Looking after your low-profile (button) gastrostomy tube

What is a low-profile gastrostomy (button) tube?

A low-profile gastrostomy tube is commonly referred to as a 'button'. It is balloon retained, and can be beneficial if you are very active.

• Low-profile: sits flush to the skin.
• Gastrostomy: opening to the stomach.
• Balloon retained: A small balloon on the end of the tube which, when inflated, holds the tube in place inside the stomach.

The button needs to be accessed using an extension set whenever it is used. This set should be changed weekly.

Why do I have a button?

You have this tube because you are unable to safely swallow enough food to keep you healthy. It provides a safe route for you to receive all the nutrients you require. There are many different sizes of buttons. Your gastrostomy tract will be measured to ensure that you have the best size to fit you. This may mean that you will need to have a temporary tube whilst waiting for the correct size.

How long do I need to have my button?

Most people require a button long term; however, you will be regularly reviewed by a dietitian to see how much feed you require.

How long does my tube last for?

Your button needs to be changed after three months. If this is the first tube you have had, this first change will need to take place in hospital. This will be done by the nutrition nurse specialists either in clinic or at an arranged time.

After the first change, it doesn’t need to be changed for another three months. This can be done at home by the company nutrition nurse.

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

How do I clean my button 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 after the first week. Continue daily cleaning 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 or immerse the tube or 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. Please contact either your company nurse or the nutrition nurse specialists on the number below for advice.

Please note: always check the amount of water to use in the balloon port as this different brands vary. Always insert the maximum amount written.

Can the tube fall out?

It is possible for the tube to fall out if the balloon bursts. Should this happen, it is very important that it is replaced within an hour, as the hole in your stomach may otherwise close.

You will be provided with a spare tube; it is important to keep this with you at all times. There are instructions inside the packet; please ensure you retain these.

If your tube falls out, please contact either your company nurse or the nutrition nurse specialists on the number below or, out of hours, please go to your local emergency department (A&E) with your spare 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

It is also possible for the skin at the exit site to become pink and/or lumpy and it may bleed easily. This may be an overgrowth of tissue which can be easily treated with a special dressing or ointment.

If you notice these signs, or if you are concerned, contact your GP, your company nurse or the nutrition nurse specialists on the number below.

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 call the nutrition nurse specialists on the number below, or, 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.

Contacts and further information

Nutrition nurse specialists

Monday to Friday 08:30 (8:30am) to 16:00 (4pm): 01223 216037

Home delivery company 24 hour helpline

• Abbott Hospital to Home: 0800 018 3799
• Nutricia Homeward: 03457 623 632
• Fresenius Homecare: 0808 100 1990