G-Tube Post-Op Guideline

G-Tube Placement Completed Immediately Post-Operatively:•Ensure tubing secured to patient with duoderm/tegaderm•Place standard g –tube orders (“G-Tube Placement –General Surgery”)•Use standard g-tube note to document cc sterile water in balloon and height of disc (see inset box) EarlyInitiation of FeedsDelayedInitiation of Feeds NPO x 4 Hours Farrell to Pole x 2 Hours Initiate Feeds at 1/3rdGoal (continuous or bolus)Advance to goal by 1/3rdQ8H NPO Overnight Farrell to Pole x 6 Hours Standard Notes1). If using isolated g-tube/button template:•Type “ipstandard” into text box that reads “Insert SmartText”.•Choose appropriate note (g-tube vs. g-button)2). If g-tube inserted as part of a larger procedure:•Use dot phrase “newgtube” or “newgtubebutton” to insert phrase into “Findings” section of op noteBe sure to include number of cc sterile water in balloon and height of disc at conclusion of case in the noteIf no vomiting or distension Updated 2/2019 v1.0Sources:•IslekA, et al. Percutaneous Endoscopic Gastrostomy in Children: Is Early Feeding Safe? JPGN 2013;57(5): 659-662.•CorkinsMR, et al. Feeding After Percutaneous Endoscopic Gastrostomy in Children: Early Feeding Trial. JPGN2010;50(6):625-627.•Hendrickson RJ, et al. Feeding Advancement and Simultaneous Transition to Discharge (FASTDischarge) after laparoscopic gastrostomy. J PediatrSurg2019;53:2326-2330. Allpatients requirean additional post-op check 2-4 hours after feed initiation *Delayed feed pathway can be chosen by attending preference