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G/GJ tubes: Balloon G tubesGG/GJ tubes: Balloon G tubesG/GJ tubes: Balloon G tubesEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Abdomen;StomachDigestive systemProceduresAdult (19+) CaregiversNA2018-10-25T04:00:00ZHolly Norgrove, RN, BScN6.5000000000000075.30000000000002843.00000000000Health (A-Z) - ProcedureHealth A-Z<p>A balloon G tube is a type of feeding tube that has a balloon on the end to help prevent the tube from being accidentally pulled out. Learn how to care for your child’s balloon G tube and change it at home. </p><p>Gastrostomy tubes (G tubes) are feeding devices that provide liquid nutrition, medications and other fluids directly into the stomach. G tubes are placed through a surgical opening in your child's tummy (abdomen) called a stoma. The tunnel from the outside into the stomach is called the tract.</p><p>Balloon G tubes have a balloon on the end inside the stomach to keep the tube in place. These tubes may be non low-profile or low-profile.</p><h2>Key points </h2><ul><li>A balloon G tube is a type of feeding tube that has a balloon on the end inside the stomach to prevent it from being pulled out. </li><li>A non low-profile balloon G tube extends further out of the stomach and has a disk on the outside to keep the tube from moving too far into the stomach. A low-profile balloon G tube sits close to the skin and is easy to conceal. </li><li>Balloon G tubes should be changed at least every six to eight months to prevent the balloon from leaking which can cause the G tube to accidentally fall out. </li><li>The G tube feeding extension set should be changed every month. </li><li>Whenever you change or re-insert a G tube, before using it for feeds and medications, always check the pH of the fluids that come from the tube to make sure it is in the stomach. </li><li>You do not need to go to the emergency department if your child’s balloon is broken, blocked or the tube accidentally falls and you replace the tube or insert a Foley catheter. You will only need to go the emergency department if you cannot insert an emergency Foley catheter and there is nothing in the tract. </li></ul><h2>What to do if your child’s balloon G tube is pulled out or becomes blocked</h2><h3>If the tube is accidentally pulled out</h3><p>It is possible that the G tube may accidentally fall out or be pulled out. This may happen if the balloon is broken or does not have enough water in it.</p><p>To check if the balloon is broken, fill it with 5 mL of water. If you do not see a leak, remove the water from the balloon, wash the G tube with soap and water and reinsert it into the stoma as described above. Fill the balloon with the amount of water you normally use. Check the balloon every two to three days to be sure there are no further problems.</p><p>If the balloon is broken, replace it with a new tube as described above.</p><p>If you cannot replace the G tube, insert a temporary Foley catheter. To learn how to insert the Foley catheter, please see the article “<a href="/Article?contentid=2910&language=English">What to do if your child’s feeding tube is pulled out</a>”. You can use the Foley catheter for feeds and medication until a new G tube inserted. </p><h3>If the tube becomes blocked</h3><p>To learn what to do if your child’s G tube becomes blocked, please see the article “<a href="/Article?contentid=3039&language=English">What to do if your child’s feeding tube is blocked</a>”.</p><p>Remember to always carry an emergency kit that includes: </p><ul><li>a back-up G tube or Foley catheter</li><li>water-based lubricant or jelly</li><li>syringes</li><li>water</li><li>pH strips and colour reference guide</li><li>tape in case of unexpected tube changes</li><li>an adaptor or extension set</li></ul><p> <strong>You do not need to go to the emergency department if the tube falls out or becomes blocked and you replace the tube or insert a Foley catheter.</strong> You will only need to go the emergency department if you cannot insert an emergency Foley catheter and there is nothing in the tract.</p><h2>Caring for your child’s balloon G tube</h2><p>Keep the tube and stoma as dry and clean as possible, washing with soap and water daily. Your child’s stoma will not need a dressing.</p><p>Flush the tube with at least 5 to 10 mL of water before and after each feed and medication dose, and every four hours during continuous feeds. This helps prevent the tube from becoming blocked. </p><h3>The balloon</h3> <figure> <span class="asset-image-title">Balloon port</span><img src="https://assets.aboutkidshealth.ca/akhassets/Gtube_balloonport_labels.jpg" alt="Balloon and balloon inflation port at the end of a G tube" /> </figure> <p>The balloon at the end of your child’s 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. The water is inserted through the balloon port, marked “BAL”. Do not fill the balloon with saline or air. Do not feed into the balloon port. </p><p>If you are unsure how much water your child’s balloon tube can safely hold, ask your G tube specialist (at SickKids this is the G Tube Resource Nurse) or refer to the chart below.</p> <table class="akh-table"><thead><tr><th>  </th><th colspan="2">Non-low profile<br></th><th colspan="2">Low-profile</th></tr></thead><tbody><tr><td></td><td>Mic-G</td><td>Kangaroo</td><td>Mic-Key</td><td>AMT miniONE</td></tr><tr><td>12FR</td><td>3-5mL (max 7mL)</td><td>5mL </td><td>3 to 5mL</td><td>2 to 3mL</td></tr><tr><td>14FR</td><td>3-5mL (max 7mL)</td><td>5mL </td><td>5 to 10mL</td><td>4 to 5mL</td></tr></tbody></table> <p>Filling the balloon with more or less water can affect the fit of the tube to the skin. 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. 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, you can 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.</p><p>It is important to check the amount of water in the balloon at least once a week. This will help you to know if there is a problem with the balloon. Use a slip-tip syringe to check the balloon.</p><ol><li>Insert an empty syringe into the balloon port.</li><li>Remove all the water from the balloon. Throw away the old water. It is normal for the water to become discoloured (brown or yellow).