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      Feeding through the G-tube

       

      There are three methods to feeding through the G-tube (click on each to view a video).

      1. Gravity feeding through an open "racked" syringe or bag
      2. Syringe or bolus feeding
      3. Pump feeding

      What formula will you be using?

      • This will be discussed with your nutritionist before the G-tube is inserted.

      How do you advance tube feed?

      You will start the tube feed at a low rate after surgery and gradually advance the rate of the tube feed as your child tolerates the feed.

      There are three options for tube feed: standard, rapid and gradual tube feed advancement plan. Your surgeon/nutritionist will place you in one of these groups. Please follow the appropriate instructions carefully and please do not deviate from the plan.

      Standard tube feed pathway

      If your child has never had tube feeds before

      • Gastrostomy tube must be racked for 2 hours after surgery then you may start racked feeds with formula.
      • Starting rates for racked feeds and advance as follows

      Age  Initial rate Advance rate
       <1 year old
       10 ml/hour     10 ml every 8 hours  
       1-3 years old  15 ml/hour  15 ml every 8 hours
       4-10 years old  20 ml/hour  20 ml every 8 hours
       11-18 years old      30-60 ml/hour      30 ml every 8 hours

      • If appropriate, feeds by mouth can be started when rate reaches  ? of goal.
      • Your child will be transitioned to bolus feed regimen before being discharged.
      • You will then transition to pump (non-racked) feeds after 3 days.

      If your child has been receiving tube feeds via nasogastric tube

      • Gastrostomy tube must be racked for 2 hours after surgery then you may start racked feeds with formula.
      • Starting rates for racked feeds and advance as follows

      Age  Initial rate Advance rate
       <1 year old
       10 ml/hour     10 ml every 4 hours  
       1-3 years old  15 ml/hour  15 ml every 4 hours
       4-10 years old  20 ml/hour  20 ml every 4 hours
       11-18 years old      30-60 ml/hour      30 ml every 4 hours

      • If appropriate, feeds by mouth can be started when rate reaches 1/2 of goal.
      • Your child will be transitioned to your pre-hospitalization feeding regimen before discharge.
      • You will transition to pump (non-racked feeds) once at goal volume.

      Rapid tube feed pathway

      If you're in this plan, you will follow the following instructions regardless of whether your child has been on tube feed or not before the surgery.

      • The G-tube must be vented with a Farrell bag for 2 hours postoperatively then you may start racked feeds with formula.
      • Starting rates for racked feeds and advance as follows

      Age  Initial rate Advance rate
       <1 year old
       10 ml/hour     10 ml every 4 hours  
       1-3 years old  15 ml/hour  15 ml every 4 hours
       4-10 years old  20 ml/hour  20 ml every 4 hours
       11-18 years old      30-60 ml/hour      30 ml every 4 hours

      • If appropriate, feeds by mouth can be started when rate reaches 1/2 of goal
      • You will transition to bolus feeds at home.
      • You will transition to pump (non-vented) feeds after 3 days.

      Expedited tube feed pathway

      You will be able to head home after surgery once your child awakes from anesthesia. Please hold the tube feed for another day after the surgery.

      You may then start your tube feed as the following:

      If your child has never had tube feeds before

      • Gastrostomy tube must be racked for 2 hours after surgery then you may start racked feeds with formula.

      • Starting rates for racked feeds and advance as follows

      Age  Initial rate Advance rate
       <1 year old
       10 ml/hour     10 ml every 8 hours  
       1-3 years old  15 ml/hour  15 ml every 8 hours
       4-10 years old  20 ml/hour  20 ml every 8 hours
       11-18 years old      30-60 ml/hour      30 ml every 8 hours

      If your child has been receiving tube feeds via nasogastric tube

      • Gastrostomy tube must be racked for 2 hours after surgery then you may start racked feeds with formula.
      • Starting rates for racked feeds and advance as follows

      Age  Initial rate Advance rate
       <1 year old
       10 ml/hour     10 ml every 4 hours  
       1-3 years old  15 ml/hour  15 ml every 4 hours
       4-10 years old  20 ml/hour  20 ml every 4 hours
       11-18 years old      30-60 ml/hour      30 ml every 4 hours

      • Bolus feeds can be initiated at home 3 days after surgery. One option is to increase the feeding rate by 50% or 1/2 of the current rate to allow for one 4 hour break in the morning and one 4 hour break in the evening.  For example, if your child is getting 100 ml/hr around the clock, increase the feeds to 150 ml/hr and stop / disconnect the feeds from 8 a.m. to noon as well as from 6 to 10 p.m. every day.  Therefore, the feedings would only continue from noon to 6 p.m. as well as from 10 p.m. to 8 a.m. the following morning.




       


       


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