How to Have a G-Tube Baby
So, Holly has been a G Tube baby for a few weeks now and, the boxes of supplies have just been pouring in. I thought I would go through the different supplies with you and then into detail about how this tube feeding thing works.
If your child or someone in your care needs a g tube placed, don’t worry, they won’t let you leave without enough supplies to get you through a few days before the first delivery to your house. You’ll also have a one-on-one training with a member of the medical equipment company right there in the hospital, so you aren’t at a total loss when you get home.
Here is a list of all the equipment and supplies you’ll need for your new g tube lifestyle:
IV Pole
So, as part of your supply haul you get before you leave the hospital, you’ll get an IV Pole so that you can hang the bags and affix the feeding pump to it. I’m not sure how much these poles cost by themselves but, I may want to buy a second one. We feed Holly in the kitchen during the day, but then she’s in her crib for the continuous night feeds so, having to bring the IV pole up and down the stairs has become the most annoying thing ever.
Pump
Before we can even start a tube feeding, we have to set up the electric pump that will run the formula through the tube. We got the Infinity pump for Holly but, I don’t know if there’s more than one brand that they send to patient homes. All I know is, the pump they use at the hospital is different.
This infinity pump is small and lightweight with a decent size screen on the front, so the numbers show up nice and big. There are a bunch of different buttons but, you only need to regularly use a few of them.
On/off: Remember to hold the button down for a few seconds.
Prime: Unfortunately, there is no “auto-prime” option; you just have to hold down this button until the tubing is done priming. It takes forever and the machine always just stops priming before it’s done for some reason but, it is what it is.
Run/Pause: This is how you start and stop feeds once it’s set up and the tubing is primed.
Vol/Total: This will show you how many milliliters have gone through already.
Rate/Dose: This is where you’ll set up the feed. The rate will be in ml/hour. During the day, Holly gets 4 feedings of 105 ml over 1 hour. So, the rate will be 105/hour, and then I’ll hit the button again for the dose, which will be 105 ml.
+ — : Here’s where you’ll adjust the amount. During the day, we usually don’t have to mess with the amounts because the machine will remember the settings from the last feed but, overnight, we’ll change the rate to 30 ml/hour and the dose to 120 ml.
Rate/Dose: This button will switch between the rate number and the dose number on the screen.
Feeding Bag
This is the feeding bag, where the formula goes. It’s got the milliliter measurement lines on it but, it’s way easier to measure out the formula first before pouring it into the bag. Be careful to pour the formula slowly at first because the bag won’t loosen immediately. I’ve had formula come right back up and spill everywhere before and, trust me, it sucks.
You’ll probably get a bunch of these feeding bags in all of your supply shipments because they need to be changed out every 24 hours. We usually just get a new one every morning before Holly’s first daytime feed.
Since this bag is good for 24 hours, just make sure you rinse it out with warm water after every feed to make sure there’s no old formula left at the bottom that could mix in with the new stuff.
There’s a long tube that comes out of the bottom of the bag with an attachment at the end of it. This attachment will screw into an attachment on the other tubing for the second bag you need called the Feral bag.
Feral Bag
The Feral bag is basically the waste bag. I always laugh when I say, “feral bag” because I think “wild bag”. Oh, look! A feral bag appeared!
Anyway, the tube at the bottom of this bag (technically at the top of this one since it’s upside down) connects to the feeding bag tube in the middle. You’ll know the difference between the feral bag and feeding bag because, aside from it being a different color, it doesn’t open whereas the feeding tube obviously does for the formula. The feral tube also includes 2 clamps. One of them is right under the feral bag and has a roller to open and close it. The other clamp is smaller and further down on the tube. This one just has a snap to close it. I’ll get into these clamps more down below when I talk about starting the actual feed.
This feral bag will catch any formula that gets rejected by Holly’s stomach for whatever reason. It’s not good if you see a lot of formula shoot up into here; that usually means the kiddo isn’t tolerating the feed well.
Gravity Bag
You’ll also get a bunch of smaller gravity bags. These are for emergencies only when the power goes out and the pump won’t work. As the name suggests, these bags work with gravity so, if there’s no pump, you can just hook the tube up to your baby and hold up the bag, letting gravity do its thing.
Syringes
Included with your supplies will be a bunch of syringes, both 60ml and smaller ones. After each feed, it’s important to flush the g tube attachment with sterilized water (although, I think you should be fine with filtered if you run out of the sterilized) to make sure that no formula gets stuck in there and to also push any formula/stomach contents that may have come up through the tube back inside.