</li><li>Re-inflate the balloon with new sterile or distilled water.</li></ol><p>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 0.5mL.</p><p>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:<br></p><ul><li>Re-inflate the balloon with the amount of water you normally put in and check again in three to four hours. </li><li>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. </li><li>If you get less back again after three to four hours, the balloon is likely damaged and the tube will need to be replaced. </li><li>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 definitely broken and the tube will need to be replaced. </li></ul><p>If you are concerned that the balloon is broken, there is a risk that the tube may be accidentally pulled out. Tape the tube in place 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. </p><h2>Feeding extension set for a low-profile balloon G tube</h2><p>The feeding port for a low-profile balloon G tube, where your child’s feeds will enter the tube and then go into their stomach, has a one-way valve to prevent stomach contents, feeds, water and medications from flowing back out of the tube. To open this one-way valve, and give feeds and medications, you must use a feeding extension set. Each brand has their own extension set. You will receive one in the box with your new low-profile balloon G tube. Replacement extension sets are purchased separately when needed. </p><div class="asset-2-up"> <figure><span class="asset-image-title">Extension set detached from tube</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/Gtube_extensionset_separate_labels.jpg" alt="Parts of an extension set detached from G tube" /> </figure><figure><span class="asset-image-title">Extension set attached to tube</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/Gtube_extensionset_attached_labels.jpg" alt="Parts of an extension set attached to G tube" /> </figure> </div><h3>Connecting the extension set to the tube</h3><ol><li>Open the plastic cover.</li><li>Make sure the clamp on the extension set is closed.</li><li>Match the line on the extension to the line on the tube and push the extension into the valve.</li><li>Holding the tube in place, turn the extension clockwise until you feel the extension lock into place. There is an arrow on the extension to show you which direction to turn it. </li><li>Attach your feeds, fluids and medications to the appropriate port at the end and open the clamp.</li><li>When you have finished using the extension, flush it and remove it from the tube.</li></ol><h3>Removing the extension from the tube</h3><ol><li>Make sure the clamp on the extension set is closed.<br></li><li>Holding the tube in place, turn the extension counter-clockwise (opposite to the arrow on the extension).</li><li>Match the line on the extension to the line on the tube and remove the extension.</li><li>Close the plastic cover. </li></ol><p>The extension set should be changed once every month, or if you notice the plastic is becoming stiff or there is formula, food or medications built up inside. It is important to flush the extension set with water between each use and clean it with soap and water once daily. Remove the extension set from the tube when it is not in use to prevent pulling.</p><h2>How to change the balloon G tube</h2><div class="asset-video"> <iframe src="https://www.youtube.com/embed/_qW4lemX3rE?rel=0" frameborder="0"></iframe> <br></div><h3>Supplies</h3><ul><li>New balloon G tube</li><li>Soap</li><li>Warm water</li><li>Washcloth</li><li>Sterile or distilled water</li><li>Four 5-mL slip-tip syringes</li><li>Water-based lubricant or jelly</li><li>Feeding extension set (for low-profile G tubes)</li><li>pH strips and colour reference guide</li></ul><h3>Procedure</h3><ol><li>Wash your hands with soap and water, and prepare your equipment and supplies.</li><li>Draw up the amount of water recommended to fill the balloon of your child’s tube into one syringe. Draw 5 mL of water into another syringe to flush the tube. Leave the other two syringes empty. You will use these to remove the old water from the balloon and checking the pH).</li><li>Prepare your washcloth with soap and water on one half of the cloth and non-soapy water on another part.</li><li>Check that the balloon of the new G tube is not broken by inflating the balloon with new water you have already drawn up. Gently squeeze the balloon to check for leaks caused by defects. Remove all the water from the balloon before continuing.</li><li>Remove the sterile or distilled water from the balloon of the old G tube using one of the empty syringes. Throw the water and syringe away.</li><li>Remove the old G tube. It is normal for the inner part of the tube to be brown or black. This is caused by acidic stomach contents. Throw away the old tube.</li><li>This is a great time to assess the stoma for any changes, such as redness, drainage, rash, or granulation tissue. Wash the stoma with soap and water and rinse it with non-soapy water. Then let it air dry.</li><li>Lubricate the tip of the new balloon G tube and, at a slight angle, insert it into the stoma, following the existing tract. The tube may be slightly resistant and it is okay to exert light force. Try to time insertion with when your child breaths in, as they are most relaxed at that time.</li><li>Once the tube is in place, inflate the balloon with the amount of sterile or distilled water you usually put in. Gently pull the tube until you feel resistance. This indicates that the balloon has reached the inside of the stomach wall.</li><li>Check that the tube is in the stomach by checking the pH as described below. Once you know the tube is in the stomach, by getting a pH of 6.0 or less, flush the tube with 5mL of water. If your child has a low-profile tube you will need to use the feeding extension set to flush the tube.</li><li>If your child has a non low-profile tube, adjust the outer disk so it sits snug against the skin. </li></ol><p>You may now use the tube for feeding and medications.