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 o After 6 hours the tube will be flushed with 50mls of sterile water. If your PEG is required for feed or medication, these can be given via the PEG the following morning but not before.

An anaesthetist will also see you to explain the anaesthetic in more detail. If you have any medical problems, like allergies, please tell the doctors.You will be asked to put on a hospital gown. If you wear spectacles or dentures you will be asked to remove them. Never force fluid through the button. If appropriate for your child’s diet, try a half ounce of cola through the button. Remember to flush with lukewarm water before and after feedings or medications to help prevent clogs. The button came out: Lohsiriwat V. Percutaneous endoscopic gastrostomy tube replacement: A simple procedure? World J of Gastrointest Endosc. 2013;5(1):14-8. 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.

Clothes made from knitted or 'jersey' fabrics are often easier to manage than more stiff, woven fabrics. A small percentage of elastane or Lycra also makes fabric more stretchy, and can help it regain its shape after being stretched. However, if you have sensitive skin, you may wish to avoid synthetic fabrics 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. Skirts and trousers with elasticated waistbands are often easier to manage than those with fasteners such as buttons or zipso After 24 hours the triangular fixation plate can be loosened. It should be kept 0.5-1cm from the abdominal wall. Do not keep the fixation plate too tight or a pressure sore may develop. Wrap-around tops, cardigans and skirts may be easier, although you may need to be able to secure them at the waist. You may be able to adapt a belt by using hook and loop fastener, such as Velcro, or a large popper or magnetic button Some chemicals used in textile manufacture wash out, some remain within the fabric. You are advised to wash new clothes before wearing them and where possible select clothes which are made of undyed, natural fabric. Clip and Pull is canvas strap and clip device is designed to help someone to pull trousers up with use of one hand only. Your community dietitian will arrange further deliveries of feed and other equipment once you are at home.

This is granulation tissue and is common. Call your health care provider if the tissue bleeds, grows in size, or if fluid or pus leaks. Fluid leaks around the button: National patient Safety Agency (2010) Rapid Response Report: Early detection of complications after gastrostomy. If you find it difficult to reach clothes once they are lowered, fit long loops of tape inside the waistband. Keep the loop around your wrist when you are seated on the toilet. When you need to pull the pants/trousers up, you can use the loop. There are also dressing aids, such as trouser clips, which might help Before you go to the endoscopy room, the Doctor or Nurse placing the PEG will discuss the procedure, explaining any risks and give you the opportunity to ask questions. Then you will be asked to sign a consent form. This will be completed before you go to the endoscopy room. Novotny NM et al. Percutaneous endoscopic gastrostomy buttons in children: superior to tubes. J Pediatr Surg. 2009;44(6):1193-6Initial percutaneous endoscopic gastrostomy Although this review focuses on replacement of (PEG) placement is a commonly performed percutaneous gastrostomies placed endoscopically, procedure for patients unable to maintain the information is also applicable for percutaneous nutrition with adequate oral intake and there are multiple professional society guidelines for its use. Approximately 200,000 initial PEG tube placements are performed in the U.S. annually. With such a large number of PEG tubes being placed, correspondingly there are a large number of PEG tubes being replaced as well. Despite this, there are no official recommendations for the replacement of PEG tubes. Appropriate timing, technique and management of PEG replacement is critical to prevent complications and provide maximal benefit of long-term enteral feeding. If you have difficulty managing or holding layers of clothing when you go to the toilet, consider alternative ways of temporarily securing your clothes. There is equipment for this (for example a Pants aid) but you may find it easier to sew discrete loops and buttons to hold layers out of the way o Leave the feeding line clamp open when the PEG is not being used for feeding, as this will prevent flattening of the tube.

If you have a nasogastric tube as a method of feeding you should not have any feed down it for at least six hours (preferably overnight) before the procedure. If you have not had a gastrostomy before, there is a very small chance that the large intestine could be damaged during the insertion, but using barium beforehand reduces this risk. If you have not had barium the night before the procedure, the consultant may cancel the operation as the risk of damaging the large intestine may be too great. As well as the risks of the general anaesthetic, formation of a gastrostomy can cause damage to the foodpipe, stomach or nearby structures. Careful measures are taken to manage these risks. If you are concerned about the risks to your child please discuss with the team performing the procedure. 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.

Things to do at least once a day

Develop comprehension: Record captions for pictures. Allow pupils to match the correct Talking Point to the correct picture. This could make a fine game! o The tube should remain under moderate tension for 24 hours to promote good adaptation of the stomach wall to the abdominal wall. (Fresenius insertion guideline) Magnetic, or hook and loop fasteners (such as Velcro), are usually the easiest to manage. Shirts, trousers, bras and skirts are available ready made with these types of fastenings, or it is possible to adapt your own clothing. For example, Velcro dots can be used instead of buttons to fasten a shirt