Balloon retained gastrostomy tube (Mic-G) in children

This information pertains to a type of gastrostomy tube called a ‘Mic-G’ tube. It includes sections on:

• what a Mic-G tube is
• advantages and disadvantages compared to other types of gastrostomy
• advice on administration of feed and medications
• advice on general care
• answers to common questions
• problem solving advice
• useful contact details

Gastrostomy insertion is a procedure also used for adults; please note that this leaflet has been written with children in mind.

What is a balloon retained ‘Mic-G’ gastrostomy tube?

A gastrostomy tube passes into the stomach through a stoma (hole), in the skin. Once in place a gastrostomy tube enables feed, and medication, to be fed directly into the stomach. A gastrostomy tube is used in cases where a child cannot eat or cannot eat enough to meet normal nourishment needs, cannot drink or cannot drink enough to maintain hydration or, where children cannot take their medication orally.

There are different types of balloon retained gastrostomy tubes. This leaflet is about a specific balloon retained gastrostomy called a Mic-G tube which is made of silicone, has an inflatable balloon at one end (inside the body) and an external disc at the other end (outside the body) The Mic-G tubes can be inserted as a laparoscopic (‘key-hole’) or open procedure; your surgeon will discuss with you which method is suitable for your child. The Mic-G tube can be a temporary tube to form a gastrostomy tract or used as a regular tube for children requiring gastric decompression.

The silicone retention balloon

The balloon retained gastrostomy tube is fitted with a small balloon which is inflated inside the stomach to hold the tube in place. It is filled with sterile (cooled, boiled) water which should be changed for the first time four weeks after the tube is inserted and weekly thereafter. This will be carried out by your child’s community nurse until you are happy to do it yourself.

The external disc

The external disc holds the tube in place yet allows air to circulate around the skin. The bottom of the base should rest just above the skin surface. When the tube is placed for the first time there will be sutures (stitches) in place which will be removed by the community nurse after 10 days.

The inflation port

The inflation port is used to access the retaining balloon.

The feed/medication port

The feed/medication port is accessed using enteral feeding syringes and feeding sets.

Advantages of the balloon retained gastrostomy tube

• When used as a temporary device the tube can be replaced six to eight weeks after initial insertion for a low profile balloon retained tube on the ward, therefore no need for any anaesthetic for subsequent tube changes.
• In children that need gastric decompression the tube allows effective decompression to be carried out with ease.
• Should the gastrostomy tube no longer be needed it can be removed without the need for surgery, but only with medical advice.

Disadvantages of the balloon retained gastrostomy tube

• Should the retaining balloon perish or burst, the gastrostomy tube will fall out. It is also possible for the tube to be pulled out. Regardless of how long the child has had their Mic-G, displacement of a Mic-G tube is an emergency and requires medical attention within one to two hours; otherwise, the stoma (‘hole’) will close, making it difficult or impossible to insert a new tube.
• If a Mic-G tube displaces (falls out) in the first six weeks after surgery it is possible that the new tube will not be passed directly into the stomach or, that there will be an internal leak because the gastrostomy tract has not had time to heal. Recommencing use before confirmation of appropriate placement which is free of leaks can result in a condition called ‘peritonitis’ which is a serious internal infection. See section below on Problem Solving – Tube Displacement.
• Requires a general anaesthetic for initial placement.
• Is a foreign object in the body and can therefore be associated with some minor complications, for example, infection around the site.
• Requires careful care/securing as it can be pulled out.
• All carers (for example, parents/baby sitters/school) need to be both competent and confident with tube replacement in case an emergency situation arises whereby the tube has fallen out.
• Serious complications related to gastrostomy tubes are very rare and symptoms are seen usually within a maximum of 72 hours after insertion or change. If your child develops any of the ‘red flag’ symptoms within 72 hours of gastrostomy tube insertion or change you should contact the paediatric surgery nurse specialist team (contact number at the end of this leaflet).