</p><h2>Checking that the newly changed balloon tube is in the right spot</h2><p>Before using the newly changed tubes for feeds and medications, you will need to check that it is in the stomach by checking the pH of the contents that are pulled from the tube. </p><h3>How to check the pH</h3><p>You will need:</p><ul><li>One empty slip tip syringe</li><li>The feeding extension set for a low-profile balloon G tube (for low-profile tubes only)</li><li>pH strips</li><li>pH colour reference guide</li></ul><p>What to do:</p><ol><li>Once you have inserted the new tube, insert the empty syringe into the extension feeding set (for a low-profile balloon G tube) or directly into the tube’s medication port (for a non low-profile balloon G tube) and pull back a small amount of stomach contents. If you cannot get stomach contents, move your child side to side or sit them up.</li><li>Empty the stomach contents from the syringe onto the pH strip.</li><li>Compare the colours on the pH strip to the colours on the reference guide.</li></ol><p> <strong>If the pH is 6.0 or less</strong>, the tube is in the stomach and you can flush the tube and use it for feeding and medications.</p><p> <strong>If the pH is higher than 6.0</strong>, the tube may not be in the stomach. Medications and recent feedings can affect the pH. <strong>If you get a high reading, do not use the tube for feeding or medications and check the pH again one hour later.</strong> If the reading is still higher than 6.0, do not use the tube and contact your G tube specialist to have the position checked in an interventional radiology department. </p><h2>Resources</h2><p>For more information about the Mic-Key, visit <a href="https://www.mic-key.com/">www.mic-key.com</a>.</p><p>For more information about the AMT miniONE, visit <a href="https://www.appliedmedical.net/enteral/minione/balloon/">www.appliedmedical.net/enteral/minione/balloon/</a>.</p>
Sondes gastriques (G) et sondes gastrojéjunales (GJ) : sondes G à ballonnetSSondes gastriques (G) et sondes gastrojéjunales (GJ) : sondes G à ballonnetG/GJ tubes: Balloon G tubesFrenchGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Stomach;Abdomen;Small IntestineDigestive systemProceduresAdult (19+) CaregiversNA2018-10-25T04:00:00ZHolly Norgrove, RN, BScNHealth (A-Z) - ProcedureHealth A-Z<p>La sonde G à ballonnet est une sonde alimentaire comportant un ballonnet à son extrémité afin d’éviter qu’elle soit retirée de manière accidentelle. Apprenez à prendre soin de la sonde G de votre enfant et à la changer.</p><p>Les sondes G sont des dispositifs d’alimentation qui permettent d’administrer des aliments liquides, des médicaments et des liquides directement dans l’estomac. On les met en place en pratiquant une ouverture (stomie) au moyen d’une intervention chirurgicale dans l’abdomen de l’enfant. Nous appelons « tube » le tunnel ainsi formé depuis l’extérieur jusque dans l’estomac.</p><p>Les sondes G à ballonnet comportent à l’extrémité d’un raccord un ballonnet qui se trouve dans l’estomac afin de garder la sonde en place. Ces sondes peuvent être de type discret ou non.</p><h2>À retenir</h2><ul><li>La sonde G à ballonnet est une sonde alimentaire comportant à son extrémité un ballonnet placé dans l’estomac afin d’éviter qu’elle ne soit retirée de manière accidentelle.</li><li>La sonde G à ballonnet de type non discret se prolonge hors de l’estomac et comporte un disque à l’extérieur pour l’empêcher de pénétrer trop profondément dans l’estomac. La sonde G discrète affleure la peau et peut être facilement dissimulée.</li><li>Il faut remplacer les sondes G à ballonnet au moins tous les six à huit mois pour éviter que des fuites du ballonnet ne provoquent leur retrait accidentel.</li><li>L’assortiment de rallonges pour l’alimentation de la sonde G doit être remplacé tous les mois.</li><li>Lors du remplacement d’une sonde G ou de sa réinsertion, et avant de l’utiliser pour l’alimentation ou l’administration de médicaments, il convient de toujours vérifier le pH des liquides qui proviennent de la sonde afin de s’assurer que celle-ci se trouve bien dans l’estomac.</li><li>Vous n’avez pas besoin de vous rendre au service des urgences en cas de bris ou de blocage du ballonnet ou si la sonde tombe par accident et qu’il vous faut la remettre en place ou introduire un cathéter de Foley. Le seul cas où vous devrez vous y rendre, c’est celui où vous êtes incapable d’introduire d’urgence un cathéter de Foley et que le tube est vide.<br></li></ul><h2>Ce qu’il faut faire si la sonde G à ballonnet de votre enfant est retirée ou se bouche </h2><h3>En cas de retrait accidentel de la sonde</h3><p>Il est possible que la sonde G soit retirée par accident ou qu’elle tombe. C’est ce qui peut arriver si le ballonnet est endommagé ou qu’il ne contient pas suffisamment d’eau.</p><p>Afin de vérifier si le ballonnet est endommagé, ajoutez-lui 5 ml d’eau. Si vous n’observez aucune fuite, retirez l’eau du ballonnet et nettoyez la sonde G à l’eau et au savon. Réintroduisez-la ensuite dans la stomie comme le suggère la description donnée ci-dessus. Versez dans le ballonnet la quantité d’eau habituellement utilisée. Vérifiez-le tous les deux ou trois jours pour vous assurer qu’il n’y aura plus de problèmes.</p><p>Si le ballonnet est endommagé, remplacez-le et installez-le accompagné d’une nouvelle sonde comme on le décrit ci-dessus.</p><p>Si vous ne pouvez pas remplacer la sonde G, utilisez temporairement un cathéter de Foley. Pour savoir comment introduire celui-ci, veuillez lire l’article « <a href="/Article?contentid=2910&language=English">What to do if your child’s feeding tube is pulled out</a>». Vous pouvez utiliser le cathéter de Foley pour l’alimentation et l’administration de médicaments jusqu’à ce qu’une nouvelle sonde G soit introduite.</p><h3>En cas de blocage de la sonde</h3><p>Pour savoir ce qu’il faut faire lorsque la sonde G se bouche, veuillez lire l’article « <a href="/Article?contentid=3039&language=French">Sondes gastriques (G) ou gastrojéjunales (GJ) : quoi faire si la sonde d’alimentation est bouchée</a> ». Rappelez-vous de toujours garder avec vous une trousse de secours qui contient ce qui suit :</p><ul><li>Une sonde G ou un cathéter de Foley de sauvegarde </li><li>Un lubrifiant à base d’eau ou un hydrogel</li><li>Des seringues</li><li>De l’eau</li><li>Des bandelettes indicatrices de pH et un guide de référence des couleurs</li><li>Du ruban adhésif en cas de changements inattendus dans la sonde</li></ul><p>Vous n’avez pas à vous rendre au service des urgences si la sonde tombe ou qu’elle se bouche et que vous la remplacez ou vous vous servez d’un cathéter de Foley. Il n’est nécessaire de vous y rendre que si vous êtes incapable d’introduire un cathéter de Foley et que le tube est vide.