Pre‐procedure

ActionRationale

1. 1.Show
   Explain and discuss the procedure with the patient.
   To ensure that the patient understands the procedure and gives their valid consent (NMC [126], C).
2. 2.Show
   Wash hands with soap and water or an alcohol‐based handrub, and assemble the equipment required. Apply apron and clean gloves.
   Hands must be cleansed before and after patient contact to minimize the risk of cross‐infection ([115], C).

Procedure

1. 3.Show
   Remove the post‐procedural dressing if in place. Observe the peristomal skin and stoma site for signs of infection, erythema, irritation or excoriation.
   To gain access to the stoma site. To detect complications early and instigate appropriate treatment (Healey et al. [66], R).
2. 4.Show
   Observe the tube and consider how it is being kept in place, and note the presence of any sutures, external fixation plates, clamps or balloon ports.
   To minimize the risk of accidental displacement of the tube. E
3. 5.Show
   Check that the T‐fasteners are intact. These will stay in place for approximately 10–14 days after RIG insertion. The timing should be checked with the radiologist. For removal see Procedure guideline 8.14: Removal of T‐fasteners.
   To stabilize the stomach against the abdominal wall and allow the tract to form without complications (Lang et al. [79], E).
4. 6.Show
   Pull back the RIG flange and clean the stoma site with sterile solution, such as 0.9% sodium chloride, using a circular outward motion.
   To minimize the risk of cross‐infection and ensure the stoma site is thoroughly cleaned (Loveday et al. [91], R; NNNG [127], R).
5. 7.Show
   Use low‐linting gauze to dry the area thoroughly.
   To ensure the stoma site is thoroughly dried (NNNG [127], R).
6. 8.Show
   If it is 10–14 days after insertion, remove the T‐fasteners and secure the fixation plate 1–2 cm away from the skin (if applicable). Refer to the manufacturer's guidelines as to whether the tube should be rotated.
   To prevent the RIG tube moving into the stomach (Lang et al. [79], E).
7. 9.Show
   Secure the tube to the skin with hypoallergenic tape. Do not secure near the stoma site.
   To prevent the weight of the tube pulling on the exit site. Tape near the stoma site will make it difficult to clean. E
8. 10.Show
   Advise the patient not to use moisturizing creams or talcum powder around the stoma.
   To prevent infection and/or irritation to the skin. E
9. 11.Show
   If this is a balloon gastrostomy, change the water in the balloon on a weekly basis. See Procedure guideline 8.15: Changing the balloon water and checking the volume of a balloon gastrostomy.
   To prevent tube displacement. E

Post‐procedure

1. 12.Show
   After T‐fasteners have been removed, do not cover the gastrostomy site with a new dressing unless there is a heavy discharge or leakage from the stoma site.
   To encourage wound healing. E
2. 13.Show
   Remove and dispose of any equipment.
   To reduce the risk of cross‐infection. E
3. 14.Show
   Record the procedure in the patient's notes.
   To maintain accurate records (NMC [126], C).