What is a balloon gastrostomy tube?

A balloon gastrostomy tube (BGT) is a flexible feeding tube, usually made from silicone. On the outside of your body, the tube is visible with two ports at the end. One port is for feeding and this is where your feeding equipment will be connected. The other port is the balloon inflation valve and is used to deflate and reinflate the balloon which secures the tube inside your stomach.

Why may I need a BGT? 

A BGT is used to feed a person straight into their stomach if they have a problem eating, cannot maintain their weight, or are unable to digest food. It can be used either to meet all their nutritional needs or to supplement oral diet.

How is the BGT inserted?

Following information being provided and consent being obtained, this procedure is undertaken in the endoscopy department. You will have a gastroscopy where the doctor places a long thin, flexible tube through the mouth and into the stomach. The stomach is secured to the abdominal wall with two or three clip sutures. A small incision is made between these buttons and the BGT is inserted. The balloon on the end of the tube is then inflated with water to keep the tube in place.

If you experience pain on feeding or external leakage of stomach contents, or fresh bleeding is noted within 72 hours of insertion of your tube, stop feeding and urgently contact your nearest accident and emergency department and attend urgently.

What can you expect after your procedure?

You will be able to see the two or three clips sitting on your skin and the external fixation plate, which can feel tight. Sometimes these T-clips dissolve and fall out on their own. If they don’t fall out after two weeks, or they are not dissolvable, it will be necessary to contact your community nurse or enteral feed company nurse to get them removed, depending on where you live. You will be advised who to call by your dietitian.

Daily care for your BGT

Checking position

The tube has centimetre (cm) markings on it. Every day, check that the cm marking at the level of your skin is the same. It is important that the tube does not move. If the cm marking changes, this may be an indicator the tube has moved. If the cm marking at skin level has changed, please do not use the tube and contact your enteral feed company nurse for advice.

Do not move the external fixation plate for the first fourteen days, to allow the stoma (hole) tract to heal.

Cleaning your BGT

• Wash your hands according to your hand hygiene leaflet.
• Gently remove any dressing the day after tube insertion.
• Every day, carefully clean around the gastrostomy site (also known as stoma), under the external fixation plate and around the tube and buttons with water and a disposable cloth or gauze and dry.
• When the area settles at around 10 to 14 days, it may be cleaned with mild soap and water and then dried.
  • You may have a shower. Be careful not to direct the flow of water directly at the stoma site. Cap off the end of the tube prior to showering. If you can only have a bath, it is important to avoid soaking the stoma. Please make sure that the water level lies below the stoma site.
  • You may have a deep bath or go swimming after the site has healed, generally after about two to three weeks. Make sure the tube is secured and capped.
  • Do not use creams or talcum powder near or around the stoma site, to reduce the risk of irritation and breakdown of the tube.
• If the site is dry, then no dressing is needed. If there is any discharge around the stoma, please ask your enteral feed nurse for advice.

If you experience any of the following symptoms it could indicate that the site is infected. Please contact your GP, enteral feed company nurse or community nurse for advice if you notice: 

• oozing or odour coming from the stoma site
• redness
• soreness
• raised area
• you have a temperature or feel unwell.

After 14 days AND the buttons have fallen off or been removed by a health care professional, please then start the following:

Rotating and advancing your tube

Rotating and advancing your tube is important to help healing and reduces the risk of the tube sticking to the stoma tract and embedding in the stomach wall. This is called buried bumper syndrome and could result in a hospital admission.

Rotation

Each day you should rotate the tube through a full circle (360°) after cleaning.

Advancing

The external fixation plate can be moved away from the body and the tube advanced 2 to 3cm into the stomach. Return the external fixation plate to its original position 0.5 to 1cm away from the skin. This needs to be done at least once a week.

What if I can’t advance or rotate my tube?

If you are unable to advance or rotate your tube, you need to seek urgent advice from your enteral feed company nurse, as the tube may have become stuck to the stomach lining. If this happens you may require medical intervention. This is called buried bumper syndrome.

