10. Create a tension loop for added protection.

Rotate the direction of the tape with each change to prevent the tube from leaning the same way repeatedly.

Tips for all dressing types:

• Always wash hands before and after dressing changes.
• Clean the site daily with soap and water, even if the dressing doesn’t need to be changed.
• Rotate placement of dressing materials to protect the skin and reduce irritation.
• Monitor the site for redness, swelling, or signs of infection.

Venting releases extra air or stomach contents to relieve pressure. This is sometimes called burping through the G-tube. You can do this before, during, or after feedings, especially if your child shows signs of discomfort.

Steps to vent the G-tube:

1. Insert a 60-milliliter syringe without the plunger into the G-tube.
2. Hold the syringe upright and unclamp the tube. You may hear air or see stomach contents rise into the syringe.
3. Allow venting for one to two minutes.
4. Let the contents flow back into the stomach. If they don’t, gently push them back with the plunger.
5. Clamp the tube and remove the syringe.

Important notes:

• Do not throw away stomach contents unless your child’s doctor or nurse tells you to.
• If contents overflow, collect them in another container and refeed them when your child is calm. These fluids contain electrolytes and may also contain medicines.
• Kids who have had a Fundoplication procedure may need venting more often because their stomach is smaller.

Checking the residual shows how much formula is in your child’s stomach before the next feeding. Only check this if your child’s doctor or nurse tells you to.

Steps to check residuals:

1. Insert a 60-milliliter syringe without the plunger into the G-tube.
2. Lower the syringe below your child’s stomach, letting stomach contents drain into a cup.
3. When the flow stops, measure the amount by holding the cup at eye level.

What to do with the result:

Bolus feedings:

• If residual is less than half the last feeding, return it to the stomach, and start the next feeding.
• If more than half, stop the feeding, wait 30 minutes, and check again before feeding.

Continuous drip feedings:

• If residual is less than one hour’s feeding, return it to the stomach, and begin the feeding.
• If more than one hour’s worth, stop the feeding, wait 30 minutes, then recheck.

Call your child’s doctor if large residuals keep happening.