Advantages of Gastrostomy less time spent giving feeding feeding can be done at night when child is sleep easily

easily administered provides an alternative route of feeding and drug administration decreases the risk of pulmonary aspiration sure way of administering formula directly into the stomach

Disadvantages of Gastrostomy leakage risk of infection skin irritation gastric distention bleeding

Types of Gastrostomy 1. Stamm (Temporary and Permanent ) require either an upper abdominal midline incision or a left upper quadrant transverse incision requires the use of concentric purse string sutures to secure a tube to the anterior gastric wall an exit wound is created in the left abdominal midline incision or a left upper abdomen to provide for the gastrostomy.

2. Janeway (Permanent) require the same as stamm an upper abdominal midline incision or a left upper quadrant transverse incision

necessitates the creation of a tunnel (called a gastric tube) that is brought out through the abdomen to form a permanent stoma

3. Percutaneous Endoscopic Gastostomy is a procedure that requires the series of two physicians (or a physician and a specially trained nurse) the initial PEG device can be removed and replaced once the tract is well established (10 14 days after insertion)

4. Low Profile Gastrostomy Device (PGD) may be inserted 3 6 months after initial gastrostomy tube placement these devices are inserted flush with the skin; they eliminate the possibility of tube migration and obstruction and have antireflux valves to prevent gastric flux

Two types of devices may be used: Obturated Devices (PEG Button or Gastro Part II) have done tip that acts as an interval stabilizer Nonobturated Devices (MIC - KEY) has an external skin disk and is inserted into the stoma without force; a balloon is inflated to secure placement

Types of Tube Feeding Methods 1. Bolus Tube Feedings Allow introduction of 250 to 400 ml formula through the tube in a short period (usually 15 30 minutes) Administered by syringe or gravity flow system attached to the distal end of the feeding tube

2. Intermittent Tube Feeding Allow delivery of between 250 and 400 ml formula are 30 6- minutes Delivered by gravity flow system or an electric feeding pump 3. Continuous Tube Feeding Allow formula to be administered at low rates usually 1.5ml/min over a longer time (usually 12 24 hours) Delivered by gravity flow system or an electronic feeding 4. Cyclic Tube Feeding Allow formula to be administered at lower rates usually 1.5 ml/min over a longer time (usually 12 24 hours) Ensure adequate nutrition during weaning from tube to oral feeding Alternate with oral food intake until client can take most nutrition orally Types of Feeding Formula 1. Blenderized Formula used infrequently, are more likely to clog feeding tube since they have a high viscosity 2. Commercially Prepared Polymeric Formula contain unaltered molecules of proteins, carbohydrates and fats. They are best for people who can digest and absorb nutrients without difficulty are available as standard formulations containing protein isolate with one or more sources of carbohydrates and fats. 3. Modular Formula is an incomplete liquid supplement that contains specific nutrients usually single macronutrient. 4. Chemically Defined Formula represent the ultimate reduction of food and have been called Space Diets 5. Disease Specific Formula available to meet the needs of patients with specific medical problems, such as glucose intolerance, liver disease, ling disease, GI dysfunction, renal disease, etc.