The nurse specialist team is available Monday to Friday 08:00 (8am) to 18:00 (6pm) on 01223 586973, excluding bank holidays. Outside of these hours you should speak to your GP or local hospital who will contact the Paediatric Surgery Specialist Registrar at Addenbrooke's. The ‘red flag symptoms’ are:

Administering feed/fluids via a balloon retained gastrostomy tube

• Your gastrostomy care team (dietitian, nurse specialist and nutrition nurse) will recommend a suitable feeding plan for your child’s needs and will teach you how to administer it whilst your child is in hospital. This may be via a pump, by gravity ‘bolus’ feeds or a combination of both.
• It is not necessary to check the position of the tube prior to feeding unless you are concerned that the tube does not have its normal appearance/may have become dislodged.
• It is important to wash hands carefully prior to and after using any gastrostomy tube.
• To prevent the tube from blocking a flush should be administered after a feed has been given (see section ‘Flushing’).
• Administer feeds at room temperature.

Administering medication via a gastrostomy tube

Administering medication correctly will avoid the gastrostomy tube becoming blocked.

• Remind anyone prescribing medication for your child that the medication is to be delivered via the gastrostomy tube.
• Request that your child’s medication is provided in a liquid form wherever possible.
• Some liquid medications are known to be associated with tube blockages and so need to be further diluted with water (usually a 50:50 dilution – half liquid medication, half water) before being administered via a gastrostomy tube. Ask a member of your gastrostomy care team if you are unsure.
• If medication is only available in tablet form, seek advice from your GP/pharmacist/nurse specialist on whether tablets can be crushed/mixed with water and how to make a solution with crushed tablets. Tablet particles can lead to tube blockages.
• Ensure the gastrostomy tube is flushed before and after administering drugs as well as after giving drugs. (See section ‘Flushing’)
• Remember to wash your hands before and after handling a gastrostomy tube.
• Please note, Clarithromycin will block your child’s tube and so should never be given through the tube. This is an antibiotic commonly used for chest infections. Other antibiotics which sound similar (for example erythromycin) do not block tubes.

General care

Cleaning/skin care

• The area where the tube goes through the skin is called the stoma site. You may experience a discharge at the stoma site for the first few days (seven to ten days) until the stoma heals.
• After initial insertion there will be external stitches to help keep the gastrostomy tube in place whilst the tract is healing, these will be removed after approximately 10 days; this is usually carried out by your child’s community nurse.
• Daily care of the gastrostomy site and tube will reduce the possibility of soreness or infections. Older children should be encouraged to care for their gastrostomy sites themselves.
• Always ensure that you wash your hands before and after caring for your child’s gastrostomy tube.
• The gastrostomy site should be cleaned daily with warm soapy water.
• Always avoid using cream/powders on the skin around the tube (unless otherwise advised by your care team) as they can damage the tube material and may lead to irritation of the skin and give rise to infection. If you notice that the skin is becoming inflamed or there is discharge from the site, you should contact a member of your gastrostomy care team.
• In the first six weeks after initial surgery, to keep the tube secure it is essential that a dressing is kept in place. The dressing should be changed with the daily cleaning of the site and whenever it is seen to be falling off (see section on changing dressings below).

Flushing

Flushing the tube is essential to maintain patency (ie prevent blockages).

• The gastrostomy tube should be flushed with water (sterile/cooled, boiled water if the child is below one year of age).
• Unless otherwise specified by your dietitian, a minimum of 20ml of water should be used for flushes after feeds. (See section on ‘Administration of medications’.) Your dietitian may advise that, in addition, you give a flush prior to feeding to ensure your child’s fluid requirements are met.
• When giving drugs, it is important to flush between each medicine and after them to prevent precipitation (settling of the drugs) in the tubing.

