If the balloon doesn’t work, use your replacement button. Call your home health company as soon as possible to get another button for the future. If you had a low profile balloon button GJ device inserted, you will usually be able to start using it for fluids and feeds straightaway Fastenings for clothing can be used to adapt existing clothing. This includes Velcro fastenings and zips that can be unzipped from either end. These fastenings may be easier to manage than buttons if you have reduced grip or dexterity in your hands and fingers. Lee C, Kang H, Lim Y, et al. Comparison of complications between endoscopic and percutaneous replacement of percutaneous endoscopic gastrostomy tubes. J Korean Med Sci. 2013;28(12):1781-7.

Smooth, slippery fabrics are usually easier to get on and off, as they glide easily over your skin or other layers of clothing The dietitian will discuss with you the most appropriate method of feeding. This depends on your medical condition, the particular needs of your family, and your home circumstances. As the jejunum cannot hold feed like the stomach, feeds will be continuous given over a long period of time using a feeding pump so that the jejunum has time to absorb nutrients. Scheduled replacements require no antibiotics and the tubes can be used immediately as long as no complications are suspected. Stoma tract measurement is required when initially replacing with a low-profile tube and can be estimated from the markings and fit of the existing tube. Dedicated stoma tract measuring devices will give more accurate measurements, remembering that the tract length may increase 0.5-1.0 cm when the patient goes from supine to upright position. 6 Misplacement into the colon can also occur. In this situation the initial PEG has been placed through the transverse colon into stomach. Often the initial PEG will function well, but upon exchange the replacement PEG is placed into the colon. Symptoms include pain, infection, feculent leakage, and diarrhea. Treatment is removing the misplaced PEG, waiting for the stoma tract to heal and placement of new PEG. 10 Other complications of PEG replacement include bleeding, pain, infection, and peristomal leakage. Peristomal leakage occurs more often in those with underlying medical conditions that predispose them to delayed wound healing. It is important to evaluate for other causes, such as tube displacement, buried bumper, and delayed gastric emptying. It is also important to minimize sideto-side movement of the PEG tube where it exits the skin as that can enlarge the tract. This can be accomplished by changing to low profile tube or external stabilization with a right-angle bumper or clamp. Good stoma care with zinc oxide-based protectants and consult to wound

Balloon PEGs

G-buttons need to be replaced for different reasons (balloon leaks, your child grows, etc.). We recommend changing them every four months and will show you how to do this. It is often possible to adapt ready-made clothes from the high street so that they are more comfortable or practical to wear whilst using a wheelchair. You, a friend or family member may be able to make the alterations, or a local dressmaker or dry cleaner may be able to do the alterations for you. You can drink a total of 12 ounces of water between midnight (12 a.m.) and 2 hours before your scheduled arrival time. Do not drink anything else. Gkolfakis P, Arvanitakis M, Despott EJ, et al. Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and postprocedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021;53(2):178-195.

The percutaneous endoscopic gastrostomy (PEG) is the most common enteral feeding tube for long term nutrition support. Multiple guidelines and teaching materials are available for initial PEG placement. While this is beneficial for PEG placement, there is little evidence-based published literature to guide clinicians for PEG replacement. Rather than a “Willy-Nilly” approach, herein we combine the available evidence, published guidelines and expert opinion on PEG replacement. We review the why, when, what, who, and how of replacing PEGs with emphasis on practical clinical guidance. Optimal management of patients with PEG tubes necessarily requires expert PEG replacement practices to provide the best quality of life for these patients. INTRODUCTION Numerous chemicals are used in textile production and some of these chemicals can cause allergic reactions. The source of allergy to textiles can be the fabric itself and chemical additives used in processing the fabric. The most frequent allergens are textile dyes which are causes of acute dermatitis with rapid onset. The “When” in PEG replacement encompasses when it is safe to replace a PEG tube after initial placement and also how long an existing tube will function before deterioration resulting in malfunction occurs. After initial placement the PEG stoma tract begins to mature in 1-2 weeks and is usually well-formed in 4 weeks (Figure 1,2). This process may take longer in patients with impaired wound healing (ascites, malnutrition, immunosuppressive medications or states, diabetes, obesity). Therefore, PEG replacement after initial placement can be safely performed as soon as 4-6 weeks in most patients. It may need to be longer (up to 3 months) in higher risk patients as described above. 5 If a tube is inadvertently removed or has a complication requiring replacement before stoma tract maturation, confirmation of correct placement with one of the methods explained later in this article in the “How” of PEG placement is mandatory. 3 Bolus feedings (formula given over 10 – 20 minutes) and medications are given with a bolus connecter and a small slip-tip syringe.Lohsiriwat V. Percutaneous endoscopic gastrostomy tube replacement: A simple procedure? World J of Gastrointest Endosc. 2013;5(1):14-8. If you find dressing difficult, there are a number of things you can try to remain independent with dressing. You will be prescribed a special liquid feed, which contains all or most of the nutrients you need. Please talk to your dietitian if you would like to know more about it. You may be able to also continue to eat regular food by mouth, using the GJ to ‘top-up’ their nutrient levels, but this depends on the reasons why it is required. Your doctors and dietitians will talk to you about this. You will need to ‘flush’ the device before and after giving feeds or medicines. We will show you how to do this.

Develop comprehension: Record captions for pictures. Allow pupils to match the correct Talking Point to the correct picture. This could make a fine game! Boot levers are usually a rectangular piece of wood or plastic with a 'V' or 'U' shape at one end. They may assist you to remove your boots or shoes without bending down to hold the shoe or boot. To use a boot lever, place the heel of the boot or shoe into the 'V' or 'U' shaped end of the remover. Your other foot should then be positioned on the other end of the remover to hold it steady while you ease your foot out of the boot or shoe.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. The first stage is to remove the existing device and replace it with a balloon button gastrostomy device if necessary, stretching the stoma. The balloon GJ device is threaded through the existing opening in the skin and the tube positioned into the jejunum using x-rays to guide the tube into position. If there is a gastrostomy tube in place already, they will have a well-developed tract through the skin to the stomach, so converting the gastrostomy to a GJ tube device carries few risks.

Your community dietitian will arrange further deliveries of feed and other equipment once you are at home. PEG replacement is a critical component of enteral access, but there is very limited published data and guidance on its practice. Multiple caregivers including patients, families, and healthcare professionals at all levels may be involved and care from multi-disciplinary teams are required for management of patients requiring PEG tubes. We prefer timely replacement of PEG tubes using appropriate protocols and the techniques described above. Awareness of the data and expert opinion are required to prevent, perform, and manage complications from PEG replacement. This will allow provision of optimal nutritional, hydration, and medication support as well as maximize quality of life for patients living with PEG tubes. References When you’re fully awake, your nutrition nurse practitioner (NP) will show you and your caregiver how to give yourself the feedings and care for your PEG or PEJ tube. It’s very important to have your caregiver with you during the teaching session. You’ll also receive a resource that explains how to give yourself feedings with your PEG or PEJ tube.If you use a wheelchair, you may find that some standard clothes are not practical or comfortable to wear for long periods of time. There are clothes designed for wheelchair users commercially available and it is possible to adapt your preferred clothes if you so choose. Depending on your upper body mobility, you may find clothes which pull over the head, or fasten at the front, easier to manage If your PEG needs replacing, your GP may refer you to the hospital to be seen by the Gastroenterologist and the Nutrition Nurse. They will review the PEG and decide if it needs changing. If you no longer need your PEG your GP will refer you to the Gastroenterologist to remove it.