</p><h2>Les soins à apporter à la sonde G à ballonnet de votre enfant</h2><p>Prenez soin de garder la sonde et la stomie aussi propres et secs que possible, en les nettoyant chaque jour à l’eau et au savon. La stomie ne nécessite aucun pansement.</p><p>Rincez la sonde en utilisant au moins 5 à 10 ml d’eau avant et après chaque repas et administration de médicaments et toutes les quatre heures pendant les séances d’alimentation continue. Ces précautions ont pour but de prévenir le blocage.</p><h3>Le ballonnet</h3><p>Le ballonnet à l’extrémité de la sonde a pour but de la garder en place et de prévenir son retrait accidentel de l’estomac. Il contient de l’eau stérile ou distillée qui a été versée par l’orifice du ballonnet sur lequel est inscrit « BAL ». Ne le remplissez pas d’air ni d’eau saline. N’utilisez pas l’orifice du ballonnet pour l’alimentation. Si vous ignorez la quantité exacte d’eau qu’il doit contenir, informez-vous auprès de l’expert des sondes G (à l’hôpital SickKids, notre infirmier-ressource pour les sondes G joue ce rôle) ou reportez-vous au tableau ci-dessous.</p><table class="akh-table"><thead><tr><th>  </th><th colspan="2">Type non discret</th><th colspan="2">Type discret</th></tr></thead><tbody><tr><td></td><td>Mic-G</td><td>Kangaroo</td><td>Mic-Key</td><td>AMT miniONE</td></tr><tr><td>12 Ch</td><td>De 3 à 5 ml (max 7 ml)</td><td>5ml</td><td>De 3 à 5 ml</td><td>De 2 à 3 ml</td></tr><tr><td>14 Ch</td><td>De 3 à 5 ml (max 7 ml)</td><td>5ml</td><td>De 5 à 10 ml</td><td>De 4 à 5 ml</td></tr></tbody></table><p>Un volume d’eau supérieur ou inférieur à celui indiqué pour le ballonnet nuira à l’adaptation de la sonde au site d’insertion. Un volume inférieur diminuera la tension sur la sonde qui aura tendance à sortir de l’estomac. Un volume supérieur aura l’effet inverse en rapprochant la sonde de la peau et en augmentant la tension. Si vous observez sur la peau une marque indiquant une trop forte pression, vous pouvez réduire la quantité d’eau contenue dans le ballonnet. Si la sonde visible à l’extérieur est trop longue et qu’elle pend, vous pouvez augmenter la quantité d’eau. Dans le cas où les modifications apportées ne sont d’aucun secours, vous pouvez demander à l’expert des sondes G de mesurer de nouveau la sonde.</p><p>Il est important de vérifier la quantité d’eau que contient la sonde au moins une fois par semaine. Il sera également plus facile de détecter un problème quelconque avec le ballonnet. Vous pouvez utiliser une seringue à embout glissant à cette fin.</p><ol><li>Introduisez une seringue vide dans l’orifice du ballonnet.</li><li>Drainez complètement le ballonnet. Jetez l’eau qu’il contient. Il est normal qu’elle soit trouble (de couleur jaune ou brune).</li><li>Gonflez de nouveau le ballonnet en le remplissant d’eau distillée ou stérile.</li></ol><p>Il est normal que le volume d’eau ait diminué au fil du temps à cause de l’évaporation. Une différence maximale de 0,5 ml est tout à fait normale. Si la différence entre le volume que vous avez ajouté et celui que vous avez retiré est supérieure à 0,5 ml, le ballonnet peut être endommagé et la sonde peut devoir être remplacée. Dans ce cas, procédez comme suit :</p><ul><li>Versez la quantité d’eau habituelle dans le ballonnet et vérifiez de nouveau trois à quatre heures plus tard.</li><li>Si la quantité d’eau n’a pas varié, l’évaporation peut simplement s’être produite plus vite que d’habitude. Remplissez de nouveau le ballonnet en versant la quantité d’eau habituelle et vérifiez toutes les trois à quatre heures plus tard pour vous assurer qu’il n’y a plus aucun problème.</li><li>Si la quantité d’eau est inférieure après ce délai, le ballonnet est probablement endommagé et vous devrez remplacer la sonde.</li><li>Si la quantité de liquides est supérieure après ce délai et qu’il semble que le contenu de l’estomac ou des aliments se retrouvent dans le ballonnet, ce dernier est définitivement défectueux et la sonde doit être remplacée.</li></ul><p>Si vous craignez que le ballonnet ne fonctionne pas comme prévu et que la sonde risque d’être retirée par accident, il convient de bien la fixer à l’aide de ruban adhésif en attendant qu’elle soit remplacée par vous ou l’expert des sondes G dont vous aurez eu soin de réserver les services en prenant rendez-vous pour qu’il vous aide à remplacer la sonde. En attendant, la sonde se trouvant toujours dans l’estomac, vous pouvez continuer à l’utiliser pour l’alimentation et l’administration de médicaments. Il n’y a pas lieu de vous présenter au service des urgences si le ballonnet est endommagé.</p><h2>Assortiment de rallonges pour l’alimentation prévues pour une sonde G à ballonnet de type discret</h2><p>L’orifice pour l’alimentation d’une sonde G à ballonnet de type discret, soit l’endroit par lequel les aliments sont introduits dans la sonde pour être ensuite dirigés vers l’estomac, comporte une valve unidirectionnelle qui empêche le contenu de l’estomac, les aliments, l’eau et les médicaments de refluer vers la sonde. Pour que la valve unidirectionnelle puisse laisser passer les aliments et administrer les médicaments, vous devez la brancher à un assortiment de rallonges prévues à cet effet qui varient selon la marque. Celle qui vous convient est fournie avec votre nouvelle sonde G à ballonnet de type discret. Au besoin, vous pouvez acheter des assortiments de rallonges séparément.</p><h3>Branchement de l’assortiment de rallonges à la sonde</h3><ol><li>Ouvrir l’emballage en plastique.</li><li>S’assurer que la pince sur la rallonge est en position fermée.</li><li>Faire correspondre la ligne indicatrice sur la rallonge à la ligne indicatrice sur la sonde et enfoncer la rallonge dans la valve.