As you know we have been rewriting the GT protocols again. I wanted to give you a quick overview of the NEED TO Know basics. Please, do read through the new protocols when you have a minute. As always, you can find them in the standards section on the Swedish home page.

Quick review of GT types. We have the Mic-key usually placed on an older infant. This is very similar to the AMT mini which we are seeing more of and the extensions are interchangeable. The Bard you will see on a smaller infant and bigger premie. These have the flat hole that appears like you can stick a syringe tip directly into it-don’t. The Mallencot you may see in ISCU or NICU. It does not have a securment for the skin like the other types do- be careful not to dislodge it. The PEG is usually the first GT placed, not the markers on the tube at the skin to determine the tube has not moved and be sure the brace is not too tight.

These recommendation come from our GI team and the ASPEN recommendations for 2009. We are using these extension tubings to feed children with gastric sensitivities and those who are immunocompormised in many cases and cleaning our ends is one way to reduce infections. We have moved to tossing the extensions just as we remove NGs after 1 week. The protein buildup and potential for bacteria is too great to continue using them longer. This is Dr Muir’s recommendation for home as well. Nancy has added a supplement to the protocol to help you determine what can be added to formula if you are trying to restrict the amount of water you flush with. Please, use it otherwise you risk clogging a GT by having a med react with the formula.

List 3 things you would like to clarify with this mom or teach differently. What is she doing right?

This brings us to parent teaching. If you have not used the EPIC teaching for GTs please review it. If you are looking for further references please give parents these sites and tell them to stay away from youtube!

What questions do you have? Anything you want to go over again?

These are the references for the websites, images and videos used in this presentation. The majority of the new recommendations come from the American Society for Parenteral and Enteral Nutrition. Thanks for your time, I hope this was helpful.

Gastrostomy Tube Care Update Pediatric Nurse Review Series Jennifer Casperson, RN, BSN

GT Types Mic-Key AMT mini Bard Mallencot PEG

Accessing New for this year: Alcohol Wipes used to clean the end of the extension tube prior to access. Throw away brand specific extension tubing after one week. Medication chart in protocol for information on compatibility with formula.

Bolus Feeding Grab a piece of paper and critique the following video.

Teaching for Parents http://kidshealth.org/parent/system/surgery/g_tube.html Copyright © 1999–2011 Children's Memorial Hospital. All rights reserved This site is sponsored by a medical center and contains general information on surgery and types of tubes. http://www.parent-2-parent.com/tubefeeding/type.htm All information on this site is © Reflux in Children This site is a parent sponsored site and offers support as well as simple information on what to expect.

Questions? ???

References: Bankhead, R., et al  (2009).  Enteral nutrition practice recommendations.Journal of Parenteral and Enteral Nutrition, 33(2), pp. 122-167.  American Society for Parenteral and Enteral Nutrition. Children’s Memorial Hospital., Chicago, IL. (2007) Gastrostomy tubes and feedings: A parent's guide. Retrieved April 20, 2011 from http://www.childrensmemorial.org/depts/pediatricsurgery/gastrostomy.aspx Reflux in children. (2009) Parent-to-parent tube feeding. Retrieved April 20, 2011 from http://www.parent-2-parent.com/tubefeeding/type.htm TheWagnerThree (2010) Gravity tube feeding. Youtube.com . Retrieved April 20, 2010 from http://www.youtube.com/watch?v=PCwgy7wgrGs&feature=related Images: Kimberly-clark.com Retrieved April 20, 2011 from Google Images.