Replacing feeding sets

• We advise that all gravity (bolus) feeding (‘giving’) sets are changed every 24 hours. Between each use the tubing should be washed with hot soapy water, rinsed then left to dry. They should be sterilised if the child is less than one year of age.
• Continuous (‘Pump’) feeding sets should be discarded 24 hours after first use.

Infection

• Daily cleaning of the gastrostomy site with soapy water will help to reduce the risk of infection.
• If you notice that the gastrostomy site is inflamed/red/sore/discharging, contact a member of your gastrostomy care team for advice.

Changing the dressing

Children usually have a small dressing to help secure the tube for the first six weeks after initial surgery. Your nurse will show you how to change the dressing prior to your discharge home. The following instructions should be followed:

• The suture (stitch) which is in place should not be removed until approximately day 10 after initial surgery. (If it falls out spontaneously extra care should be taken for example, extra taping).
• The dressing used to secure the Mic-G tube should be changed whenever it is coming off or is soiled.
• It is important to ensure that the tube is not pulled any more than necessary during tape changes as this can lead to accidental dislodgement.
• Wash hands prior to and after changing the dressing.
• Unless your child has an allergy, a plaster remover wipe (for example Zoff) should be used to help detach the tape from the skin/tube.
• Once the old dressing has been removed, clean around the stoma site with warm soapy water.
• Pat the skin dry so that the new dressing will stick effectively.
• Dressings should be applied in such a way that the tube stands erect from the skin. This ensures that a round stoma is created. If the tube is taped flat onto the skin an oval hole will be created which can lead to leakage.

Changing water in the balloon

• The water in the retaining balloon must not be changed until week four after surgery to insert a Mic-G tube. It should then be changed weekly.
• The purpose of changing the water is to check the condition of the balloon. If the balloon is beginning to perish you will see one or both of two signs. Either you will draw out (aspirate) less water than you expect from the balloon or the water will be discoloured. If observe either of these signs you should contact your community nurse within 24 hours. If these signs are ignored the balloon is at risk of bursting and the gastrostomy tube may fall out.

Procedure - To change the water in the retaining balloon:

• Collect together the equipment required:
  • two clear (‘luer slip’) syringes
  • sterile (cooled boiled) water
• Wash hands.
• Draw up 5ml of the water into one of the syringes.
• Hold the gastrostomy tube still by placing a finger and thumb on either side.
• Insert the empty syringe into the balloon valve (marked ‘Inflation’) and remove all water from the balloon. Do not let go of the tube.
• Check the aspirated water in the syringe for volume and colour.
• Discard old water.
• Insert the syringe filled with the new water and insert it into the inflation port and let go of the syringe. If the syringe has been inserted fully it will stay connected to the tube when you release it.
• Gently push the syringe so that the water is injected into the device.
• Once all the water has been injected, remove the syringe by using a slight twisting motion. It is important to keep your thumb on the end of the syringe whilst removing it to prevent water being drawn back into the syringe spontaneously.

Common questions

Can my child bath/shower?

Once the site is fully healed (usually about seven days after insertion) your child can bath/shower as normal. Always ensure that the tube end is closed. Dry the area thoroughly afterwards.

Can my child go swimming?

We advise that your child refrains from swimming in the first six weeks after surgery to insert a Mic-G tube; after this time children can go swimming. Make sure the tube cap is closed.

Will my child be able to move around freely?

For six weeks after initial placement your child should refrain from PE at school and any activities where the tube could be pulled out. After this your child’s gastrostomy tube should not affect or restrict their normal activities.

Where do I get the equipment and supplies?

We will provide you with initial supplies (usually enough to last for one week) and a spare tube to use in case the gastrostomy tube falls out. You will receive further supplies from your community healthcare team; some areas use a home delivery service. If you have any problems getting supplies at home please ring your nurse specialist who will be able to help you. You should remember to order new supplies in good time before you run out and only use equipment for the length of time specified by the manufacturer.

Will my child be able to go to school?

