Section 10 - Cystic Fibrosis Clinical Care Pathway

Figure 7:
MIC-KEY
gastrostomy
button
b) Gastrostomy Button
The button is a skin level, silicone anti-reflux feeding device. In practice there
may be problems with leaking around the button site and repeated local skin
infections leading to granuloma formation. However, some children will
prefer this less obtrusive device even with the associated problems. The
button can only be inserted into a previously established stoma and this can
be performed as an outpatient. The initial stoma is formed under general
anaesthetic and a replaceable gastrostomy tube inserted (Corpack). This is left
in position for six to eight weeks before being replaced with the button
device. The stoma nurse specialist or one of the surgical registrars should
carry out the first change of this tube.
3.4.2 Admission procedure
Planning an admission for a gastrostomy must include liaison with the Cystic
Fibrosis Clinical Nurse Specialist to establish links with the local community
children’s nursing team before admission. This must be set up before
discharge to ensure that long term supplies of pumps and equipment is
established. The duration of admission will depend on the severity of chest
disease (e.g. requiring intravenous antibiotics and intensive physiotherapy
prior to surgery) and the tolerance of feeds.
3.4.3 Feeding regimen
Feeds can be started 24 hours after the insertion of a PEG if bowel sounds are
present. Continuous overnight feed administration via a feeding pump over
seven to ten hours (as practical) is the approach preferred by most children. A
one to two hour break off tube feeds before morning physiotherapy can
reduce nausea. Most children will thrive if about two-thirds of their estimated
energy requirements are provided from an overnight tube feed.
Hyperglycaemia has been reported in some older children following initiation
of overnight feeds and so blood sugars should be monitored first thing in the
morning during the hospital admission.
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