</li><li>La sonde étant en position, tourner la rallonge dans le sens des aiguilles d’une montre jusqu’à ce qu’elle soit bien en place. Une flèche figurant sur la rallonge indique dans quelle direction il faut tourner. </li><li>Fixer les différentes sondes pour l’alimentation, les liquides et les médicaments à l’orifice approprié et ouvrir la pince.</li><li>Une fois que la rallonge n’est plus utile, la rincer à grande eau et la retirer de la sonde.</li></ol><h3>Retrait de la rallonge raccordée à la sonde</h3><ol><li>S’assurer que la pince sur la rallonge est fermée.</li><li>Tout en gardant la sonde en place, tourner la rallonge dans le sens contraire des aiguilles d’une montre (du côté opposé à la flèche indiquée sur la rallonge).</li><li>Faire correspondre la ligne indicatrice sur la rallonge à celle de la sonde et retirer la rallonge.</li><li>Fermer le couvercle en plastique.</li></ol><p>L’assortiment de rallonges doit être remplacé tous les mois ou avant si vous remarquez que le plastique durcit ou que des aliments, des médicaments ou de la préparation lactée s’y accumulent. Il est important de le rincer à grande eau entre chaque utilisation et de le nettoyer au savon et à l’eau une fois par jour. Retirez la rallonge de la sonde lorsqu’elle n’est pas utilisée pour prévenir son retrait accidentel.</p><h2>Comment remplacer la sonde G à ballonnet</h2><h3>Fournitures</h3><ul><li>Nouvelle sonde G à ballonnet</li><li>Savon</li><li>Eau chaude</li><li>Débarbouillette </li><li>Eau stérile ou distillée</li><li>Quatre seringues à embout glissant de 5 ml</li><li>Lubrifiant à base d’eau ou hydrogel</li><li>Assortiment de rallonges pour l’alimentation (prévues pour les sondes G de type discret)</li><li>Bandelettes indicatrices de pH et guide de référence des couleurs</li></ul><h3>Procédure</h3><ol><li>Lavez-vous les mains à l’eau et au savon, et préparez l’équipement et les fournitures.</li><li>Soutirez le volume d’eau recommandé pour remplir le ballonnet de la sonde à l’aide d’une seule seringue. Avec une autre seringue, soutirez 5 ml d’eau pour bien rincer la sonde. Réservez les deux autres seringues vides (qui serviront à drainer la vieille eau du ballonnet et à vérifier le pH).</li><li>Préparez votre débarbouillette en savonnant et en humectant bien une moitié, mais en humectant l’autre moitié sans la savonner.</li><li>Vérifiez que le ballonnet de la nouvelle sonde G n’est pas endommagé en le remplissant de la nouvelle eau que vous avez soutirée. Pressez doucement sur le ballonnet pour vérifier les fuites possibles causées par des défauts. Retirez toute l’eau que contient le ballonnet avant de continuer.</li><li>Drainez l’eau stérile ou distillée du ballonnet de la vieille sonde G à l’aide de l’une des seringues vides. Jetez l’eau et la seringue.</li><li>Retirez l’ancienne sonde G. Il est normal que la partie intérieure de la sonde soit brune ou noire. Le contenu acide de l’estomac en est la cause. Jetez l’ancienne sonde.</li><li>Le moment est idéal pour évaluer la stomie en repérant tous les changements survenus comme la rougeur, la capacité de drainage, la présence d’une éruption cutanée ou d’un tissu de granulation. Nettoyez la stomie à l’eau et au savon et rincez-la à l’eau non savonneuse. Laissez-la sécher à l’air libre. </li><li>Lubrifiez l’extrémité de la nouvelle sonde G à ballonnet et introduisez-la dans la stomie en l’inclinant légèrement, en suivant le parcours existant. La sonde peut se légèrement résister et vous pouvez exercer raisonnablement une certaine force. Faites correspondre le mouvement d’insertion avec les inspirations que prend l’enfant, soit au moment où il se détend le plus.</li><li>Une fois la sonde en place, gonflez le ballonnet en injectant la quantité d’eau distillée ou stérile qui y est habituellement introduite. Retirez-la délicatement jusqu’à ce qu’une résistance se fasse sentir. Le ballonnet a alors atteint l’intérieur de la paroi de l’estomac.</li><li>Vérifiez la position de la sonde dans l’estomac en vérifiant le pH selon la méthode décrite ci dessous. Une fois que vous vous êtes assuré qu’elle se trouve bien dans l’estomac en ayant obtenu une lecture d’un pH égal ou inférieur à 6, rincez-la avec 5 ml d’eau. Si votre enfant est muni d’une sonde discrète, vous devrez utiliser l’assortiment de rallonges pour l’alimentation prévue pour rincer la sonde.</li><li>Si votre enfant n’est pas muni d’une sonde de type discret, ajustez le disque extérieur de manière à ce qu’il soit plaqué contre la peau.</li></ol><p>Vous pouvez maintenant utiliser la sonde pour l’alimentation et l’administration de médicaments.</p><h2>Vérification de l’emplacement de la nouvelle sonde à ballonnet</h2><p>Avant d’utiliser les nouvelles sondes pour l’alimentation et l’administration de médicaments, vous devrez vérifier que la sonde se trouve bien dans l’estomac en vérifiant le pH du contenu qui est retiré de la sonde.</p><h3>Comment vérifier le pH</h3><p>Vous aurez besoin des outils suivants :</p><ul><li>Une seringue à embout glissant vide</li><li>Un assortiment de rallonges pour l’alimentation convenant à une sonde G à ballonnet de type discret (uniquement les sondes discrètes)</li><li>Des bandelettes indicatrices de pH</li><li>Un guide de référence des couleurs du test de pH</li></ul><p>Instructions :</p><ol><li>Une fois la nouvelle sonde introduite, engagez la seringue vide dans l’assortiment de rallonges pour l’alimentation (qui convient à une sonde G à ballonnet de type discret) ou directement dans l’orifice de la sonde qui est prévu pour l’administration des médicaments (pour une sonde G à ballonnet de type non discret) et retirez une petite quantité du contenu de l’estomac. S’il est impossible de retirer un peu de ce contenu, faites rouler votre enfant sur un côté, puis sur l’autre ou demandez-lui de s’asseoir.</li><li>Videz le contenu de la seringue sur la bandelette indicatrice de pH.</li><li>Comparez les couleurs sur la bandelette de pH à celles du guide de référence.</li></ol><p>Si le pH est égal ou inférieur à 6, la sonde se trouve bien dans l’estomac et vous pouvez la rincer et l’utiliser pour l’alimentation et l’administration de médicaments.</p><p>Si le pH est supérieur à 6, la sonde peut ne pas se trouver dans l’estomac. Les médicaments et les aliments récemment ingérés peuvent modifier le pH. Si la lecture est élevée, n’utilisez pas la sonde pour alimenter ou administrer des médicaments et vérifiez le pH de nouveau une heure plus tard. Si la lecture est encore supérieure à 6, n’utilisez pas la sonde et communiquez avec votre expert des sondes G qui procédera à la vérification de sa position dans les locaux des services de radiologie interventionnelle.</p><p>Pour obtenir de plus amples informations sur la sonde Mic-Key, consultez le site à l’adresse <a href="https://www.mic-key.com/">www.mic-key.com</a>.</p><p>Pour obtenir de plus amples informations sur la sonde AMT miniONE, consultez le site à l’adresse <a href="https://www.appliedmedical.net/enteral/minione/balloon/">www.appliedmedical.net/enteral/minione/balloon/</a>.</p>

 

 

 

 