Your child should be able to go to school as normal. Staff at the school can be taught what to do if the device falls out and spare supplies should also be kept at the school for emergency use.

Can we go on holiday?

• It is fine to travel (with your child) but you should discuss travel plans with your doctor/gastrostomy care team. It may be helpful, particularly if your child has complex needs, to take a letter with you from your care team which can help you if you need to seek medical advice whilst on holiday. In addition, letters from your care team can be useful to prevent any problems with airport security when you are travelling with ‘medical equipment’.
• Remember to take extra supplies with you and to pack at least some of these in your hand luggage in case your main luggage goes astray.
• Use a large dressing to avoid getting sand near the stoma site as this can irritate the skin.
• Your home delivery company will also offer practical advice.

If a tube is not being used what care is required?

The tube must be flushed at least once per day with a minimum of 20ml of water (sterile water if your child is aged below one year).

Can a ‘blended diet’ be given through a ‘Mic-G’ tube?

There is limited published evidence related to safety and efficacy of blended diet (also referred to as ‘liquidised tube feeds’) given via gastrostomy tubes and most manufacturers of gastrostomy devices do not support the use of blended diet however, we are aware that some parents/carers wish to consider this form of feeding. The following information is therefore provided and must be followed to keep children safe when administered a blended diet via a Mic-G tube:

• Where the Mic-G has been placed as a primary device, administration of blended diet is not permitted in the first six to eight weeks after surgery due to the risk of tube blockage from the blended food. After a six to eight week period (exact period will depend on the child’s underlying condition as some conditions affect rates of healing) the gastrostomy tract should have matured (healed) sufficiently to allow safe changes of tube in the event of a blockage occurring.
• It is essential that you consult with your child’s dietitian and care team before blended diet is commenced; a blended diet is not appropriate for all children eg those under six months of age, immune compromised children, those needing pump feeding and for those it may be suitable for, careful monitoring via the dietitian is essential.
• Due to the risk of tube blockage from blended food and the risk of earlier than expected deterioration of gastrostomy devices/associated equipment, it is essential that the team responsible for the ordering of consumable products have agreed to the ordering of any additional Mic-G devices and associated feeding equipment which may be required secondary to blockage by blended diet or the premature deterioration of equipment. In some areas this may require approval from the clinical commissioning group (CCG) so you must check with your child’s dietitian and community nurse in advance.
• Ensure the blended food is liquidised and sieved such that the consistency is that of single cream and lump free to minimise risk of blockage.
• Gauge of Mic-G must be at least 14Fr to minimise the risk of blockage. Administer feeds via ‘bolus’ only and never via a pump.
• Time taken to administer the blended diet meal via the gastrostomy should equate to that which would be taken if the meal was eaten orally.

What happens when the gastrostomy tube is changed for the first time?

• Before your child is discharged your nurse specialist will arrange a date for you to return to the ward for the first change of gastrostomy tube.
• It is advisable that your child is not fed for two hours prior to your appointment time as this prevents feed leaking out when the tube is removed.
• We also advise that you give your child some painkillers (for example, paracetamol) prior to leaving home for the appointment.
• On arrival your nurse specialist will meet you and discuss the course of events. The nurse specialist will remove the gastrostomy tube on the ward; this is usually uncomfortable rather than painful if paracetamol has been given earlier.
• Once the gastrostomy tube is removed the nurse specialist will measure the length of the gastrostomy tract with a specifically designed device and will then insert an appropriately sized low profile balloon retained gastrostomy tube (Mickey button), or another Mic-G tube.
• Before you go home your nurse specialist will teach you how to care for the new tube and will arrange for any changes to your home supplies to be made.

What is an emergency kit box and why do we need one?

In the event of the Mic-G tube displacing, the gastrostomy stoma can start to close within one to two hours and therefore it is essential that you always carry equipment with your child to use in the event of the Mic-G tube displacing. Prior to discharge you will be supplied with an ‘emergency kit box’ filled with equipment specific to your child for you to use in this emergency situation.

