Commonly asked questions about G-tubes
What is a G-tube?
"G" stands for "gastrostomy" which means an opening into the stomach. A G-tube is a short and hollow tube inserted into the stomach from the surface of the abdomen (tummy) through an opening called the gastrostomy site. The G-tube is used as an access to deliver nutrition supplement for a person who needs it.
How is G-tube feeding done?
G-tube feeding is usually done during the night. Formula or nutritional supplements such as Ensure©, Resource© or Vital HN© are infused over 6 to 8 hours. Occasionally, G-tube feeding may be carried out during the day when someone is sick or has too poor of an appetite to eat regular food.
Does G-tube feeding replace eating meals?
No! G-tube feeding is just one way to help someone with CF to meet his/her total caloric requirement. In fact, it is designed to help meet only 1/3 of a person's total daily calorie requirements. Therefore, a person who receives G-tube feeding should continue to eat three meal and two snacks during the day!
How is the tube inserted in the stomach? Will I need to have an operation?
The procedure is usually performed by a radiologist (a specialist who is trained to interpret X-rays and performs X- ray guided diagnostic procedures). The procedure is usually done in the interventional X-ray department. The procedure lasts no more than 30 minutes. You will received mild sedation and local freezing to keep you comfortable while the G-tube is inserted. For more details, speak to our CF nurse practitioner, Anna Tsang at the Adult CF program at St. Michael's hospital.
How long do I have to stay in the hospital?
Generally speaking, if you are in stable health, it should take no more than 5 - 7 days of hospital stay. Occasionally, someone may need to receive a course of IV antibiotic to treat his/her chest infection first before proceeding with the G-tube. In this case, your hospital stay could be as long as 2-3 weeks. You will be admitted to the hospital on the day before you G- tube insertion. After G-tube is inserted, you will receive adequate pain medication to keep you comfortable enough to do deep breathing and cough and perform your usual physiotherapy to avoid chest infection. The remaining hospital days will be used to help you test out the right type of tube feeding formula, the proper rate of feeding during the night, and how to manage your feeding equipments i.e. setting up your night feeding, operating a feeding pump and how to clean your equipment.
What are some of the benefits of G-tube feeding?
First and foremost, knowing that you can meet one third of your total daily calories by doing your night feeding, it can really relieve a lot of pressure from having to "eat, eat, eat" during the day. Some people report that they enjoy their food a whole lot more just because they don't feel the burden of having to finish the entire plate of food at meal time. Secondly, good nutrition helps to build better resistance to infection which keeps your lungs healthy. Good nutrition helps to build and strengthen muscles used for breathing; often people who started tube feeding are able to regain some lung function.
Would I have to be attached to a tube for the rest of my life?
No. In our center, once the G-tube site and G-tube track are well healed, approximately 8 to 10 weeks after insertion, the initial G-tube will be replaced by a G-button, also called a low profile G-tube. This button is smaller than a quarter in sizes which can be easily hidden under clothing. How long you will need to have the G-button for night feeding depends on how well you are and how soon you are able to gain weight and improve your nutrition. For most people who require a G-tube to gain or maintain a healthy weight, it can be a very useful device to have for a long time.
Does anyone ever have the G-tube removed?
Yes. A very small number of people who are able to keep a healthy weight for over 6 month period without G-tube feeding and stay in good health have had their G-tube removed. Also after successful lung transplantation, most patients have their G-tube removed within 3 months because they no longer require such high caloric intake on a daily basis.
What are some of the possible side effects?
There are a few possible side effects but all of them are quite manageable.The most common one is a sensation of fullness or bloating in the morning after having been fed during the night. There are medications that can be added to the feed to speed up stomach emptying so that you don't feel so full in the morning. Most people just learn to eat their breakfast a couple of hours later than usual. Occasionally, a person who just started with G-tube feeding may develop softer or looser stool. The condition can be easily corrected by slowing down the rate of the feeding per hour or change to another type of formula. Another less common side effect is skin irritation or pain in the gastrostomy site. Skin irritation may be due to leakage or infection from or around the G-tube site. Leakage most likely is due to a ruptured balloon at the end of the G-button inside the stomach. When this happens, it is best to contact your CF nurse practitioner (Kate Gent) at the CF clinic to check on the G-tube site, change to a new G-button, and receive instruction about how to keep the affected skin area clean and dry. A culture swab may be collected to check for infection and an antibiotic cream or an oral antibiotic may be prescribed for you if your CF doctor feels it is needed.
What about the cost?
In Ontario, the cost of the G-tube or G-button and all other G-tube supplies are covered partially by the government through a program called Assistive Device Plan of Ontario. This program will cover 75% of the total cost of all the supplies. If you have private health insurance plan, most insurance companies will cover the remaining 25% of the total cost. For those people who have Ontario Disability Supplementary Plan (ODSP), the remaining 25% of the cost will be covered by ODSP. The formula you use for G-tube feeding is covered entirely by the government under the CF special drug program. For any other questions regarding cost, please contact your nurse practitioner or one of the dietitians at the CF office.