Changing a G-Tube (Gastric Feeding Tube)

Changing a gastric feeding tube also known as a g-tube (sometimes gastrostomy tube), is an area of uncertainty that always seems to generate questions among the MLD Family.  Since there is nothing unique about MLD with regard to g-tubes so I though I would share a series of photos to help anyone who want to know what a g-tube is, what a MIC-KEY™ button looks like, and how easy it is to change (or in an emergency replace) a g-tube.

Of course, have a g-tube placed the first time requires a doctor’s intervention and usually some form of anesthesia.  (With MLD we recommend as low a dose of anesthesia as possible). We feel that in many cases the periodic changing of a g-tube can be done at home.  While intimidating the first time, it’s generally safe, simple and quick.  Check with your GI doctors for guidance in your specific situation.

There are several types tubes and of “endings” you can have for a g-tube where it exits the stomach.  A gastrojejunostomy or GJ feeding tube is a combination device that includes access to both the stomach and the jejunum, or middle part of the small intestine. GJ tubes are NOT changed by the family, they require a doctor.

These pictures show the basic g-tube of the type known as a  percutaneous endoscopic gastrostomy (PEG) tube with a MIC-KEY™ button from Kimberly-Clark.  Please refer to the written instructions for other usage questions and while looking that these reference pictures.

 

stomach cross section showing g-tube placement

Cross section of stomach showing g-tube placement

Here’s a cross-section of what a g-tube looks like in the belly. Note the inflated balloon that keeps the tube from coming out through the stoma (the hole through the stomach and skin):

You may click on any of the following pictures to enlarge it.

g-tube with MIC-KEY™ button

g-tube with MIC-KEY™ button. Note that the button sits almost flush to the belly and the stoma (hole) is 2-3 inches from the belly button in this adult belly.

Let’s start with a look at what  a g-tube with MIC-KEY™ button looks like in an adult belly:

g-tube with MIC-KEY™ button viewed from the side.

And this is what the g-tube with MICKEY™ button looks like from the side:

changing a g-tube

Some of the MIC-KEY™ button g-tube kit parts.

This is some of what is in the MIC-KEY™ button kit:

Let’s Get Started Changing a G-Tube

First, relax and don’t worry. The old tube will look a big grungy after being in the stomach for a few months but you do not need to worry about liquids and “stuff” gurgling out.  The stoma will not close during the 2-minute process of a change.

The fine print … Always follow your doctor’s and manufacturer’s instructions – these photos are for guidance only.  A few more things …

  1. Most families can change their g-tubes at home – but please, check with and get trained by your GI doctor before you start doing this yourself – your circumstances may be different.
  2. Please make your first g-tube change in the presence of your GI doctor or nurse to learn the process with hands on supervision.
  3. Always test inflate the new tube’s balloon before using it.
  4. If the new g-tube is not inflating or holding water after you have inserted it, leave it in the stoma deflated, and tape the MIC-KEY™ button down so it does not come out while you seek medical assistance. Head immediately to your local doctor or ER for quick assistance. As long as something is in the stoma, it’s not normally a 911 emergency. The stoma will close fairly quickly if something is not in it to keep it open. If you are uncertain call 911.
  5. Change the g-tube when the patient is calm and has a settled stomach, i.e. before, not right after meal time.
A MIC-KEY™ button g-tube showing the balloon inflated. The small syringe is used in the side port (labeled "ballon port" in this drawing)

A MIC-KEY™ button g-tube showing the balloon inflated. The small syringe is used in the side port (labeled “ballon port” in this drawing)

Important: Before you get started removing the old tube, you need to test inflate the new tube’s balloon to check for leaks by using the small syringe in the side port and the manufacturer’s suggested amount of water. If the balloon holds the water without leaking, deflate it by removing the water. If the balloon leaks DO NOT USE this button.

Now is also a great time to check that the size of the old tube and the new tube are the same by comparing the writing on the top of the button. If they don’t match DO NOT change tubes without checking with your GI doctor first.

changing a g-tube

Deflating the balloon by removing the water from the old balloon

First we need to deflate the balloon in the old tube by removing the water from the side port.  Using an empty syringe, pull out gently on the plunger to remove the old water:

changing a g-tube

You’ll know when you have removed all of the water because the plunger will encounter resistance.

Almost all removed. It is not unusual to find less water in the balloon than what you put in a few months ago.  You’ll know you are done when no more water comes out.

changing a g-tube

Gently start to remove the old tube

Now we gently pull the old tube out:

changing a g-tube

Keep pulling until the tube comes out. You may need to use a gentle tug as the balloon moves through the stoma.

Pull gently on the tube. A slight tug might be necessary as the balloon passes through the stoma. If you encounter a strong resistance double-check to make sure all of the water has been removed from the balloon.  If you still have resistance stop and consider visiting your doctor to complete the process (you may temporarily push the old tube back into the belly – do not refill the balloon, and be sure to tape the button down so it doesn’t come out).

The length of the insert into the belly depends on the size of the patient. You can refer to the new tube to get a visual idea of how long the old tube is.

changing a g-tube

Just about out.

Just about ready to come out. If the patient is relaxed you do not have to worry about anything “gushing” out of the stoma.  A little leakage is normal.

changing a g-tube

A look at an old g-tube

Here’s what the used g-tube looks like:

changing a g-tube

Showing what the balloon looks like inflated (using an old g-tube)

And here is what the old tube looked like when inflated. This is the test you want to run on the new tube to make sure the new balloon does not leak:

changing a g-tube

Lubricate the tip of the new g-tube with a water soluble lubricant before you start to insert it

The new tube needs to be lubricated with a water soluble lubricant (do not use Vaseline) before it is inserted:

changing a g-tube

Gently push the new g-tube into the stoma

Gently push the new tube into the stoma (the balloon should be completely deflated when you insert it):

changing a g-tube

New g-tube after it’s all the way in

All the way in:

changing a g-tube

Inflating a new g-tube. Use only the amount of water recommend by the manufacturer.

Now let’s inflate the balloon. Did you remember to test inflate it before you put it in? Use the amount of water recommended in the manufacturer’s instructions  and inflate using the small syringe in the side port. DO NOT OVER-INFLATE.

changing a g-tube

Inflating the balloon slowly

Almost done – inflate slowly (5-10 seconds to complete):

And you’re done … Congratulations!

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