It is essential that this emergency kit box is always with your child. All medical equipment has expiry dates so it is important that you check the contents intermittently and arrange to replace any expired items.

Problem solving

Tube blockage

To prevent tube blockage the tube should be flushed with water after giving feeds/medication (see section ‘Flushing’). Always ensure medications are administered in a way that limits the chances of tube blockage (see section on ‘administering medication’). If the tube does block you may try the following. If the first step fails, try the next:

• Ensure all clamps are open and the tube is not kinked.
• Try to flush using a pumping action with the plunger on the syringe.
• Connect a 50ml syringe to the end of the tube and try to draw back (‘aspirate’).
• Massage the tube around the area of blockage if it is obviously visible.
• Mix a solution of sodium bicarbonate (baking soda):-
  • Mix half a teaspoon of sodium bicarbonate (baking soda) with 30ml of boiling water.
  • Leave this to cool to a warm temperature then use a syringe to flush this solution down the tube.
  • Leave the solution in the tubing for at least two hours (can be left overnight) then flush it through with 20ml of water.
  • If you do not have any sodium bicarbonate, try soda water or pineapple juice.
• Contact a member of your gastrostomy care team.

Important: Never use excessive force and never attempt to unblock the tube by inserting objects down it.

Balloon will not deflate

If you cannot extract water from the balloon with the syringe:

• Ensure that the syringe has been inserted correctly. If the syringe has been pushed in too far or not far enough, water will not be expelled from the balloon.
• Ensure that the recess in the balloon valve is clean. Occasionally this recess can trap spills of feeds or other material. Clean inside the recess with warm water (cotton buds are useful for this) then try to insert the syringe again by pushing it firmly into the valve with a push and twist motion.
• If the balloon will still not deflate you should contact a member of your gastrostomy care team within 24 hours to check the nature of the problem.

Discharge observed from stoma site

It is usual to experience a discharge at the stoma site until the stoma heals (usually seven to 14 days after placement). It is important to clean the area carefully during this time. If the discharge is spoiling clothing a small ‘key hole’ dressing can be applied but this should be changed regularly or removed when no longer needed. If you notice any discharge or odour from the stoma site after the tubes initial insertion you should contact a member of your gastrostomy care team.

Feed leakage from stoma site around the tube

• If feed is observed coming from the stoma site you should check that the tubing is being held securely next to the skin.
• Feed can leak from the site because the balloon is inadequately inflated therefore the water in the retaining balloon should be changed (see section ‘changing water in the balloon’) however, it is important that this is undertaken by a trained nurse in the initial six weeks after the tube’s placement as there is a risk of the tube displacing.
• Leakage from the stoma site can occur because the stomach is too full or contains gas. (See section on ‘Venting’.) If you notice feed leaking out around the stoma site you should contact your dietitian to discuss changing feeding regimes, for example decreasing the flow rate.
• If the problem persists you should contact a member of your gastrostomy care team for advice.

Stomach is swollen and/or feels hard: ‘venting’ (or ‘decompression’)

• Mic-G tubes are commonly used in children who need regular gastric decompression as air/wind can be cleared with ease from the stomach with this type of tube.
• Some children suffer from trapped wind. This gas can be released by decompressing the stomach via the gastrostomy tube.
• To decompress the stomach attach the barrel of a syringe to the gastrostomy tube. Hold the syringe 10cms above the height of the child’s abdomen and unclamp. If necessary aspirate the gas via the feed/medication port.
• If your child needs very regular decompression please ensure you discuss with your care team as use of ‘continuous gastric decompression’ via a ‘Farrell valve’ may be needed.

Sore skin

• Redness or soreness around stoma and surrounding skin may be the result of gastric leakage.
• Clean and dry the area frequently.
• Call your community nurse or nurse specialists for advice regarding use of dressings.
• Call your community nurse if the stoma is persistently red and sore, the stoma emits an odour, the surrounding skin is swollen, you observe pus or there is bleeding from the site.

