These instructions are for Children’s Hospital of Philadelphia (CHOP) patients with mushroom G tubes, also called Malecot^® or Pezzer tubes.

Important information about mushroom G tubes:

• Mushroom G tubes (gastrostomy) are inserted by a surgeon in the operating room. These are latex (rubber) tubes with a mushroom-shaped end, which is placed into the stomach. The long end of the tube sits outside of your child’s belly. The opening on the skin that the tube goes through is called a stoma. The tube is held in place by stitches and a Hollister^® tube attachment device.
• The G tube has a funnel-shaped end. An extension set needs to be attached to give formula or medicine.
  

  

• Once the stoma has healed for at least 6 weeks, the tube may be changed to a low-profile tube. This is a tube that lays flat against the belly. Your healthcare team will tell you when the tube will be changed. The first change usually occurs 6-8 weeks after the initial tube is placed in the General Surgery outpatient clinic at the Buerger Center for Advanced Pediatric Care.

Instructions for care of the G tube:

• It is important to secure the tube to prevent it from coming out or moving so the stoma and tract can heal well. The tract is the pathway leading from the stoma into the stomach. Poor healing can cause leaking, skin irritation and granulation tissue.
• After surgery, the tube is held in place by a Hollister device. It keeps the tube still.  Your team will show you how to use the Hollister device.
• Use a permanent marker to mark the tube where it meets the Hollister strap. This tells you if the tube has moved.
• Your surgeon may suggest securing the tube with a piece of Tegaderm™, a clear, thin dressing, that tapes the tube to the skin.
• Your child’s tube should not interfere with their normal activities.  Your child can play and sleep as usual. Clothing such as onesies can prevent your child from pulling on the tube. This type of clothing can also prevent the tube from getting caught on something and keep it from getting pulled out.

Instructions for skin care:

• A dressing is placed over the site after surgery. It is removed 48 hours after the tube is placed. Sometimes Dermabond^® is used over the surgical site; this is a clear glue-like substance that will come off on its own and should not be picked, pulled or peeled off. Allow the Dermabond to fall off on its own.
• After surgery, only sponge baths are allowed. The new tube site cannot go under water in a bathtub until instructed by the Surgery Department. This could loosen the Hollister device and cause the tube to come out.
• Clean around the Hollister device with a cotton swab at the opening of the device with warm soapy water. The Hollister device should be changed once a week or sooner if it starts coming off or is dirty. You may use a skin barrier, such as Cavilon™ No Sting Barrier Film (if your child is over 1 month of age), to protect the skin from the adhesive on the Hollister device. When the Hollister is off, it is normal to have a little yellow-brown drainage and redness at the opening. Clean the stoma site every day with mild soap and water. Dry well. Do not scrub. Scrubbing can slow down the healing or cause skin breakdown.

Call your healthcare provider if you see:

• Rash with red dots on the edges  
• Signs of infection: increased redness, swelling, yellow-green drainage with a bad smell at the stoma or pain
• Open areas of skin around the stoma
• Bleeding at the stoma site
• Bleeding, painful or growing granulation tissue around the stoma
• Increased leaking at the stoma site

Instructions for leaking:

• Your surgeon will mark the tube where it meets the Hollister device. Make sure the mark on the tube is still at the Hollister strap. If it is not, gently tug on the tube and secure it with the Hollister device. This brings the mushroom tip of the G tube up against the inside of the stomach.
• If leaking continues, call your healthcare team.
• Protect the skin around the stoma with a skin barrier, such as Vaseline^®, A&D^® ointment, diaper cream, or Cavilon No Sting Barrier Film (if your child is over 1 month of age).

Instructions for care of granulation tissue: 

Granulation tissue is a type of scar tissue that forms when the body is trying to heal itself.  Because the feeding tube stoma is a new opening, your child’s body naturally may try to close it by growing this tissue. Some children have granulation tissue that grows very quickly, while others have no problem with it at all. Granulation tissue is dark pink or red. Sometimes it can cause leaking and skin irritation.  It may also bleed or cause pain.  If this happens contact your healthcare provider.

• If you see granulation tissue starting to grow, discuss it with your healthcare provider at your next visit.
• If the granulation tissue around the tube is bleeding, painful, or growing quickly, contact your healthcare provider for an appointment. They may prescribe a cream that you can use at home, or they may treat it in the office with a medicine called silver nitrate. These medicines shrink the granulation tissue. Granulation tissue may return and need to be treated with medicine again.

Instructions for venting the tube: 

Venting is a way to use the tube to burp your child and let gas out of their stomach. Your child may need to be vented if their belly is bloated, if they have belly pain, or if they gag, retch, or vomit.

If your child’s tube needs to be vented, follow these steps:

1. Remove the plunger from a catheter tip syringe.
2. Attach the syringe with the plunger removed to the tube.
3. Hold the syringe barrel above the level of your child’s stomach.
4. Keep the tube vented for 5-10 minutes before or after feeding as instructed by your child’s healthcare provider.

Instructions if the G tube becomes clogged:  

• Prevent the tube from clogging by flushing the tube with water as directed after each feeding and before and after each medicine.
• If your child is on continuous feedings, the tube needs to be flushed at least once a day.
• Even a tube that is not being used must be flushed once a day.
• If the tube becomes clogged, attach a 5ml oral syringe with warm water to the end of your feeding tube. Try to flush the tube. If you are unable to flush, pull back on the plunger of the syringe. Repeat this push and pull action up to 5 times. If you still cannot flush the tube, try using warm water in a 3ml or 1ml oral syringe and repeat the above steps.
• If this does not work, call your healthcare team.

Instructions if the G tube comes out: 

No matter how long your child has had a G tube, the stoma can close very quickly. If the G tube comes out and you are:

• If you are less than 45 minutes away from one of CHOP’s hospitals, go to the nearest CHOP Emergency Department in Philadelphia or King of Prussia.
• More than 45 minutes away from CHOP, go to the closest Emergency Department.
• If you go to another Emergency Department, ask them to call General Surgery at CHOP.

Call your CHOP team with any questions or concerns.

If you have any questions about your child’s health, please contact your child’s healthcare provider. This document is intended only to provide general educational information and is not intended as medical advice or treatment. Please consult with your healthcare provider prior to use, as some of this information may need to be adapted for your child’s specific needs. It is the responsibility of your healthcare provider to advise you on the appropriate use of this information. If you/your child are not already a CHOP patient, this document does not create a doctor-patient relationship between you/your child and CHOP. CHOP is not responsible for any outcomes you/your child might experience from your use of this document. This document is provided "AS IS", WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, express or implied. If this document refers to any drugs or medical devices, it is the responsibility of your healthcare provider to check the FDA status prior to use. If this document includes references to drug dosing, please do not rely on this document. Your healthcare provider should check the package insert for each drug before use. Hyperlinks used within this document may not be translated into other languages.

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