Button devices are held in place by a water-filled balloon inside the stomach, and you should change the water every week. Remove the water by attaching a syringe to the balloon port and replace it as you have been shown. GJ feeding is rarely the first method of ‘enteral feeding’ (feeding directly into the gastrointestinal tract) used. Nasogastric (NG) and gastrostomy feeding are usually tried first. In some cases, you may need to be started on GJ feeding without trying gastrostomy feeding first, your lead team will discuss this with you if required. The initial device most commonly used at GOSH is called a Freka® PEG. This consists of a flexible polyurethane tube which is held in place in the stomach with a silicone disc. A triangular silicone fixator holds it in place on the skin of the abdomen. The free end consists of a port with a closure cap, to which a ‘giving set’ is connected when feeding.

For example, although a man may usually stand to urinate, if you are unstable, you may find that sitting is a safer, easier option. It also means that you do not need to worry about holding items of clothing whilst using the toilet. Novotny NM et al. Percutaneous endoscopic gastrostomy buttons in children: superior to tubes. J Pediatr Surg. 2009;44(6):1193-6 Your nutrition NP will go over possible side effects that you may experience with your feeding tube and will give you the Home Parenteral Nutrition (HPN) Complication Chart as a reference. This chart provides guidelines on how to treat possible complications. You can view the chart online at www.mskcc.org/pe/hpn_chart. Call your doctor or NP if you’re having any problems. This procedure uses an endoscope (flexible tube with a camera and light at the end) to insert the gastrostomy device. It is carried out by a surgeon in the operating theatre or a gastroenterologist in the gastroenterology investigation suite. The endoscope is passed into the mouth and down the food pipe to the stomach which is inflated with air to bring it closer to the surface of the abdomen.See advice from your community nursing team or GP. You can also call the GOSH Gastrostomy and Stoma nursing team.

When considering how you use and transfer on/off the toilet, what items of clothing will you need to move or remove? Do you find it easier to pull pants up/down or would you find it easier to have pants which fasten under the crotch? How you choose to manage will depend upon your personal condition and abilities. If you wear your bag attached to your calf, you should look for loose fitting trousers which you can easily pull up and out of the way when you need to attend to the bag.To prevent the internal bumper of the PEG from becoming buried it is very important that the PEG is advanced and rotated daily. This should start 10 days after placement and not before. If you have nothing to put in the stoma, replace the old button and tape it down. This will keep the stoma open until you can seek medical attention.

Smooth, slippery fabrics are usually easier to get on and off, as they glide easily over your skin or other layers of clothing This is granulation tissue and is common. Call your health care provider if the tissue bleeds, grows in size, or if fluid or pus leaks. Fluid leaks around the button: A GJ device is usually suggested after gastrostomy feeding has been unsuccessful. Some people cannot tolerate feeding directly into the stomach, so a GJ device can be helpful as it bypasses the stomach. A GJ device can be helpful for people with gastric motility problems, where food does not pass through the stomach to the intestines as it should.

Balloon PEGs

As with all procedures, there is a very small chance that the planned method of insertion turns out to be unsuitable so an alternative approach will need to be considered. This may need to be done on a separate occasion. You will be discharged home with a 14-day supply of all the required equipment for your PEG and if required, feed. You can shower 48 hours (2 days) after your procedure. Do not take tub baths or go swimming for 2 weeks after your procedure. Support pupils in positions of responsibility: Pupils can record the messages that they are asked to take to other classrooms or school staff. They can then play them on the way so that they are more reliable and independent in delivering the right message to the right person. Develop comprehension: Record captions for pictures. Allow pupils to match the correct Talking Point to the correct picture. This could make a fine game!

If the existing device is a gastrostomy button , which is being changed to a low profile balloon GJ device, then this can be done awake, and the risks involved in this procedure are low. They will feel the doctor or nurse changing the tube, and may not like having to stay still, but this procedure is not usually painful. Family Fundprovides grants for families raising disabled or seriously ill children and young people aged 0-18. They provide grants for a wide range of items, including clothing.Two different types of Balloon PEG- Button PEG (Low profile balloon gastrostomy tube) and replacement balloon PEG