Select slightly larger sized, or loose-fitting clothes to allow easier movement, or if you require more space for incontinence pads or acatheter 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.

Novotny NM et al. Percutaneous endoscopic gastrostomy buttons in children: superior to tubes. J Pediatr Surg. 2009;44(6):1193-6 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. You can shower 48 hours (2 days) after your procedure. Do not take tub baths or go swimming for 2 weeks after your procedure. We may give you a spare nasogastric tube or gastrostomy device to take home with you. If the device falls out, you will need to insert the spare tube or device into the opening straight away, otherwise it will close. The nurse will advise you about when it is safe to do this. Otherwise, you must take your child to your nearest Accident and Emergency (A&E) department for them to maintain the opening.

Frequent issues

Choose your balloon PEG – length and the French gauge- and get customized low profile balloon PEG for that particular patient

If you take insulin or other medications for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medication what you should do the morning of your procedure. 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 Smooth, slippery fabrics are usually easier to get on and off, as they glide easily over your skin or other layers of clothingIt 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. 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.

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 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. Your child’s PEG tube has been replaced with a low-profile gastrostomy-button (or G-button). Like a PEG-tube, you can feed your child or give medicine through a G-button. There is always a small risk that it might be difficult to remove the existing gastrostomy tube if it has been in a while and has become well-attached to the inner stomach wall. Trying to remove the tube might damage the stomach wall, so if the doctors are not happy to continue trying, they might leave the gastrostomy tube in place and decide to remove it using another technique on another day.

and functionality. A solid internal bolster will last up to twice as long as a balloon internal bolster tube (i.e., 12 months vs. 6 months). However, replacing a solid tube is more complicated as they are removed and replaced using traction (sometimes using a metal obturator with the lowprofile non-balloon tubes) involving significant force. This can cause significant pain for the patient and generally performed by a health care professional. Balloon tubes are deflated on removal and inflated on replacement non-traumatically and can be performed by the patient or caregiver in the home setting. Finally, if a patient is on palliative care/hospice, a non-balloon tube with its greater longevity may be preferred so the tube will last the lifetime of the patient. The decision on a standard tube vs. a lowprofile tube is dependent on what the tube is being used for. If the tube is being used for drainage, then a standard profile tube is preferred since it does not have the anti-reflux valve that low profile tubes have. If the tube is used for infusion or feeding, The initial gastrostomy device – except for the temporary Malecot® tube – usually needs to remain in place for at least six months for the opening to establish and can then stay in place for up to two years. After this, it will need replacing as the plastic will be starting to wear out and weaken. When a primary Mic-Key™ button has been in place for five months, or a PEG has been in place for around 18 months, call the team at GOSH to arrange an appointment to discuss the device change. 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. Your GP and Community Dietitian will be sent a letter informing them of the procedure you have had. As with all procedures, there is a very small chance that the planned method of insertion turns out to be unsuitable so an alternative approach will need to be considered. This may need to be done on a separate occasion.

Remove the water. The amount that should be in the balloon is on the top of the button or in the instruction book. Choose styles which make it easy to move clothing out of the way, for example elasticated waistbands on trousers, or a wrap around skirts A zip aid is usually a piece of cord or fine chain with a hook on one end and a tab at the other to assist with doing up zips. Large rings or tape can also be attached to a zip tab to help make gripping easier. 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.

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As x-rays are used to position the GJ device in the stomach and jejunum, we have to carry out a pregnancy test on any girls aged 12 or older beforehand.