Overgranulation

Granulation tissue is the result of the body trying to repair itself. You may recognise overgranulation as a clear brownish discharge and occasional bleeding or as a pink raised tissue around the site of the stoma. The tissue may proliferate and require treatment so contact your community nurse or nurse specialist for advice. If bleeding occurs or a large amount of tissue builds up, contact a member of your gastrostomy care team for advice.

When sickness and/or stomach cramps occur

• See section on ‘Venting/Decompression’.
• You may need to slow the rate of feeding. Contact your dietitian if this problem continues.

When diarrhoea occurs

• The rate of feeding may need to be slowed down.
• If diarrhoea continues contact your doctor or dietitian.

When vomiting occurs

• See section on ‘Venting/Decompression’.
• You may need to slow the rate of feeding.
• Always check expiry dates of feed.
• If your child continues to vomit and the steps above have not helped you should contact your doctor.

Tube displacement (‘fallen out’)

If in the first six weeks after surgery care is delivered as documented in this leaflet (stitches not removed until day 10, dressing used, care given during lifting and handling) and, in the longer term, weekly checks are being carried out and any signs of balloon perishing are not ignored, a Mic-G gastrostomy tube should not fall out. However, if a tube does fall out a new tube must be inserted as soon as possible as the stoma (‘hole’) will start to heal and may completely close within one to two hours. If the stoma closes surgery will be needed. The following describes action to take in different scenarios should your child’s Mic-G tube displace:

Scenario 1: The Mic-G tube has displaced within the first six weeks after surgery to insert it:

• Stay calm.
• Place a clean tissue, handkerchief or towel over the stoma site (hole) to prevent stomach contents leaking onto clothes/skin.
• Collect together the equipment from the emergency kit box which will be needed to place a new tube:
  • Spare tube provided for emergency use
  • Lubricating jelly (for example, KY jelly) (optional)
• Wash your hands.
• Check the expiry date on the packaging prior to opening it. If you do not have your emergency kit box with spare tube with you, wipe the old tube and reinsert this.
• If lubricating gel is used apply a small amount to the tip of the tube.
• Gently push the device into the tract (push in ________ cm)
• Hold the gastrostomy tube still by placing a finger and thumb on either side of the external disc to support it.
• Tape the tube to the child’s skin to prevent movement.
• Wash hands and dispose of equipment.
• Do not use this tube.
• Attend your local emergency department taking the remainder of your emergency kit box with you. Your child will need to be assessed to ensure the Mic-G tube is appropriately positioned within the stomach and that there is no leak internally when the tube is used. In the first six weeks after surgery this confirmation is gained by your child having an x-ray called a ‘contrast study’ during which ‘contrast’ (a fluid which shows up on x-ray) is administered into the Mic-G tube.
• If there is any concern about the position of the Mic-G tube or any internal leak your child will be transferred to the paediatric surgery team and further surgery may be required.
• Once you have been given permission to use the Mic-G tube again you should contact your community nurse and nurse specialist so that your child’s emergency kit box can be re-stocked again.

Scenario 2: The Mic-G tube has displaced. It is more than six weeks since the Mic-G tube was inserted, your child has already had their first tube change and you have been taught how to replace it.

A new tube must be inserted as soon as possible as the stoma (‘hole’) will start to heal and may completely close within one to two hours. If the stoma closes surgery will be needed.

