Post-Gastrostomy feeding protocol
This protocol has been designed as a post-operative feeding regimen that can be applied to all insertion techniques.
Pre-operative management
| Medical team |
|---|
| Patient is assessed by treating medical team as requiring gastrostomy due to dependence on nasogastric tube feeding for either nutritional support, chronic aspiration risk, or supplemental feeds/fluids/medications. |
| For patients with a complex medical background, please include any additional procedures that may be required under general anaesthesia in the referral. |
| Surgical team |
|---|
| Ereferral to Paediatric General Surgery team - this will be triaged by one of the Paediatric Surgeons in the department and referred to an outpatient clinic. Alternatively, if requiring insertion during acute admission, contact the on call paediatric surgery registrar or consultant. |
| Patient to be reviewed in Surgical Outpatient Clinic or as an inpatient, and will be assessed if suitable for gastrostomy, urgency of insertion, and decision on operative technique by managing surgeon. |
| Elective booking form to be completed by surgical team. |
| Surgical bookers |
|---|
| Please email surgical dietitian to facilitate charting of feeds on patient admission. |
| Pre-operative gastrostomy education |
|---|
Parents can be directed towards: · Starship Gastrostomy Guidelines - Gastrostomy and Gastrostomy tube care · The Gastrostomy Care booklet |
Operative management
There are multiple different techniques utilised for gastrostomy insertion. The main techniques used in Starship Children’s Hospital are:
Laparoscopically-assisted open STAMM procedure
Laparoscopically-assisted Percutaneous Seldinger technique
Laparoscopically-assisted PEG (percutaneous endoscopic gastrostomy)
A single dose of intravenous Cephazolin 30 mg/kg will be given intra-operatively to minimise the risk of peri-stomal infection1.
Analgesia will be charted intra-operatively at the discretion of the Consultant Anaesthetist.
Post-operative management
There is a paucity of literature published on enhanced recovery after surgery (ERAS) protocols in paediatric surgical centres; however, 2 recent systematic reviews support the early introduction of enteral feeds post all abdominal surgery2 and bowel anastomosis3 in children.
This protocol has been designed as a post-operative feeding regimen that can be applied to all insertion techniques, as such is more conservative than some published in other paediatric tertiary centres4,5.
Patients will be commenced on their regular formula post-operatively, unless otherwise specified in the post-operative instructions6,7.
This protocol is used at the treating consultant surgeon’s discretion, and may be both expedited or delayed based on operative findings and patient factors.
Associated forms:
Clinical form CR4770 - Starship Discharge Planning: Gastronomy Tube
Access via Hippo: Clinical forms - Clinical forms library
Nutrition Review form: Gastrostomy Pre-Op Review Clinical notes form. Paediatric Dietitians, Allied Health, Starship
Grade Up Feed Plan, Starship Post Gastrostomy Insertion Protocol. Paediatric Dietitians, Allied Health, Starship
Starship Post-Gastrostomy Insertion Feeding Protocol
View a pdf of this flowchart by clicking on the image below
