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
G-Tube Post-Op Guideline
Guideline · Oct 2019 · 1 min read
In brief
In brief
Clinical guideline for postoperative management of gastrostomy tube placement in pediatric patients, covering care protocols, complication monitoring, and feeding advancement strategies.
Written by the GCMD Library team from the guideline.
Immediate Post-Operative Management
Secure g-tube with duoderm/tegaderm and place standard g-tube orders immediately after placement. Document balloon volume (cc sterile water) and disc height in operative note using standardized templates.
Early Feeding Protocol
Keep patient NPO for 4 hours, then Farrell to pole for 2 hours before initiating feeds. Start at one-third goal rate (continuous or bolus) and advance by one-third every 8 hours to reach goal feeding.
Delayed Feeding Protocol
Alternative pathway with NPO overnight and Farrell to pole for 6 hours before feed initiation. This pathway may be selected based on attending surgeon preference.
Documentation Requirements
Use isolated g-tube/button template with 'ipstandard' SmartText or 'newgtube' dot phrase for combined procedures. All operative notes must include balloon volume and disc height at case conclusion.
Post-Feeding Monitoring
All patients require additional post-operative assessment 2-4 hours after feed initiation to evaluate for vomiting or abdominal distension. This check is mandatory regardless of feeding pathway chosen.
Statements in this guideline
Ensure tubing is secured to the patient with duoderm or tegaderm immediately post-operatively.
Place standard g-tube orders using the order set 'G-Tube Placement – General Surgery' immediately post-operatively.
Document the number of cc sterile water in the balloon and the height of the disc in the operative note.
For early initiation of feeds, keep the patient NPO for 4 hours post-operatively.
For early initiation of feeds, place the Farrell to pole for 2 hours.
For early initiation of feeds, initiate feeds at one-third of goal rate, either continuous or bolus.
For early initiation of feeds, advance to goal by one-third every 8 hours.
For delayed initiation of feeds, keep the patient NPO overnight.
For delayed initiation of feeds, place the Farrell to pole for 6 hours.
All patients require an additional post-operative check 2 to 4 hours after feed initiation.
The delayed feed pathway can be chosen by attending preference.