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Looking after your Monarch tube

Patient information A-Z

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What is a Monarch (Gastrostomy) tube?

A gastrostomy tube is a soft tube placed through your skin into your stomach which allows food to enter directly.

Unlike other gastrostomy tubes, a Monarch tube is not held in place by a balloon - it has an internal retention disc that is opened inside the stomach after the tube is inserted.

(Often we may suggest using this tube if you have had repeated problems with balloon failures)

Monarch tube with labels describing specific parts
Labels: the tube is prevented from sliding too far into the stomach by the external retention bar (T-bar); A connector to attach the syringes and giving sets to the tube; A clamp which allows the tube to be closed; The tube is prevented from falling out because of the internal retention disc which lives within the stomach

What 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 GP, your company nurse or the nutrition nurse specialists.

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. Again, contact your GP, company nurse or the nutrition nurse specialists if you are worried.

  • 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 for urgent advice.

Monday to Friday 08:30 to 16:00 - nutrition nurse specialists

01223 216037

Out of hours – Please contact your GP or NHS 111

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

Why do I have a Monarch tube?

You have this tube because you are unable to eat or drink enough food to keep you healthy. It provides a safe route for you to receive all the nutrients you require.

How long do I need to have my Monarch?

Most people require a Monarch tube long term but you will be regularly reviewed by a Dietitian to see how much food you require.

How long will my tube last for?

If it is well cared for, a tube can last nine to twelve months. You will need to attend an appointment at our clinic to have the tube changed.

One way of increasing the life of your tube is to leave the clamp undone when the end cap is in place. This prevents the clamp squashing the tube. You can also change the position of the clamp along the tube to avoid squashing the same area each time.

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

You will be given special instructions on caring for your tube and skin when it is first put in place.

Once you have your tube changed to a Monarch we advise you to:

  • Clean daily with warm soapy water
  • Move the T-bar to enable easier cleaning. Make sure you replace the T-bar approximately 2-4mm from the skin so the tube does not slide in and out.
  • Do not forget to clean the T-bar and tube
  • Ensure you dry well to finish

Can I have a bath?

If the skin around your site is clean, dry and well healed after the first tube placement, you may return to your normal bathing routine. If you have any concerns please contact either your GP, Company Nurse or the Nutrition Nurse Specialists.

How do I manage my tube?

It is important to insert and rotate your tube once a week to stop the internal retention disc in your stomach getting stuck.

To do this, follow these instructions:

  • Wash your hands with soapy water and dry well
  • Move the T-bar 2-4cm along the tube away from the skin
  • Clean the tube, T-bar and stoma area with soapy water
  • Push 2-4cm of the tube into the stomach and turn the tube in a complete circle with your fingers
  • Gently pull the tube back until resistance is felt
  • Clean the tube, T-bar and stoma area with soapy water again before drying
  • Move the T-bar back in to its normal position to secure the tube and prevent it from moving about

We are smoke-free

Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.

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Contact us

Cambridge University Hospitals
NHS Foundation Trust
Hills Road, Cambridge

Telephone +44 (0)1223 245151