Patient Instructions: Balloon Gastrostomy Tube (G tube)

These instructions are for Children’s Hospital of Philadelphia (CHOP) patients with a new or existing G tube (gastrostomy tube).

Important information about balloon G tubes:

A gastrostomy tube, or G tube, is a silicone tube with a balloon at the end. The tube is placed through an opening into the stomach, also called the stoma, and balloon is filled with water. The balloon lies against the inside wall of the stomach. A retention disc is pushed down along the outside of the tube and against the skin on the belly. When the retention disc and the balloon are in the correct position the tube is held tightly in place. The rest of the tube sits outside of the belly about 6-8 inches and has three openings, called ports.

The feeding port is funnel-shaped with a cap. This is used for attaching the feeding tube or catheter tip syringe.
The medicine port is smaller and has a cap. It is used for giving medicine.
The balloon port is used to fill or let water out of the balloon. The balloon port should not be used for feeding or medicine.

Balloon G tube — Standard (or long) balloon G tube in the stomach

Instructions for care of the tube:

Your child’s tube should not interfere with their normal activities. After the site heals, they can bathe, swim, play, and sleep as usual. You may find certain clothing such as onesies, keep your child from pulling on the tube or having the tube catch on something and pull out.

When the tube is placed, a tract is created from the stoma into the stomach. It is important to prevent the tube from coming out or moving so that the stoma and tract can heal. Poor healing can cause leaking, skin irritation and granulation tissue.
You may tuck the tube into your child’s clothing, but not near their diaper area.
ElastiNet^® is a stretchy elastic net dressing that may also be used to keep the tube close to your child’s body.
Wipe the tube regularly with an alcohol pad to prevent the build-up of oil on the tube and prevent movement of the disc.
Push the disc down to hold the tube in place. Your team will tell you what number on the tube should match up with the disc. This way you can make sure the tube has not moved.
If the tube is not at the correct number, gently tug on the tube. Tugging brings the balloon up against the inside wall of the stomach.

Instructions for skin care:

After surgery, only sponge baths should be given. The new tube site should not go under water in a shower or bathtub until instructed by the your surgery team.
Wash around the stoma site and surrounding skin with mild soap and water every day, or more often if needed. Be gentle. Scrubbing can slow down healing or cause skin breakdown. Rinse with water and dry well. It is normal to have a little yellow-brown drainage and redness at the opening.

Call your healthcare provider if you see:

Rash with red dots on the edges
Signs of infection: increased redness, swelling, yellow-green drainage with a bad smell at the stoma, pain
Open areas of skin around the stoma
Bleeding at the stoma site
Bleeding, painful or growing granulation tissue around the stoma
Increased leaking at the stoma site

Instructions for leaking:

Make sure the tube is in the correct position by checking that the number on the tube at the retention disk has not changed.
If there is a lot of leaking at the stoma site, and you have not had your follow-up with surgery clinic yet, call them for an appointment.
If you have been taught how, check the amount of water in the balloon.
1. Hold down the disc against the belly and pull back on the balloon port with the syringe that comes in your G tube kit. Check the amount of water that you have pulled into the syringe.
2. If there is less than the usual amount, add water.
Balloon volumes are different based on size and type of tube. Talk to your healthcare provider about the right amount of water for your child’s tube. If the balloon contains the correct amount of water, but is still leaking, add 0.5 ml to 1 ml of water at a time to the balloon until the leaking stops. Never have more than the maximum recommended amount of water in the balloon. If you add too much water to the balloon, it may break or cause a blockage.
If leaking continues, the tube will need to be changed. Call your healthcare provider if you do not have a replacement tube.
While you are waiting to get instructions, keep your child’s skin dry by changing any wet gauze or dressing under the tube as needed.
Protect the skin around the stoma with a skin barrier, such as Vaseline^®, A & D^® ointment, diaper cream, or Cavilon^® No Sting Barrier Film (if your child is over 1 month of age).

Instructions for treating granulation tissue:

Granulation tissue is a type of scar tissue that forms when the body is trying to heal itself. Because the feeding tube stoma is a new opening, your child’s body naturally may try to close it by growing this tissue. Some children have granulation tissue that grows very quickly, while others have no problem with it at all. Granulation tissue is dark pink or red. Sometimes it can cause leakage and skin irritation. It may also bleed or cause pain. If this happens contact your healthcare provider.

