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. 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. 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

Unless the doctor gives special instructions, the gastrostomy device can usually be used straightaway to give your child medicines – if your child took regular medicines by mouth or through the NG tube, a different format may be prescribed to be given through the gastrostomy. The nurses will test the gastrostomy a few hours after the procedure, first with a small amount of water and if everything is fine, next with a small amount of feed. If there are no problems, the amount of feed given will gradually be increased. Depending on your upper body mobility, you may find clothes which pull over the head, or fasten at the front, easier to manage If you have not had a gastrostomy previously, you may have to wait several hours to have any fluids through the GJ device. Before the GJ is used and while the feeds are being introduced, you will have an intravenous infusion (drip) of fluids. 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. Picture4: The replacement balloon gastrostomy tube (not to be confused with button PEG or low profile device which also has got a balloon as a retaining device)

Call your health care provider if:

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. See advice from your community nursing team or GP. You can also call the GOSH Gastrostomy and Stoma nursing team. If you are taking any medicines e.g. Warfarin, Aspirin or Clopidogrel these may need to be altered or stopped before your procedure. You may also need to have blood tests. Please speak to your GP, the assessment nurse or the hospital doctor for advice.

Smooth, slippery fabrics are usually easier to get on and off, as they glide easily over your skin or other layers of clothing The nurse will also take details on whether you have any allergies to any medicines, any medical conditions and anything which would require you to be given any further antibiotics before the procedure (for example an artificial heart valve or if you suffer from valvular heart disease). If you have previously had a gastrostomy device, which has been converted to a GJ feeding device, you will usually be able to start using it for fluids and feeds straightaway but following a new feeding plan. Steenblik M, Hilden K, Fang JC. A retrospective correlation of percutaneous feeding tube stoma length in sitting and supine positions compared with body mass index. Nutr Clin Pract. 2012;27(3):406-9.

Frequent issues

Support pupils during ‘choosing’ time: Adults can record directions for each activity. As pupils move to each activity they can replay the prompts to make sure they are doing the ‘right’ thing. Perforation, which is a little tear in the wall of the bowel. This is rare and would require a hospital stay for antibiotics and possibly a surgical repair.