G/GJ tubes: Balloon G tubes2908.00000000000G/GJ tubes: Balloon G tubesG/GJ tubes: Balloon G tubesGEnglishGastrointestinal;OtherChild (0-12 years);Teen (13-18 years)Abdomen;StomachDigestive systemProceduresAdult (19+) CaregiversNA2018-10-25T04:00:00ZHolly Norgrove, RN, BScN6.5000000000000075.30000000000002843.00000000000Health (A-Z) - ProcedureHealth A-Z<p>A balloon G tube is a type of feeding tube that has a balloon on the end to help prevent the tube from being accidentally pulled out. Learn how to care for your child’s balloon G tube and change it at home. </p><p>Gastrostomy tubes (G tubes) are feeding devices that provide liquid nutrition, medications and other fluids directly into the stomach. G tubes are placed through a surgical opening in your child's tummy (abdomen) called a stoma. The tunnel from the outside into the stomach is called the tract.</p><p>Balloon G tubes have a balloon on the end inside the stomach to keep the tube in place. These tubes may be non low-profile or low-profile.</p><h2>Types of balloon G tubes</h2><h3>Non low-profile balloon G tubes</h3><p>A non low-profile balloon G tube is a long type of feeding tube that extends further out of the stomach. It has a disk that sits on the outside of the stomach to prevent the tube from moving too far into the stomach. You can connect feeding bags and syringes directly into the tube.</p> <figure> <span class="asset-image-title">Kangaroo G tube</span><img src="https://assets.aboutkidshealth.ca/akhassets/Gtube_non_lowprofile_Kanga_labels.jpg" alt="Parts of a Kangaroo G tube" /> </figure> <p>There are several brands of non low-profile balloon tubes, including:</p><ul><li>Halyard Mic-G</li><li>Kangaroo</li><li>Cook Entuit</li></ul><h3>Low-profile balloon G tubes</h3><p>A low-profile balloon G tube is a type of feeding tube that sits close to the skin and is easy to conceal. These tubes are sometimes referred to as a “button” because of how they sit on the skin. It is very important to know the specific brand of tube your child has. Low-profile balloon G tubes need a special extension set to connect to the tube to feed your child.</p><p>There are several different brands of low-profile G tubes, including:</p><ul><li>Mic-Key</li><li>AMT MiniONE</li><li>Nutriport</li></ul><div class="asset-2-up"> <figure> <span class="asset-image-title">Mic-Key</span><img src="https://assets.aboutkidshealth.ca/akhassets/Gtube_lowprofile_MIC_labels.jpg" alt="Parts of a Mic-Key low-profile G tube" /></figure><figure> <span class="asset-image-title">AMT MiniONE</span><img src="https://assets.aboutkidshealth.ca/akhassets/Gtube_lowprofile_AMT_labels.jpg" alt="Parts of an AMT MiniONE low-profile G tube" /> </figure></div><h2>Key points </h2><ul><li>A balloon G tube is a type of feeding tube that has a balloon on the end inside the stomach to prevent it from being pulled out. </li><li>A non low-profile balloon G tube extends further out of the stomach and has a disk on the outside to keep the tube from moving too far into the stomach. A low-profile balloon G tube sits close to the skin and is easy to conceal. </li><li>Balloon G tubes should be changed at least every six to eight months to prevent the balloon from leaking which can cause the G tube to accidentally fall out. </li><li>The G tube feeding extension set should be changed every month. </li><li>Whenever you change or re-insert a G tube, before using it for feeds and medications, always check the pH of the fluids that come from the tube to make sure it is in the stomach. </li><li>You do not need to go to the emergency department if your child’s balloon is broken, blocked or the tube accidentally falls and you replace the tube or insert a Foley catheter. You will only need to go the emergency department if you cannot insert an emergency Foley catheter and there is nothing in the tract. </li></ul><h2>What to do if your child’s balloon G tube is pulled out or becomes blocked</h2><h3>If the tube is accidentally pulled out</h3><p>It is possible that the G tube may accidentally fall out or be pulled out. This may happen if the balloon is broken or does not have enough water in it.</p><p>To check if the balloon is broken, fill it with 5 mL of water. If you do not see a leak, remove the water from the balloon, wash the G tube with soap and water and reinsert it into the stoma as described above. Fill the balloon with the amount of water you normally use. Check the balloon every two to three days to be sure there are no further problems.</p><p>If the balloon is broken, replace it with a new tube as described above.</p><p>If you cannot replace the G tube, insert a temporary Foley catheter. To learn how to insert the Foley catheter, please see the article “<a href="/Article?contentid=2910&language=English">What to do if your child’s feeding tube is pulled out</a>”. You can use the Foley catheter for feeds and medication until a new G tube inserted. </p><h3>If the tube becomes blocked</h3><p>To learn what to do if your child’s G tube becomes blocked, please see the article “<a href="/Article?contentid=3039&language=English">What to do if your child’s feeding tube is blocked</a>”.