What are the best practices for G-tube (Gastrostomy tube) maintenance?

G-tube Maintenance Best Practices

Daily cleaning of the G-tube site with mild soap and water is the cornerstone of proper gastrostomy tube maintenance, along with regular tube flushing with water to prevent clogging. 1

Site Care and Cleaning

• Clean the gastrostomy site daily with mild soap and water 1
• Do not use hydrogen peroxide after the first week as it can irritate skin and contribute to stomal leaks 1
• Dry the area thoroughly after cleaning 1
• Inspect the site daily for signs of infection (redness, pain, purulent discharge, fever) 1
• Avoid occlusive dressings as they can lead to skin maceration and breakdown 1
• If using dressings, foam dressings are preferred over gauze to reduce skin irritation 1
• Place cut drain sponges over (not under) the external bumper to avoid excessive tension 1

Tube Positioning and Movement

• Ensure proper tension between internal and external bumpers:
  • Allow free movement of at least 5mm 1
  • Avoid excessive pressure which can cause tissue ischemia 1
• Push the tube approximately 2-3cm inward and gently pull back to the resistance point daily to prevent adhesions and buried bumper syndrome 1
• Rotate the tube weekly to prevent mucosal overgrowth 2

Preventing and Managing Tube Clogging

• Flush tube with 30-40ml of water: 1, 2
  • Before and after each feeding
  • After medication administration
  • Every 4 hours during continuous feeding
• For clogged tubes, try these interventions in sequence: 1
  1. Simple water flush (resolves ~33% of clogs)
  2. Installation of pancreatic enzymes (resolves additional ~50% of clogs)
  3. Mechanical devices (Fogarty balloon, biopsy brush, commercial tube decloggers)
  4. Tube replacement as last resort
• Avoid using carbonated beverages, cranberry juice, or pineapple juice for flushing as they are inferior and may cause tube degradation 1, 2

Managing Common Complications

Granulation Tissue

• Common causes: excess moisture, friction, tube movement, infection 1
• Management options: 1
  • Apply barrier film or cream to protect surrounding skin
  • Clean minimum once daily with antimicrobial cleanser
  • Apply topical silver nitrate directly to granulation tissue
  • Alternative: topical high-potency corticosteroid cream for 7-10 days
  • Consider foam dressing to provide compression
  • For persistent cases, consider changing tube type or brand

Site Infection

• Risk factors: diabetes, obesity, poor nutrition, immunosuppression 1
• Prevention: aseptic wound care and early detection 1
• Management: 1
  • Apply antimicrobial agent to entry site and surrounding tissue
  • Consider antimicrobial dressings (silver, iodine, or polyhexamethylene biguanide)
  • For persistent infections, add systemic antibiotics
  • Avoid topical antibiotics 1
  • If infection cannot be resolved, tube removal may be necessary 1

Peristomal Leakage

• Risk factors: skin infection, increased gastric acid, gastroparesis, increased abdominal pressure, side torsion of tube 1
• Management: 1
  • Apply topical barrier products (zinc oxide-containing creams, powdered absorbing agents)
  • Consider proton pump inhibitors and/or prokinetics
  • Ensure proper tension between bolsters
  • Correct side torsion by stabilizing tube or switching to low-profile device
  • For balloon devices, check volume content weekly

Tube Replacement

• Most bumper-type tubes can remain in place for 1-2 years 1
• Balloon-type tubes typically need replacement every 3-4 months due to balloon degradation 1
• Indications for replacement: tube breakage, occlusion, dislodgment, or degradation 1
• For balloon-type replacement tubes: 1
  • Inflate with sterile water (not saline)
  • Use 5-10ml of water
  • Check water volume weekly to prevent spontaneous deflation

By following these evidence-based practices, complications can be minimized and tube longevity maximized, improving patient outcomes and quality of life.