Gastrostomy feeding is common in children with non-malignant palliative care needs. There are 2 main types: Percutaneous endoscopic gastrostomy (PEG), which is usually sited first, and MIC-KEY a balloon-type, low profile device.

Troubleshooting

Blockage

• Aim to prevent blockage by flushing before and after all feeds or medication. A minimum of 10mL of water is appropriate for most children
• Appropriate formulation of drugs given by gastrostomy is essential
• If partially blocked, warm water, soda water, cola or pineapple juice may help dissolve blockages
• Pancrex V ( prescription only) can be instilled for 30 minutes to dissolve blockages
• Consider change of gastrostomy

Leakage

• Common before the tract is fully formed: manage with hygiene measures
• Protect the skin from excoriation – Cavilon or other barrier cream
• Check device fit: Is the balloon broken or not fully inflated? Check external fixation on gastrostomy tube
• Consider volume in child’s stomach – remove excess air prior to feeding
• Consider child’s position during feeds to aid gastric emptying or reduce feed rate / volume
• Consider external pressure – exclude constipation
• Pancrex V (prescription only) can be instilled for 30 minutes to dissolve blockages
• Consider change of gastrostomy

Infection

• Erythema, swelling, tenderness and discharge may be present
• Swab before treating
• Treat superficial infections with Fucidin cream
• More extensive infection may require systemic antibiotics

Granulation tissue

• Produces mucus type discharge and may bleed
• Treat with topical steroid based antifungal creams twice daily for 10 days e.g. Trimovate.

Dislodgement

• Stoma sites can close quickly
• Most children with MIC-key® tubes will have spare devices which should be inserted on dislodgement
• A 12g Foley Catheter can be used to keep the tract open whilst awaiting surgical assistance. If used for feeding / medication, care must be taken to ensure that the catheter has not migrated to the small bowel.