• Stay calm.
• Place a clean tissue, handkerchief or towel over the stoma site (hole) to prevent stomach contents leaking onto clothes/skin.
• Collect together the equipment which will be needed to place a new tube from your emergency kit box: New tube; sterile (cooled boiled) water; Two clear (‘Luer slip’) syringes; Lubricating jelly (for example, KY jelly) (optional)
• Wash your hands.
• Check the expiry date on the packaging prior to opening it.
• Before inserting the new tube it is important to check that its parts all function. Draw up 5ml of water into one syringe. Push the syringe into the balloon port (marked Inflation). Let go of the syringe and ensure that when you let go the syringe stays attached in the balloon port. Push the water into the balloon and disconnect the syringe. Examine the balloon for faults (for example, a hole) and ensure that the shaft of the device is in the centre of the balloon. If the shaft is to one side massage the balloon in your hand until it is centralised and therefore fully symmetrical (leakage may occur if the balloon is not symmetrical when inside the stomach). Place the syringe back into the balloon port and deflate the balloon fully. Refill the syringe to 5ml with water (a small amount of water will have been taken up by the new device).
• If lubricating gel is used apply a small amount to the tip of the tube.
• Gently push the device into the tract until _______ cm mark sits level on your child’s skin.
• Hold the gastrostomy tube still by placing a finger and thumb on either side to support it.
• Insert the syringe into the balloon port, let go of the syringe and ensure it remains connected.
• Gently push the syringe so that the water is injected into the device.
• Once all the water has been injected, remove the syringe by using a slight twisting motion. It is important to keep your thumb on the end of the syringe whilst removing it to prevent water being expelled back into the syringe spontaneously.
• Gently pull back on the Mic-G tube until resistance is felt then slide the external disc down to skin level.
• Aspirate a small amount of gastric content using the extension set and test it on a pH strip to ensure correct positioning. This pH check is required because this was an unplanned tube change. If the pH is 1 to 5 the tube can be used. If the pH is of a higher number or if you are unable to obtain an aspirate of gastric content do not use the tube and seek urgent medical attention.
• Wash hands and dispose of equipment.
• Telephone your delivery company, community nurse or dietitian and order a new gastrostomy tube so that you have a spare one again.

Scenario 3: The Mic-G tube has displaced. It is more than six weeks since the Mic-G tube was inserted but you have not been trained to insert a new gastrostomy tube, are not happy to carry this out, or, you don’t have a spare tube:

• Stay calm.
  • Place a clean tissue, handkerchief or towel over the stoma site (hole) to prevent stomach contents leaking onto clothes/skin.
  • Collect together the equipment which will be needed to place a new tube from your emergency kit box:
    • spare tube provided for emergency use
    • lubricating jelly (for example, KY jelly) (optional)
  • Wash your hands.
  • Check the expiry date on the packaging prior to opening it.

If you do not have your emergency kit box with spare tube with you, wipe the old tube and reinsert this.

• If lubricating gel is used apply a small amount to the tip of the tube.
• Gently push the device into the tract (push in ________ cm)
• Hold the gastrostomy tube still by placing a finger and thumb on either side of the external disc to support it.
• Tape the tube to the child’s skin to prevent movement.
• Wash hands and dispose of equipment.
• Do not use this tube.
• Seek urgent advice by using the contact numbers at the end of this leaflet

You are unable to insert your child’s regular size of tube

If you are unable to insert your spare tube or can’t push the tube which fell out back into the tract the stoma may have started to close. Surgery may be prevented if a smaller sized tube can be inserted in the first instance and the tract can be dilated.

• Attempt to insert a smaller tube. (This may be a smaller sized gastrostomy tube or a catheter).
• Tape the tube to the skin.
• Do not use this tube.
• Contact a member of your gastrostomy care team or Emergency department immediately and explain what has happened. Provide as much information as you can regarding the type/size of tube your child usually uses.

Details of your or your child’s balloon retained gastrostomy tube

Date of insertion:

Size of tube (Fr):

Date of planned change:

Contact numbers for your gastrostomy care team

Clinical Nurse Specialist Team for Paediatric Surgery:
01223 586973 Monday to Friday (excluding public holidays) 08:00 (8am) to 18:00 (6pm)

Children’s community nursing team:

Dietitian:

Home Delivery Company: