This section includes instructions and videos for basic G-tube care, including new stoma care, venting, securing the extension set, checking the balloon, and changing the tube.

Caring for the New Stoma

Less is more with tube site care, particularly in the beginning.

New stomas often ooze cream-colored secretions. Initially, you may use gauze or another dressing around the site. You should change the gauze as often as needed to keep the site dry. Keeping the site dry is important to healing.

The dressing usually can be removed after a few days. Keeping the site open to the air is good for healing. You may continue to see leakage that is clear or tan in color, which may become crusty as it dries. There may be small amounts of blood. You can gently wash the site with warm water and gauze or cotton swabs as needed throughout the day. Dry the site with clean gauze or a towel after.

New tube sites should not be submerged in water for at least a week or two unless otherwise directed by your doctor. Ask your doctor about any restrictions your child may have.

Think of the G-tube like an earring. In order to form the stoma, the new G-tube needs to be spun daily.

See our Tube Sites pages for more help with stoma care.

Venting a G-Tube

Some children get uncomfortable when there is air in the stomach. You can vent air out of the stomach every few hours as needed. You may want to vent before each feeding, around the time of each diaper change, or after feeding. Children who receive fundoplication surgery may need to be vented more often. You will learn how often your child needs to be vented.

In order to vent, you need a large syringe with the plunger removed, a cup, and towel because sometimes stomach contents comes out with the air. If your child has a button-style tube, you will need an extension set (preferably a straight/bolus extension). Note that the Bard Button has a special extension set for venting called a decompression tube.

Insert the open syringe into the end of the long tube or into the extension set, then unclamp the tube. Gently pushing on the stomach (or raising your child’s legs to the chest) will help to move the air towards the tube and allow it to move out. Food may also come out. You should let it slowly run back in when finished. This is often referred to as re-feeding. For more continuous venting, even while feeding, you can use a Farrell valve bag.

Securing the PEG or Extension Set

Other than the daily spinning of the G-tube, movement and pulling on the site should be minimized to prevent trauma and leakage.

Many parents use medical tape, such as Micropore (paper tape) or Hypafix, or a securement device, such as a Grip-Lok, to secure tubes and extension sets, especially for continuous feeders. You can secure the tube to the stomach with tape. Or you can form a tab to pin to the child’s clothing or diaper by wrapping tape around the tubing and folding it back onto itself.

Little hands can be persistent, so many families have had to come up with unique ways to secure the tube. The image on the right is just one creative example.

Checking the Balloon

If your child has a button or tube held in with a balloon, you may need to periodically check the water level in the balloon. Some doctors like you to check the balloon on a regular basis, such as once a week, while others only suggest you check the balloon if the tube seems to be loosening up or tightening.

To check the balloon, insert a slip tip syringe into the balloon port. While holding the tube in place, withdraw back the water from the balloon into the syringe. Sometimes you will also withdraw some air. It can be difficult to get all of the water and air in one try, so you may need to pull back a few times.

Once you have emptied the balloon, note how much water is in the syringe. If there is more or less water in the syringe than there should be, add or remove water until the right amount remains in the syringe. If the water from the balloon is very discolored or looks contaminated, you may want to replace it entirely. Note that the stomach is not sterile, so regular tap water is fine unless your child has an immune system disorder.

Children with MicKey buttons tend to keep 5ml in the balloon, but your doctor may advise putting more or less water into the balloon, depending on your child’s size and needs. AMT MiniONE balloons should be filled according to the manufacturer’s guidelines (p. 11). Insert the correct amount of water back into the balloon and remove the syringe.

If the balloon seems to be losing water continuously, or if more fluid is in the balloon than was initially inserted, the balloon may have a small hole. Replace the tube or button as soon as possible. Even if the balloon has burst, the tube or button can be taped in place until it can be replaced.

Changing the Tube

Depending on the type of tube or button your child has, it may be possible for you to learn to change it at home. Do not change a tube or button at home until your doctor or nurse has said you may do so and instructed you on the proper method. New tubes should not be changed at home, as the tube tract may not have fully developed yet.

Children with tubes held in by mushrooms, barriers, or collapsible barriers typically cannot be changed at home. Your doctor or nurse will need to change the tube in the office using special tools, such as an obturator.

If your child has a balloon button or tube and has had the device for at least two months, you may be able to change the tube at home. Ask your doctor or nurse for instructions on how to change the tube. In most cases, it is no more difficult than changing an earring.

The general method for changing a tube is as follows:

  1. Place your child on a flat surface where there is a low risk of falling. If your child is grabby or wiggly, you may want to have a second person hold him or her, or wrap the arms up in a partial swaddle. Make sure you have clean hands, a towel for any messes, the new tube kit, water-based lubricant, and a small cup of fresh water.
  2. The best time to change a button or tube is when the stomach is empty. Of course, this is not always possible. If the stomach is full, expect that some formula may leak out.
  3. First, prepare to remove the old button or tube. You may want to place some gauze or a towel around the stoma in case there is any leakage. Attach a slip tip syringe to the balloon port and withdraw all of the water from the balloon port. Pull out the tube or button. If the tube will not come out, do not force it. Tape it in place and call your nurse or doctor for assistance.
  4. Next, you may want to prepare the new tube by testing the balloon. Hold the new tube in the air and attach a a fresh slip tip syringe filled with the amount of water your doctor has recommended. Tap water is fine unless you have unsafe water or your child has immune system problems. Inflate the balloon by pushing the water in the syringe into the balloon port to test the balloon for leaks. If there are no leaks, deflate the balloon by drawing the water back into the syringe. Leave the syringe attached.
  5. Coat the balloon and “stem” of the new tube with water-based lubricant, such as KY jelly, and slide it into the stoma. If you cannot get the tube in, call your doctor or nurse immediately. Sometimes it does take a bit of effort, but you should not feel like you are forcing it in.
  6. Once the tube is in place, fill the balloon with the water by pushing the water in the syringe into the balloon port. Remove the syringe and save for later use. Clean the area around the stoma in case any leakage occurred. You may also want to turn the tube once or twice to make sure it fits well and moves easily.
  7. Some doctors recommend that you verify the placement of the tube by withdrawing gastric contents through the new tube. If no gastric contents are seen, call your doctor or nurse before using the tube.