What are feeding tubes?
Gastrostomy tubes (G tubes), combination gastrostomy/gastrojejunostomy (G/GJ) and gastrojejunostomy tubes (GJ tubes) are feeding devices. A G tube gives liquid nutrition, medication and other fluids directly into the stomach. A GJ tube gives liquid nutrition, medication and other fluids directly into the small intestine (the jejunum). Both G tubes and GJ tubes are placed through a small opening in the stomach. This opening is called a "stoma". The tunnel from the outside of the body to the stomach is called the "tract".
| The SickKids G-Tube Feeding Program has developed a one page guide to help you quickly troubleshoot any issues with your child's feeding tube: G-Tube Feeding Program Family One Pager |
The balloon port
- The balloon at the end of your child’s feeding tube is what keeps the tube in place and prevents it from being accidentally pulled out.
- The balloon is inflated with sterile or distilled water. You may also use tap water that has been boiled and cooled down.
- The water is inserted through the hard plastic port, which may be marked "BAL". If you are unsure how much water your child’s balloon tube can safely hold or you are not sure how much water the balloon was originally filled with, ask your G tube specialist (at SickKids this is the G Tube Resource Nurse) or refer to the chart below.
G tubes
| Non-low profile |
Low-profile | |||
|---|---|---|---|---|
| Mic-G | Kangaroo | Mic-Key | AMT miniONE | |
| 12FR | 3 to 5 mL (max 7 mL) | 5 mL | 3 to 5 mL | 2 to 3 mL |
| 14FR | 3 to 5 mL (max 7 mL) | 5 mL | 5 to 10 mL | 3 to 5 mL |
Mic-Key GJ tube
5 to 10 mL
Low profile combination G/GJ tube
| Internal tube length | Minimum balloon volume | Maximum balloon volume |
| 15 cm, 22 cm and 30 cm | 3 mL | 5 mL |
| 45 cm | 5 mL | 10 mL |
Checking the volume of water in the balloon
It is important to check the amount of water in the balloon at least once a week. Use a 5 mL slip-tip syringe to check the balloon.
- Insert a 5 mL syringe into the balloon port.
- Remove all the water from the balloon. Throw the removed water away. It is normal for the removed water to be discoloured (brown or yellow).
- Re-inflate the balloon with new sterile or distilled water.
It is normal for less water to be removed from the balloon than you originally put in. This is because some of the water might have evaporated. It is normal for there to be a difference of up to 0.5 mL.
If there is a difference of more than 0.5 mL of water from what you put in and what you remove, the balloon may be damaged, and the tube may need to be replaced. If this happens:
- Re-inflate the balloon with the amount of water you normally put in and check the volume again in three to four hours.
- If you get all the water back, the water may have simply evaporated quicker than usual. Re-inflate the balloon with the amount of water you normally put in and check the balloon volume every three to four days to be sure there are no further problems.
- If you get less water back again after three to four hours, the balloon is likely damaged, and the tube will need to be replaced.
- If you get more fluid than what you originally put in the balloon, and it looks like stomach contents or food, this means the balloon is broken and the tube will need to be replaced.
If the balloon is broken, there is a risk that the tube may be accidentally pulled out. Tape the tube in place to the abdomen until you can change the tube yourself or book an appointment with your G tube specialist to help you change the tube.
Meanwhile, the tube is still in the stomach so you can continue to use the tube for feeding and medications. There is no need to go the emergency department if the balloon is broken.
Fit of balloon tube
For low profile balloon tubes, filling the balloon with more or less water can affect the fit of the tube to the skin. Leaking and stoma issues may occur if the tube does not fit properly. Less water in the balloon makes the tube sit looser and stick out from the skin. More water in the balloon makes the tube sit tighter and closer to the skin.
Adjusting the balloon for a tighter/looser fit
If the tube is so tight you can see an indent in your child’s skin, you can decrease the amount of water in the balloon.
If the tube sticks out too much and is dangling from the stoma or leaking, increase the amount of water in the balloon. If adjusting the balloon volume does not help with the fit of your child’s tube, you may need to have the tract re-measured by your G tube specialist.
For non low-profile balloon tubes, the retention disk may be adjusted to manage the fit of the tube. Ensure the balloon is in a good position against the stomach wall before adjusting the disk. You can achieve this by pulling the tube upward until you feel resistance, which represents the balloon against the stomach wall. You can then slide the retention disk down the tube shaft, flush against the abdominal wall.