What is a balloon gastrostomy tube (BGT)?

A BGT is the term used for a Balloon Gastrostomy Tube.

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

BGTs can be used either temporarily or permanently. Manufacturers’ guidelines suggest that each tube placed can be used for up to six months. Liquid feeds are given through the tube either with a syringe or via a feeding pump.

 

A 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 and a fixation plate.

One port (1) is for feeding, and this is where your feeding equipment will be connected.

The other port (2) is the balloon inflation valve and is used to deflate and re-inflate the balloon, which secures the tube inside your stomach.

How is a BGT inserted?

A BGT can be:

1. inserted straight into the stomach via a procedure called gastropexy or Radiologically Inserted Gastrostomy (RIG)
2. used as a replacement tube after a Percutaneous Endoscopic Gastrostomy (PEG), RIG or gastropexy, where there is already an opening formed through to the stomach (known as a stoma).

If you have recently had a RIG or BGT inserted via gastropexy please refer to:

• Introduction and care of BGT by gastropexy

Important note: If you experience pain on feeding or external leakage of stomach contents or fresh bleeding is noted within the first 72 hours after tube insertion, stop feeding and seek urgent medical advice.

What should my stoma site look like?

Once your incision stoma has completely healed, your stoma should be dry and clean with:

• no leakage
• no redness around the tube
• no pain.

Daily care

Once your stoma site has healed (usually after 10 to 14 days), follow these steps:

• wash your hands thoroughly
• clean around the gastrostomy site gently with mild soap and water, then dry thoroughly
• you may shower. Ensure the tube is capped and avoid directing water straight at the stoma site
• you can take a bath or go swimming once the site has fully healed (typically after two to three weeks). Ensure the tube is secured and capped. A waterproof dressing can help
• do not use creams or talcum powder around the stoma, as this can cause irritation and damage the tube
• a dry stoma does not need a dressing. A small amount of discharge can be normal, but if it continues or increases, contact your enteral feeding company nurse or community nurse for advice.

If you experience any of the following symptoms, it may indicate an infection. Please contact your GP, enteral feeding company nurse or community nurse if you notice:

• oozing or an unpleasant odour from the stoma site
• redness
• soreness
• swelling or a raised area
• a temperature or feeling unwell.

Get to know which cm marking sits at skin level, monitor this at least daily, because it is important the position of your tube does not move. If you notice a different centimetre marking at skin level or the tube moves excessively in and out of the stoma the tube may have become displaced. In which case please contact your enteral feed company nurse or community nurse for advice.

Rotating and advancing your tube

It is important to rotate and advance the BGT to prevent 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 (from day 14) you should rotate the tube through a full circle (360°).

Advancing

Do not move the external fixation plate for the first 14 days to allow the stoma tract to heal. On day 14, the external fixation plate can be moved away from the body and the tube advanced 2cm into the stoma. 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, unless you are advised to do something different by a healthcare professional and have a care plan to support this.

Important note:

If you cannot advance or rotate your BGT, stop using the tube and seek advice from your enteral feeding company nurse, GP or HEN team. It is important to report this promptly, as it may lead to a complication called buried bumper syndrome, which could require hospital admission.

How to check the water in your BGT

You should check the amount of water in the balloon once a week. You or your carer can be trained to do this at home, or your community nurse may be able to support you.

If the balloon is damaged or has burst, there may be less water or no water present. If this happens, tape the tube in place to prevent it from falling out and arrange for the tube to be replaced, or contact the person responsible for replacing your BGT.

If you have difficulty withdrawing the water, or notice any change in the amount removed, contact your enteral feeding company nurse or community nurse for advice.

What should I do if my BGT falls out?

It is important to always keep a spare tube with you. This allows you or your carer to put the tube back in promptly if it comes out. The opening (stoma) where the BGT sits can begin to close quickly, sometimes within one to two hours, or occasionally sooner.

Please see our What to do if your gastrostomy tube comes out leaflet: www.kentcht.nhs.uk/leaflet/what-do-to-if-your-gastrostomy-feeding-tube-comes-out/

When should my BGT be replaced?

Your BGT is usually able to be replaced at home every five months; however, this can vary. Our enteral feed company nurses or community nurses normally support with this. If you or your carer wishes to be trained in how to replace the tube, please discuss this with your enteral feed company nurse.

Flushing your BGT

If you are not using your gastrostomy tube for feeding please ensure you flush the tube at least once a day with fresh tap water to reduce the risk of the tube blocking. Please contact your dietitian to advise you on the amount required.

Method

• wash your hands according to the hand hygiene leaflet
• if you are caring for someone, apply gloves and an apron
• place all the equipment you require on a clean surface, such as a 60ml syringe and 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

1. Remove the cap from the end of your BGT.
2. Remove the plunger from the syringe and attach it to your feeding 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.
4. Remove the syringe and recap your tube.

Or

1. Draw up the required amount of water into your syringe.
2. Remove the cap from the end of your BGT. Attach the syringe to your BGT and slowly press down the plunger in the syringe to flush water into the tube.
3. Remove the syringe and recap your BGT.

• when flushing your tube, try to avoid emptying the tube completely by closing the clamp before all the water has gone through. If you do not do this, air can then 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 reduce the risk of reflux and regurgitation
• clean the syringe following the cleaning and storage of reusable syringes.

Further assistance

If you feel that you have exhausted all advice in this leaflet and you are still concerned, please contact your nurse or HEN Team.

Information for carers

Remember to document your observations and care given.