a. A gastrostomy is a surgical opening into the stomach, made through an incision in the left, upper abdomen.

The anterior gastric wall is sutured to the abdomen, preventing leakage of gastric contents into the abdominal cavity. The gastrostomy procedure is done when disease or injury of the esophagus makes gastric intubation by way of the esophagus impossible.

At the time of surgery, the gastrostomy tube, with usually a size 20 to 26 catheter, is inserted into the stomach through the incision. The distal end is clamped to prevent leakage, and the tube is secured at the incision with one or two sutures. As healing of the wound takes place, a stoma (artificial opening) is formed, and the catheter can then be removed and reinserted. Some patients are fitted with a plastic prosthesis instead of the catheter. The prosthesis remains in place and a catheter is inserted through its lumen for feeding. A screw cap or plug seals off the prosthesis opening when the catheter is not in use.

b. Special attention must always be paid to the skin area around the tube since there may be some leakage of gastric secretions and, unless the skin is kept clean and dry, it will soon become very irritated. When the nursing paraprofessional does the gastrostomy feeding, he must also know how to carry out the prescribed skin care and dressing procedure.

c. For the patient’s morale, his feeding procedure should resemble as much as possible a normal meal procedure and not be an activity incidental to the dressing and skin care routine. For example, dressing and skin care materials should not be assembled on the same tray with his feeding set. When the time intervals for doing all required procedures coincide, plan to do the dressing and skin care procedures first so that the patient is as clean, comfortable, and relaxed as possible for his meal.

d. The teeth and mouth of a patient with a gastrostomy must be kept in optimum condition by frequent oral hygiene measures.

e. If permissible, chewing gum may be given to stimulate the flow of saliva and keep the mouth moist. If the patient is unable to swallow the saliva, a covered, disposable sputum container should be provided and changed frequently. Measurement of expectorated saliva should be recorded on the I&O worksheet.

f. The physician may allow the patient to chew food and spit it out. This will stimulate salivation and exercise the gums. This measure should only be entrusted to reliable, compliant patients.