McKenna C, Garvin G, et al., eds. Nursing Care of the General Pediatric Surgical Patient. Gaithersburg, MD: Aspen;

2000:261; Metcalfe P, Schwarz R. Bladder exstrophy: neonatal care and surgical approaches. Wound Ostomy Continence Nurs.

2004;31:284; Wound Ostomy and Continence Nurses Society. Pediatric Ostomy Care: Best Practice for Clinicians. Mount

Laurel, NJ: Wound Ostomy and Continence Nurses Society, 2011.

Chapter 42 ■ Neonatal Ostomy and Gastrostomy Care 299

care of normal newborns (4). Occasionally, skin breakdown

does occur; it can be treated with moisture barrier products

and frequent diaper changes.

Gastrostomy Tubes

A. Indications

For indications and insertion technique, see Chapter 41.

B. Types of Tubes

See Table 42.4.

C. Gastrostomy Care

1. Assessment

a. The health care provider must know if the patient

has undergone a Nissen fundoplication or other

antireflux procedure together with the gastrostomy.

b. Tolerance to feedings

c. Type and size of tube

d. Insertion site

e. Condition of the peristomal skin

2. Special considerations for patients with Nissen or other

antireflux procedure

a. Patient cannot vomit or burp.

b. Vent tube after crying and at first sign of gagging,

discomfort, or distress.

3. Gastrostomy tube site and routine skin care (6,10)

a. Clean gastrostomy tube site two to three times per

day in the postoperative period and once per day

after the site has healed. Use normal saline and sterile cotton swabs in the early postoperative period.

Use mild soap and water after the site has healed.

Diluted hydrogen peroxide (50% hydrogen peroxide

and 50% water) is not recommended unless the site

has dry, crusted blood (9).

b. Ensure that the antimigration device is flush against

skin and the gastrostomy tube has not migrated.

c. Position tube at 90-degree angle.

d. A bottle nipple placed over the tube with the flanges

resting on the abdominal wall may also be used to

keep the tube at a 90-degree angle; secure with tape

(Fig. 41.5).

e. Stabilize gastrostomy tube to prevent excess movement of tube, to decrease risk of stoma erosion, infection, bleeding, and development of granulation tissue.

f. Use an anchoring device (e.g., Hollister Tube

Drainage Attachment Device, Hollister Inc.,

Libertyville, Illinois) if the patient is allergic to tape

or as a routine to secure the tube to skin.

g. Rotate bolster, flange of nipple, or wings of button

every 4 to 8 hours to prevent pressure necrosis of

skin. Do not place gauze between skin and bolster.

A tension tab can be created by placing tape on the

tube and pinning it to the diaper. A one-piece shirt

with snap enclosure or tubular elastic dressing can

also be used to cover the tube.

h. Assess site and peristomal skin for leaking, irritation,

redness, rashes, or breakdown. Erythema and a minimal amount of clear drainage are to be expected in

the first postoperative week.

D. Gastrostomy Tube Complications

Table 42.5 lists interventions for treating complications

related to gastrostomy tubes.

Table 42.4 Types of Gastrostomy Tubes

Type Description Examples

Temporary/traditional Most commonly used as initial tube

following Stamm procedure; long,

self-retaining catheters of latex or

silicone rubber with self-retaining

devices (i.e., balloon)

Malecot (Bard, Covington, Georgia)

(collapsible wings), dePezzer

(mushroom)

Gastrostomy feeding tubes Silicone catheter with antimigration

device and end cap

MIC (Kimberly-Clark/Ballard

Medical, Draper, Utah), CORFLO

(CORPAK MedSystems, Wheeling,

Illinois)

Skin surface devices Intended for use in established gastrostomy tract; have self-retaining devices,

antimigration devices, and antireflux

valves; two types, balloon and

“Malecot type”

Bard Button (Bard, Covington,

Georgia), MIC-KEY (Kimberly

Clark/Ballard Medical, Draper,

Utah)

Data from Borokowski S. Pediatric stomas, tubes, and appliances. Pediatr Clin North Am. 1998;45:1419.