</p><p>Remember to always carry an emergency kit that includes: </p><ul><li>a back-up G tube or Foley catheter</li><li>water-based lubricant or jelly</li><li>syringes</li><li>water</li><li>pH strips and colour reference guide</li><li>tape in case of unexpected tube changes</li><li>an adaptor or extension set</li></ul><p> <strong>You do not need to go to the emergency department if the tube falls out or becomes blocked and you replace the tube or insert a Foley catheter.</strong> You will only need to go the emergency department if you cannot insert an emergency Foley catheter and there is nothing in the tract.</p><h2>Caring for your child’s balloon G tube</h2><p>Keep the tube and stoma as dry and clean as possible, washing with soap and water daily. Your child’s stoma will not need a dressing.</p><p>Flush the tube with at least 5 to 10 mL of water before and after each feed and medication dose, and every four hours during continuous feeds. This helps prevent the tube from becoming blocked. </p><h3>The balloon</h3> <figure> <span class="asset-image-title">Balloon port</span><img src="https://assets.aboutkidshealth.ca/akhassets/Gtube_balloonport_labels.jpg" alt="Balloon and balloon inflation port at the end of a G tube" /> </figure> <p>The balloon at the end of your child’s 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. The water is inserted through the balloon port, marked “BAL”. Do not fill the balloon with saline or air. Do not feed into the balloon port. </p><p>If you are unsure how much water your child’s balloon tube can safely hold, ask your G tube specialist (at SickKids this is the G Tube Resource Nurse) or refer to the chart below.</p> <table class="akh-table"><thead><tr><th>  </th><th colspan="2">Non-low profile<br></th><th colspan="2">Low-profile</th></tr></thead><tbody><tr><td></td><td>Mic-G</td><td>Kangaroo</td><td>Mic-Key</td><td>AMT miniONE</td></tr><tr><td>12FR</td><td>3-5mL (max 7mL)</td><td>5mL </td><td>3 to 5mL</td><td>2 to 3mL</td></tr><tr><td>14FR</td><td>3-5mL (max 7mL)</td><td>5mL </td><td>5 to 10mL</td><td>4 to 5mL</td></tr></tbody></table> <p>Filling the balloon with more or less water can affect the fit of the tube to the skin. 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. 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, you can 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.</p><p>It is important to check the amount of water in the balloon at least once a week. This will help you to know if there is a problem with the balloon. Use a slip-tip syringe to check the balloon.</p><ol><li>Insert an empty syringe into the balloon port.</li><li>Remove all the water from the balloon. Throw away the old water. It is normal for the water to become discoloured (brown or yellow).</li><li>Re-inflate the balloon with new sterile or distilled water.</li></ol><p>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 0.5mL.</p><p>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:<br></p><ul><li>Re-inflate the balloon with the amount of water you normally put in and check again in three to four hours. </li><li>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. </li><li>If you get less back again after three to four hours, the balloon is likely damaged and the tube will need to be replaced. </li><li>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 definitely broken and the tube will need to be replaced. </li></ul><p>If you are concerned that the balloon is broken, there is a risk that the tube may be accidentally pulled out. Tape the tube in place 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. </p><h2>Feeding extension set for a low-profile balloon G tube</h2><p>The feeding port for a low-profile balloon G tube, where your child’s feeds will enter the tube and then go into their stomach, has a one-way valve to prevent stomach contents, feeds, water and medications from flowing back out of the tube. To open this one-way valve, and give feeds and medications, you must use a feeding extension set. Each brand has their own extension set. You will receive one in the box with your new low-profile balloon G tube. Replacement extension sets are purchased separately when needed. </p><div class="asset-2-up"> <figure><span class="asset-image-title">Extension set detached from tube</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/Gtube_extensionset_separate_labels.jpg" alt="Parts of an extension set detached from G tube" /> </figure><figure><span class="asset-image-title">Extension set attached to tube</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/Gtube_extensionset_attached_labels.jpg" alt="Parts of an extension set attached to G tube" /> </figure> </div><h3>Connecting the extension set to the tube</h3><ol><li>Open the plastic cover.</li><li>Make sure the clamp on the extension set is closed.</li><li>Match the line on the extension to the line on the tube and push the extension into the valve.</li><li>Holding the tube in place, turn the extension clockwise until you feel the extension lock into place. There is an arrow on the extension to show you which direction to turn it. </li><li>Attach your feeds, fluids and medications to the appropriate port at the end and open the clamp.</li><li>When you have finished using the extension, flush it and remove it from the tube.</li></ol><h3>Removing the extension from the tube</h3><ol><li>Make sure the clamp on the extension set is closed.<br></li><li>Holding the tube in place, turn the extension counter-clockwise (opposite to the arrow on the extension).</li><li>Match the line on the extension to the line on the tube and remove the extension.</li><li>Close the plastic cover. </li></ol><p>The extension set should be changed once every month, or if you notice the plastic is becoming stiff or there is formula, food or medications built up inside. It is important to flush the extension set with water between each use and clean it with soap and water once daily. Remove the extension set from the tube when it is not in use to prevent pulling.</p><h2>How to change the balloon G tube</h2><div class="asset-video"> <iframe src="https://www.youtube.com/embed/_qW4lemX3rE?rel=0" frameborder="0"></iframe> <br></div><h3>Supplies</h3><ul><li>New balloon G tube</li><li>Soap</li><li>Warm water</li><li>Washcloth</li><li>Sterile or distilled water</li><li>Four 5-mL slip-tip syringes</li><li>Water-based lubricant or jelly</li><li>Feeding extension set (for low-profile G tubes)</li><li>pH strips and colour reference guide</li></ul><h3>Procedure</h3><ol><li>Wash your hands with soap and water, and prepare your equipment and supplies.