When we first started doing this, my husband and I thought we needed to discard anything that came up but, a nurse described that as Holly basically vomiting constantly. It feels so weird flushing stomach acids back down in there but, it’s apparently fine.
Tube Attachments
Depending on what kind of g tube is placed, you may need a separate attachment that connects the feeding tube to the baby. Before we knew all of this, I thought the g tube button was the best way to go because, outside of feeding times, Holly wouldn’t have to deal with a tube dangling around that she could pull at. It’s actually become quite stressful having to connect this attachment directly to the button each time. And, honestly, when she had to keep the original attachment on for a week after surgery, it was so easy to just tuck it into her onesie. She never even noticed it.
So, if you do opt for the button g tube placement, just know that you’ll also get a bunch of the attachment adapters that you’ll have to connect to the button before each feed. Holly h a t e s when we do this. She doesn’t even like when we consider messing with her button. I don’t think it hurts her anymore but, it’s definitely not comfortable. Honestly, it isn’t comfortable for me either. Pushing the end of the adapter into the button, knowing that it’s directly connected to a hole in her stomach, makes me feel sick if I think about it too much. With the dangling attachment, I could almost forget about that.
Starting the Tube Feeding
Okay so, now that we’ve gone over all the different supplies that are needed for tube feeding, it’s time to hook it all up and start running the formula.
The first thing you want to do is make sure that the feeding tube and feral tubes are connected at the Y attachment in the middle. Remember that the end of the feeding tube screws into the Y attachmentand the end of the feral tube is what gets connected to baby.
Next thing you want to do is set up the pump. The feeding tube will pass through the pump in order to run the formula through it so, you’ll need to pop open the door at the top of the pump to thread it through. Infinity made this easy by having the tube already attached to a loop you can stretch along the grooves inside the door. There’s a plastic part that holds all of this together and you’ll just need to stretch the loop until the plastic pops into place. Once it’s in, you’re all set, and you can close the lid.
Now you want to turn on the pump. Make sure the end of the feral bag tube has a cap on it and that the small clamp is closed. This ensures that no old formula will leak out onto the floor or your hands. I’ve about had it already with leaky formula.
When you turn on the pump, it’ll go through a series of screens before it settles, and then you can start hitting buttons. If this is the very first feed, you’ll want to hit Rate/Dose and the + — buttons to adjust the amounts.
Once the rate and dose are set, it’s time to prime the tubing. Before you start priming, make sure the little clamp on the feral tube is open so that the old formula can pass all the way through. Make sure that the clamp under the feral bag is closed, though, or else all of the old formula is just going to shoot up into the feral bag as you’re priming.
Uncap the end of the feral bag tube and place it in a plastic cup or somewhere you don’t mind getting drops of old formula. If this is the very first feed and a new feeding back, you’ll want to catch a few drops of the new formula to make sure the tubing is fully primed. If it’s just the next feed, you’ll want to pay careful attention to where the old formula ends and the new formula begins. Hold down the prime button until there is only new formula coming out of the tube. For some reason, the infinity pumps will randomly stop the prime before it’s done but, I usually just need to press it again once.
Once the priming is done, close the small clamp back up so no formula drips out and make sure you open the feral bag clamp. You can unclamp the feral tube once it is attached to baby. You’ll also want to make sure that the clamp on baby’s attachment is open so the formula can go all the way up into baby’s tummy. All there’s left to do now is hit Run.
And there you have it! You’ve successfully started a tube feeding. Now it’s time to wait until it’s done. If your baby is anything like Holly, this waiting period will feel like an eternity due to all the fussing.
Once the feed is done, it’s time to unhook baby, turn off the machine, and then flush the attachment. The first thing you’ll want to do is turn off the machine and make sure that both baby’s clamp and the feral tube clamp are closed so you don’t have a mess to clean up when you unhook.
Once the clamps are closed, you can unscrew the feral tube from baby’s attachment and put it off to the side.
Grab a bottle of the sterilized water (or filtered water if you’re out of sterilized) and one of the big 60 ml syringes. Pull 30ml of water (or however many your doctor instructed you to flush with) into the syringe and bring it over to the attachment. The end of the syringe should screw onto the end of baby’s attachment perfectly. Make sure to open up the attachment clamp and then all you’ll need to do is push the water through.
If there’s any gas or stomach acids that try to come back up, they will be pushed back down with the pressure of the syringe water.
Once baby’s attachment is flushed, make sure you close the clamp back up, unscrew the syringe, and that’s it! Now, your baby is free to get out of that highchair! Or nap, as is always the case with Holly.
