What Are MIIPs? / Feeding Tube


A gastrostomy tube is a long-term feeding tube placed directly into the stomach through the skin. It can be used to feed patients who have a hard time getting enough calories and nutrients on their own.



Who needs a gastrostomy tube?

Some patients have difficulty swallowing food or drink due to illnesses such as stroke or cancer. A short-term solution is to feed the patient a liquid diet through a tube going through their nose and into their stomach – this is called a nasogastric tube, or “NG tube”. Patients who do not get better at swallowing after a few weeks need a longer-term solution: a gastrostomy tube is a safer, more comfortable way to feed the patient.



How is a gastrostomy tube placed?

A gastrostomy tube is placed by an Interventional Radiologist (IR), a doctor who specializes in minimally invasive, image-guided procedures (MIIPs). Your IR may have you take contrast the night before so your intestines will show up on X-ray. Then you will be asked not to eat or drink anything for at least 6 hours before the procedure.

Your IR may first look at your belly with ultrasound and moving X-rays called fluoroscopy and draw on your belly to mark the best place for your gastrostomy tube. Then your stomach will be filled with air using a temporary NG tube (see above) to make it easier to place the tube.

Typically, the IR will numb your skin and then place 2-3 special clips to fasten the stomach up against the abdominal wall. Sometimes they look like buttons. These can be removed in 7-10 days after the procedure.

Afterwards, the IR will numb your skin then put the tube directly through the skin and into the stomach. The IR confirms the position by squirting contrast dye into the tube and looking with X-ray. A balloon or pigtail curve on the end of the tube helps to keep the tube in the stomach.

Usually you have to wait a day or so before using the gastrostomy tube to make sure it is safe to use.



How do you care for the gastrostomy tube?

    • Only put liquids in the gastrostomy tube. A nutritionist can recommend the best liquid diet for you.
    • Give medications in liquid form only, if possible.
      • Medications that do not come in liquid form may need to be crushed.
        • Ask your pharmacist if you can crush the medication.
      • Completely dissolve crushed medications in water before giving them. Crushed medicines that are not completely dissolved settle in the tube like cement and clog it.
    • Flush the tube well after every use.
    • Keep the skin around the tube clean and dry.
    • Avoid yanking on the tube. The pigtail or balloon help to keep the tube in the stomach, but it can be pulled out with enough force. If that happens, call your IR to replace it.
    • Return to your IR regularly (every 3-6 months) to exchange the tube. The stomach acids weaken the tube over time, so it needs to be replaced.



When to call a doctor


Call your IR if
    • The tube comes out
    • The tube is clogged
    • There is pain or swelling around the tube

Go to the emergency room in case of

    • Fever
    • Abdominal pain or stiffness
    • Vomiting, nausea



What happens if the patient no longer needs the tube?

Some patients get better and do not need the gastrostomy tube anymore. A swallowing test will be done to make sure the patient can safely swallow different liquids and textures. If they pass this test and can eat enough calories, they can be sent back to the IR to have the tube removed.

Removing the tube is simple and painless. Do not try to remove the tube yourself. A professional first needs to release the pigtail or the balloon to remove the tube safely. A dressing will be placed over the hole because it may leak a bit at first. The hole closes up on its own over days to weeks. Do not submerge that area in water until the hole completely heals shut.



What other feeding tubes are there?

The gastrostomy tube allows for feeding directly into the stomach, but this does not work for all patients. If a patient has reflux, they can do better with a longer tube placed through the stomach and into the intestine – it is called a gastrojejunostomy tube. If the patient has had stomach surgery or a hiatal hernia, it may not be safe to place a tube into the stomach. A solution is to place a feeding tube directly into the intestine – this is called a jejunostomy tube.



For more information:

https://depts.washington.edu/uwvir/wordpress/wp-content/uploads/2012/02/Percutaneous- Gastrostomy.pdf

http://www.emoryhealthcare.org/radiology/procedures/miscradioproced.html 




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