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Balloon PEGs


The module covers:

  1. Two different types of Balloon PEG- Button PEG (Low profile balloon gastrostomy tube)  and replacement balloon PEG
  2. When to use which one and how

Low profile balloon gastrostomy tube (also called button PEG)

  1. This is for the individual who is ambulatory and feels the long PEG tube is socially inconvenient (not to be confused with Replacement balloon PEG which also has got a balloon as a retaining device)
  2. Once the tract is formed – remove the old PEG
    The measuring device
    Picture1: The measuring device
  3. Use the measuring device to measure the length of the tract
    16 French 3cm Corflo cuBBy PEG- low profile gastrostomy tube 16 French 3cm Corflo cuBBy PEG- low profile gastrostomy tube
    Picture2: 16 French 3cm Corflo cuBBy PEG- low profile gastrostomy tube
  4. Choose your balloon PEG – length and the French gauge- and get customized low profile balloon PEG for that particular patient
  5. Accurate length is important as there is no sliding outer retaining device (in contrast to the Replacement balloon gastrostomy PEG) – so if the tube is longer than necessary it can bob up and down and  stoma will leak.
  6. Introduce the lubricated tip of the Low profile balloon gastrostomy tube  gently into the tract
  7. Inflate the balloon with the required amount of water
    The extension tube to be attached just before feed
    Picture3: The extension tube to be attached just before feed
  8. Before the feed- the attachment tube needs to be fixed – the blue mark on the attachment tube needs to be aligned with the blue mark on the button PEG and turned by 90 degrees
  9. Once feed is over the extension tube is turned in the opposite direction and removed
  10. Because of the extension tube needs to be repeatedly connected and disconnected -button PEG tends to wear out and needs replacement on a regular basis

Replacement balloon gastrostomy tube

  1. This tube is placed if an old PEG has fallen/pulled out and there is a well formed and matured tract
  2. Disadvantage over endoscopically inserted PEG is that it’s life is much shorter compared to the former.
  3. Once the PEG falls out -the tract may close as early as 4 hours -so quick replacement (with balloon PEG or Foley’s catheter) is needed
  4. Clean the stoma
    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)
    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)
  5. Insert the lubricated balloon PEG into the stoma gently and it should pass freely without much resistance
  6. Inflate the balloon with water – 5-6ml
  7. Pull the tube out until the balloon stops it- slide the outer fixation bumper snugly to the skin
  8. The extension tube with the Y connector
    Picture5: The extension tube with the Y connector

  9. Attach the extension tube with the Y connector- one takes bladder wash syringe and the other- Luer lock syringe
  10. After care- the patient or the carer to check the water amount in the balloon and top up as and when necessary

Here are the links for button PEG and replacement balloon PEG insertion video’s respectively:

Button PEG

http://www.youtube.com/watch?v=hSv4FOwZ9kQ&feature=related

Acknowledgement/Bibliography:

  1. Guidelines for enteral feeding in adult hospital patients : BSG 2003
  2. Novotny NM et al. Percutaneous endoscopic gastrostomy buttons in children: superior to tubes. J Pediatr Surg. 2009;44(6):1193-6
  3. Heiser M et al. Balloon-type versus non-balloon-type replacement percutaneous endoscopic gastrostomy: which is better? Gastroenterol Nurs. 2001 Mar-Apr;24(2):58-63
  4. Product guide of the respective companies- Merck Serono and Flocare

http://www.youtube.com/watch?v=hqsaWOTG2ZQ


Article printed from Gastroenterology Education and CPD for trainees and specialists: http://www.gastrotraining.com