Looking after your Pexact tube

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What is a Pexact?

A Pexact is a soft balloon retained gastrostomy tube placed through your skin into your stomach to allow feed to enter directly.

Occasionally the tube that you will have may differ slightly in its design.

Balloon Retained – there is a small balloon on the end which when inflated with water, holds the tube in place inside the stomach.

Gastrostomy – opening to the stomach.

There are two stitches close to the tube to help secure its position. These will be removed after about four weeks by the nutrition nurse specialists at Addenbrooke’s. The tube is prevented from falling out because of the balloon inflated in your stomach. The big port is where your food and water must go down to enter your stomach, there is a choice of two ends to close the tube.

What else do I need to look out for?

You need to look at your site regularly to check for signs of infection. The things to look out for are:

• redness
• pain
• discharge which is yellow and smelly

If you notice these signs, contact your GP, your company nurse or the nutrition nurse specialists.

It is also possible for over granulation to occur at the PEG site and it may bleed easily. This can be easily treated with a special dressing or ointment. Again, contact your GP, company nurse or the nutrition nurse specialists if you are worried.

Also look out for:

• leaks of fluid around the tube
• pain on feeding or flushing your tube
• new bleeding

If you have any of the above signs stop feeding immediately and telephone:

Monday to Friday (08:30 to 16:00) –

Nutrition nurse specialists - 01223 216037

Out of hours – Please contact your GP

If you cannot wait to be seen by your GP, please contact your local hospital’s emergency department.

Why do I have a Pexact?

You have this tube because you are unable to safely swallow enough food and drink to keep you healthy. It provides a safe route for you to receive all the nutrients you require without choking on your food.

How long do I need to have my Pexact?

Most people require a feeding tube for a long time as their swallow remains unsafe.

After approximately six weeks your Pexact will need changing to another similar tube along with removing the stitches. This will be done by the nutrition nurse specialists. We will arrange this to fit in with your treatment and clinic appointments.

After the first change, it does not need to be changed for another three to four months. It may be possible that this can be done at home by the company nurse.

You will be reviewed regularly by a dietitian who will advise how long you need the tube for and when you can eat and drink normally again.

If you no longer need the tube it can easily be removed by either the nutrition nurse specialists or your company nurse.

How do I clean my Pexact and the skin around it?

For the first week:

• Remove the dressing the day after your tube is inserted, this is no longer required.
• Clean the tube and site daily.
• Carefully clean under the outside bumper and around the site using neat Octenisan body wash, then cleanse with warm water and dry well.
• Apply the Bactroban/ Naseptin ointment around where the tube exits the skin.
• It is important not to move the outside bumper for the first week as keeping it in place helps the site to heal.

After the first week:

• It is no longer necessary to use the Octenisan and Bactroban/ Naseptin. Still clean daily with warm soapy water.
• You can now move the outside bumper along the tube to make cleaning the site easier. Make sure you replace the bumper approximately 2mm from the skin so that the tube does not slide in and out.
• Do not forget to clean the back of the bumper.

Can I have a bath?

For the first two days after your tube is placed do not have a bath or shower, instead wash using the Octenisan body wash.

For the rest of the first week you may have a shallow bath or a brief shower using the Octenisan body wash. Do not soak/ immerse the tube and exit site.

After the first week, if the skin around your site is clean and dry, you may return to your normal bathing routine. If you have any concerns please contact either your company nurse or the nutrition nurse specialists.

How does the balloon stay inflated?

Once a week you need to check that the balloon is still full of water. To do this:

• Fill a 5ml syringe with 5ml of cooled boiled water.
• Have another empty 5ml syringe ready.
• Hold the tube in place with your spare hand (you may wish to tape the tube to your skin instead).
• Use the empty syringe to draw the water out of the balloon.
• Swap syringes and inflate the balloon with the new water.

If you find the amount of water you draw out of the balloon is less than 3ml this could be a sign that the balloon is not working properly. If this occurs, use tape or an adhesive dressing to secure the tube to your stomach then contact either your company nurse or the nutrition nurse specialists for advice.

Can the tube fall out?

It is possible for the tube to fall out if the balloon bursts. It is very important that it is replaced within an hour or the hole in your stomach may close up.

You will be sent a spare tube, it is important to keep this with you at all times.

If your tube falls out, please contact either your company nurse or the nutrition nurse specialists immediately within the hours of:

08:30 to 16:00 Monday to Friday - 01223 216037

If it is outside of working hours (weekends or bank holidays), please go to your local emergency department (A&E) with your spare tube for replacement.