If you see granulation tissue starting to grow, discuss it with your healthcare provider at your next visit.
If the granulation tissue around the tube is bleeding, painful, or growing quickly, contact your healthcare provider for an appointment. They may prescribe a cream that you can use at home, or they may treat it in the office with a medicine called silver nitrate. These medicines shrink the granulation tissue. Granulation tissue may return and need to be treated with medicine again.

Instructions for venting the G tube:

Venting is a way to use the tube to burp your child and let gas out of their stomach. Your child may need to be vented if their belly is bloated, if they have belly pain, or if they gag, retch, or vomit.

If your child’s tube needs to be vented, follow these steps:

Remove the plunger from a catheter tip syringe.
Attach syringe barrel with the plunger removed to G tube feeding port.
Hold syringe barrel above the level of your child’s stomach.
Keep the tube vented for 5-10 minutes before and after feeding and as instructed.

Instructions if the tube becomes clogged:

Try to prevent the tube from clogging. Flush the tube with water as directed after each feeding and before and after each medicine. If your child is on continuous feedings, the tube needs to be flushed at least once a day.
Even a tube that is not being used must be flushed once a day.
If the tube becomes clogged, attach a 5ml oral syringe with warm water to the end of the feeding tube. Try to flush the tube. If you are unable to flush, pull back on the plunger of the syringe. Repeat this push and pull action up to 5 times. If you still cannot flush the tube, try using warm water in a 3ml or 1ml oral syringe and repeat the above steps.
If this does not work, and it is a new tube, call the surgery team. If you have been taught how, you may change the tube.

Instructions if a new G tube comes out:

No matter how long your child has had a G tube, the stoma opening can close very quickly.

If you have not been taught how to replace a tube, follow the directions below:

If you are less than 45 minutes away from one of CHOP’s hospitals, go to the nearest CHOP Emergency Department in Philadelphia or King of Prussia.
If you are more than 45 minutes away from CHOP, go to the closest Emergency Department.
If you go to another Emergency Department, ask them to call General Surgery at CHOP.

Instructions if the G tube comes out and you have been taught how to change it:

Change the tube by following these instructions:

Check the balloon of the new G tube to be placed by filling the balloon with water using a syringe. Check the balloon and balloon port for any leaks. The balloon should fill evenly and completely around the tube. If the balloon leaks or does not fully fill, get another tube.
After making sure there are no leaks in the replacement tube, reconnect the syringe and remove the water from the balloon by pulling back on the plunger. Disconnect the syringe.
Put water-soluble lubricant on the end of the tube. Never use Vaseline^® or oils. These weaken the balloon.
Insert the end of the tube into the stoma. Push it in 2-3 inches, until you reach the number along the tube that should match up with the disc. Do not force it.
Attach the water-filled syringe to the balloon port. Fill the balloon with water to the recommended volume.
Keep your thumb on the syringe plunger while you remove the syringe from the balloon port. This will keep the water in the balloon as you remove the syringe instead of flowing back into the syringe.
Gently tug on the tube. This brings the balloon up against the wall of the stomach and holds the tube in place.
Clean the stoma site to remove any extra lubricant.
Slide the disc down the tube so that it rests against the belly.
Check to see if the tube is in the stomach. Attach a 60ml catheter tip syringe to the feeding port. Pull back on the plunger to check for stomach contents. If nothing comes back into the syringe, change your child’s position and try again.
Flush the tube with water as you have been taught.

If the tube breaks and you do not have a replacement, follow these steps:

Put water-soluble lubricant on the end of the old tube.
Insert the end of the old tube into the stoma. Push it in 1-2 inches. Do not force it.
Tape the tube to the belly to hold it in place.
Do not feed your child through the broken tube.
Call your home care company for a new tube or call your healthcare team for next steps.

Call your CHOP team with any questions or concerns.

If you have any questions about your child’s health, please contact your child’s healthcare provider. This document is intended only to provide general educational information and is not intended as medical advice or treatment. Please consult with your healthcare provider prior to use, as some of this information may need to be adapted for your child’s specific needs. It is the responsibility of your healthcare provider to advise you on the appropriate use of this information. If you/your child are not already a CHOP patient, this document does not create a doctor-patient relationship between you/your child and CHOP. CHOP is not responsible for any outcomes you/your child might experience from your use of this document. This document is provided "AS IS", WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, express or implied. If this document refers to any drugs or medical devices, it is the responsibility of your healthcare provider to check the FDA status prior to use. If this document includes references to drug dosing, please do not rely on this document. Your healthcare provider should check the package insert for each drug before use. Hyperlinks used within this document may not be translated into other languages.