h. Keep accurate intake and output records. Large amounts of fluid and
electrolytes are lost during continuous suction drainage. Information on all in-take and
all output is used by the doctor in planning fluid replacement.
i. Observe the patient frequently when he is asleep, noting the tube marking at
the nostril. The patient may have unknowingly pulled the tube out partially or
completely. If partially out, advance the tube to the required point and check for
drainage. Tape securely. If the tube has been accidentally removed, notify the nurse or
doctor. Reinsert only on order.
GASTROSTOMY, COLOSTOMY, ILEOSTOMY
1-40. NURSING CARE OF THE PATIENT WITH A GASTROSTOMY
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
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,