Checking balloon inflation

Unless you have been advised, whilst the clips are in place please do not deflate or re-inflate the balloon, as the clips may puncture the balloon and it may displace as a result.

The balloon in your BGT is holding your tube in place. It is essential after the buttons have fallen off, or have been removed, to check the water in your BGT every week. This is to make sure that the balloon has water in it and is not leaking or perishing.  

If you notice that you can't get the normal volume of fluid out of the balloon or the fluid is cloudy, then please tape the tube down and call your enteral feed company nurse. It may indicate that the balloon has burst or is leaking. If this is the case, you may require a replacement tube.

You should have been shown how to check and replace balloon water by your enteral feed company nurse, but use these steps to help you. If you are finding this difficult or need further support, please contact your enteral feed company nurse.

You will need:

• cooled boiled water
• two luer slip syringes (five to 10 ml)
• gloves and apron if you are a carer.

1. Following the hand hygiene advice, wash and dry your hands.
2. Check your cm marking is at its usual position and then, using the luer slip syringe, draw up the identified amount of fresh cooled boiled water to be inserted into the balloon.
3. Advance the tube approximately 1cm into the stomach. Holding the gastrostomy tube firmly, insert an empty luer slip syringe into the balloon valve.
4. Draw back with the syringe and completely remove all the water from the balloon. You may need to do this twice to make sure all the water is removed. Note the volume and appearance of water that has been removed. Disconnect and discard the syringe.
5. Attach the syringe of fresh cooled, boiled water to the valve, push the plunger and re-inflate the balloon gently. Detach and discard the syringe.
6. Gently pull the tube to check for resistance and check the cm marking at skin level hasn’t changed. Both of these checks will help confirm the tube is secure. If not, please contact your enteral feed company nurse for advice.

Never fill the balloon with air.

Flushing your tube

If you are not using your gastrostomy tube for feeding, please make sure you flush the tube at least once a day with fresh tap water to prevent the tube from blocking. Your dietitian can advise you on a suitable amount.

Method 

• Wash your hands as per your hand hygiene leaflet.
• Place all the equipment you require on a clean surface, such as a 60 ml syringe, measured water in a jug or cup.
• Make sure the position of the feeding tube has not moved by checking the skin level centimetre marking.

Either                                                                                                               Or

1. Remove the cap from the end of your tube.	1.	Draw up the required amount of water into your syringe.
2. Remove the plunger from the syringe and attach it to your feeding tube.	2.	Remove the cap from the end of your tube. Attach the syringe to your tube and slowly press down the plunger in the syringe to flush water into the tube.
3. Use your syringe as a funnel to slowly pour the correct amount of water into your feeding tube, keeping the syringe higher than the stoma site.	3.	Remove the syringe and recap your tube.
4. Remove the syringe and recap your tube.

 

• When flushing your tube, try to avoid emptying the tube completely, otherwise air can enter your stomach and make you feel uncomfortable and bloated.
• Try to remain upright for at least 30 minutes after a feed or flush to help prevent reflux and regurgitation.
• Please see our leaflet on washing and cleaning syringes in your welcome pack for information on cleaning and disposal.

When will my tube be replaced?

A BGT tube needs changing every four to six months. If there haven’t been any complications, then changes can be done at home by your enteral feed company nurse, or this may be done in hospital.

Please make sure you know when and where your tube is to be replaced. If you are unsure, please contact the Home Enteral Nutrition (HEN) Team or your enteral feed company nurse, who will be able to help you. 

Further assistance
It is important for you to always carry a spare balloon gastrostomy tube with you, should your tube fall out.  

If your tube falls out in the first eight weeks of insertion, replacing the tube correctly can sometimes be more difficult. If you have not been given special instructions by your doctor to attempt tube replacement, cover the stoma tract and urgently make your way to your nearest accident and emergency department with your spare tube in-hand. 

If your tube has been in longer than eight weeks, please see the leaflet on what to do if your gastronomy feeding tube comes out.

Please act swiftly, as your stoma can close within one to two hours, which if not acted on could result in hospital admission.  

If you feel you need any more information or support, please contact your enteral feed nurse or the HEN Team.