</li><li>Draw up the amount of water recommended to fill the balloon of your child’s tube into one syringe. Draw 5 mL of water into another syringe to flush the tube. Leave the other two syringes empty. You will use these to remove the old water from the balloon and checking the pH).</li><li>Prepare your washcloth with soap and water on one half of the cloth and non-soapy water on another part.</li><li>Check that the balloon of the new G tube is not broken by inflating the balloon with new water you have already drawn up. Gently squeeze the balloon to check for leaks caused by defects. Remove all the water from the balloon before continuing.</li><li>Remove the sterile or distilled water from the balloon of the old G tube using one of the empty syringes. Throw the water and syringe away.</li><li>Remove the old G tube. It is normal for the inner part of the tube to be brown or black. This is caused by acidic stomach contents. Throw away the old tube.</li><li>This is a great time to assess the stoma for any changes, such as redness, drainage, rash, or granulation tissue. Wash the stoma with soap and water and rinse it with non-soapy water. Then let it air dry.</li><li>Lubricate the tip of the new balloon G tube and, at a slight angle, insert it into the stoma, following the existing tract. The tube may be slightly resistant and it is okay to exert light force. Try to time insertion with when your child breaths in, as they are most relaxed at that time.</li><li>Once the tube is in place, inflate the balloon with the amount of sterile or distilled water you usually put in. Gently pull the tube until you feel resistance. This indicates that the balloon has reached the inside of the stomach wall.</li><li>Check that the tube is in the stomach by checking the pH as described below. Once you know the tube is in the stomach, by getting a pH of 6.0 or less, flush the tube with 5mL of water. If your child has a low-profile tube you will need to use the feeding extension set to flush the tube.</li><li>If your child has a non low-profile tube, adjust the outer disk so it sits snug against the skin. </li></ol><p>You may now use the tube for feeding and medications.</p><h2>Checking that the newly changed balloon tube is in the right spot</h2><p>Before using the newly changed tubes for feeds and medications, you will need to check that it is in the stomach by checking the pH of the contents that are pulled from the tube. </p><h3>How to check the pH</h3><p>You will need:</p><ul><li>One empty slip tip syringe</li><li>The feeding extension set for a low-profile balloon G tube (for low-profile tubes only)</li><li>pH strips</li><li>pH colour reference guide</li></ul><p>What to do:</p><ol><li>Once you have inserted the new tube, insert the empty syringe into the extension feeding set (for a low-profile balloon G tube) or directly into the tube’s medication port (for a non low-profile balloon G tube) and pull back a small amount of stomach contents. If you cannot get stomach contents, move your child side to side or sit them up.</li><li>Empty the stomach contents from the syringe onto the pH strip.</li><li>Compare the colours on the pH strip to the colours on the reference guide.</li></ol><p> <strong>If the pH is 6.0 or less</strong>, the tube is in the stomach and you can flush the tube and use it for feeding and medications.</p><p> <strong>If the pH is higher than 6.0</strong>, the tube may not be in the stomach. Medications and recent feedings can affect the pH. <strong>If you get a high reading, do not use the tube for feeding or medications and check the pH again one hour later.</strong> If the reading is still higher than 6.0, do not use the tube and contact your G tube specialist to have the position checked in an interventional radiology department. </p><h2>How often should you change the balloon G tube?</h2><p>Most G tube manufacturers do not give a set time for how long you can use the tube. They suggest that it can stay in as long as it is functioning without leaks or defects. However, the tube should be changed at least every six to eight months to prevent leaks in the balloon, which could cause the tube to accidentally fall out.</p><p>When changing the tube, it is important to remember the risks involved.</p><p><em>Infection</em>: When you replace the tube, the stoma and the tract can become irritated and bacteria can be introduced. This increases the risk of <a href="/Article?contentid=2906&language=English">infection</a>. Always wash your hands before handling the tube, and whenever you have touched your child’s skin, and continue to clean the site with soap and water. Keep the site open to air.</p><p><em>Increased granulation tissue</em>: Removing an old tube and inserting a new one can irritate the skin and cause <a href="/Article?contentid=3019&language=English">granulation tissue</a>. This is a common occurrence. Your G tube specialist can help you deal with granulation tissue.</p><p><em>Perforation</em>: There is a possibility that, when inserting a new tube, the tube is not inserted along the existing tract. It could create a new tract and space inside the body. This is extremely rare. If your child has instant intolerance (vomiting) or severe pain after their first feeding with a new tube, go to the emergency department for assistance. A G tube check may need to be scheduled in the interventional radiology department. Perforation can lead to a condition called <a href="/Article?contentid=3398&language=English">peritonitis</a>. <br></p><h2>Resources</h2><p>For more information about the Mic-Key, visit <a href="https://www.mic-key.com/">www.mic-key.com</a>.</p><p>For more information about the AMT miniONE, visit <a href="https://www.appliedmedical.net/enteral/minione/balloon/">www.appliedmedical.net/enteral/minione/balloon/</a>.</p>https://assets.aboutkidshealth.ca/akhassets/Gtube_non_lowprofile_Kanga_labels.jpgG/GJ tubes: Balloon G tubesFalse

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