From the Guidelines
A comprehensive postoperative care plan for open gastrostomy tube placement should prioritize wound care, tube management, feeding protocols, and complication monitoring to minimize morbidity, mortality, and improve quality of life. The plan should be based on the most recent and highest quality evidence available.
Key Components of Postoperative Care
- Initially, maintain the surgical dressing for 24 hours, then clean the stoma site daily with mild soap and water, applying antibiotic ointment if prescribed, as recommended by 1.
- The tube should be secured with a stabilizing device to prevent dislodgement, and the site should be monitored for signs of infection such as redness, swelling, or drainage.
- Feeding typically begins 24-48 hours post-procedure, starting with clear water flushes before advancing to formula, with the patient positioned with the head elevated 30-45 degrees during and for 30 minutes after feeding to reduce aspiration risk, as suggested by 1.
- Use 30-60 mL of water to flush the tube before and after each feeding or medication administration to prevent clogging, and medications should be in liquid form when possible or thoroughly crushed and dissolved.
Complication Monitoring and Prevention
- Common complications to watch for include tube dislodgement (requiring immediate medical attention if within 4 weeks of placement), site infection, leakage around the tube, and tube blockage, with frequencies as reported in 1.
- Pain management typically involves scheduled acetaminophen 650-1000 mg every 6 hours for 3-5 days, with stronger medications like oxycodone 5-10 mg every 4-6 hours as needed for breakthrough pain.
Long-term Care and Follow-up
- After approximately one week (or if properly healed) the stoma site can be cleansed twice a week with a clean cloth using fresh tap water and soap, and the skin can be gently and thoroughly dried, as recommended by 1.
- With a well-healed exit site, showering, bathing, and swimming (with a waterproof dressing when swimming in public pools) is possible after a few weeks, and an additional fixation or securement may be advisable to minimize traction on the stoma site. By following this comprehensive care plan, patients with open gastrostomy tubes can minimize the risk of complications and improve their overall quality of life, as supported by the most recent evidence from 1.
From the Research
Postoperative Care Plan for Open Gastrostomy (G-tube) Tube Placement
The postoperative care plan for open gastrostomy (G-tube) tube placement involves several key considerations, including:
- Monitoring for complications such as infection, peristomal leakage, and dislodgment of the tube 2, 3, 4
- Initiating feeding through the G-tube, with some studies suggesting that early feeding (within 3 hours) is as safe as delayed feeding 2, 5
- Educating patients and caregivers about the proper care and maintenance of the G-tube, including how to prevent complications and manage any issues that may arise 3, 4
- Assessing the patient's nutritional status and adjusting the feeding regimen as needed 6
- Evaluating the patient's quality of life and making any necessary adjustments to the care plan 4, 6
Key Considerations
Some key considerations for the postoperative care plan include:
- Checking residual volumes, tube length, and peristomal leakage regularly 2
- Monitoring vital signs and performing a global assessment every 4 hours 2
- Evaluating the patient's psychological, social, and physical performance status 4
- Assessing the patient's quality of life and making any necessary adjustments to the care plan 4, 6
Potential Complications
Potential complications of G-tube placement include: