Advice after your nerve block for surgery
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Introduction
This leaflet explains about how to look after your balloon gastrostomy tube (BGT) at home, including any problems which can occur. If you have any further questions, please contact your dietitian or specialist nurse.
General Information on Feeding
A balloon gastrostomy tube is a tube which is inserted in radiology allowing you to feed directly into your stomach. You may sometimes hear it referred to as a RIG (radiologically inserted gastrostomy).
Why Do I Need a Balloon Gastrostomy Tube?
You may have had a balloon gastrostomy tube inserted because it is unsafe to have food by mouth, or because you are struggling to take enough food. It is likely that this will be for a long period of time. The tube should therefore provide additional food and fluid to meet your nutritional needs.
Initial Few Weeks After Tube Placement
You will notice your gastrostomy tube on your stomach, in the middle of two, three or four small discs. These discs each lock in place a suture (stitch) that secures your stomach to the inside of the abdomen. After 2-3 weeks these sutures will have done their job and will start to fall off. If the sutures do not fall off in the suggested time, please contact your nutrition specialist nurse to arrange removal.
If, in the first week following tube placement, you experience: any pain on feeding, any leakage at the tube insertion site or bleeding which does not resolve, seek urgent advice.
A few things to remember:
- For the first two weeks after placement:
- Do not rotate the suture locks, this may weaken the suture and cause early detachment
- Do not rotate or advance the gastrostomy tube
- Do not inflate / deflate the balloon
- It is important to keep the stoma site and suture lock sites clean using cool boiled water. A cotton bud is suitable for cleaning under the suture lock.
- Do not submerge the gastrostomy site in water before the sutures have been removed. If you have a shower, protect the gastrostomy site with a waterproof dressing
- Inspect the stoma and suture lock sites daily and assess for any signs of infection. Notify your doctor or nurse of any of the following:
- Redness
- Irritation
- Oedema (bruising)
- Swelling
- Tenderness
- Warmth
- Rash
- Purulent or gastrointestinal discharge
- Assess for any signs of pain, pressure or discomfort
Checking the Balloon Volume
- The balloon is filled with water, which is inflated and deflated by inserting a syringe into the balloon inflation valve. Since the balloon holds the feeding tube in place, the integrity of the balloon is critical.
- Two weeks post insertion and then on a weekly basis you should check the balloon volume to ensure it is undamaged, to do this:
- Discontinue feeding.
- Advance the tube 3cm into the tract and hold in place.
- Insert a clear 5ml syringe into the balloon valve. Withdraw the fluid, being careful not to remove the tube from the stoma channel.
- Ensure that the balloon is completely empty.
- Check the volume of fluid that is withdrawn. It is normal for small amounts of water to evaporate from the balloon, so the volume may not be the same as the volume indicated on the balloon valve. A regular reduction of more than 1.5ml each week could indicate the balloon is leaking and will require replacing.
- Re-inflate the balloon with the prescribed amount of water. This is usually printed on the balloon valve.
- Distilled water or cooled boiled water can be used at home for the replacement fluid once the stoma site has healed. Your dietitian can advise you on this.
- It is important not to over inflate the balloon, as it may burst.
- Never fill the balloon with air. Air will rapidly migrate out of the balloon, and the feeding tube will not stay in place
Hygiene
- Always wash your hands carefully and dry hands on a clean towel or paper towel before handling the feed or feeding tube. The six-stage procedure described later in this booklet will help you to effectively decontaminate all areas of your hands
- Handle and store feed and equipment in accordance with recommendations.
Comfort and Safety
- If any sickness or breathing difficulties are experienced during feeding, stop the feed immediately.
- Avoid lying flat while feeding. Sit up if possible. If feeding in bed, the upper back and head should be raised on extra pillows aiming for an angle of 30-45 degrees. This helps to prevent indigestion/ regurgitation/ heartburn. Remain upright for 30-45 minutes post feed.
- A feeling of ‘fullness’ during feeding may indicate that feed is being administered more quickly than recommended. Try reducing the rate by 10 - 20mls/hr.
Skin Care
- The area around the tube site should be kept clean and dry to prevent any soreness or infection.
- Washing the area daily with a gentle soap and water is usually all that is needed.
- Do not use talcum powder or creams on this area unless prescribed by your GP. Dressing or gauze are best avoided under normal circumstances.
- Any soreness, swelling, odour or discharge should be reported to your nutrition specialist nurse team/ the nurses from the company providing your feed/ your GP.
Mouthcare
- It is important, even when not eating or drinking, to take good care of your teeth and mouth.
- Teeth and gums should be brushed as usual.
- Lip salve can prevent dryness or soreness around the mouth
- It is important to visit the dentist at usual intervals.
Care of the Gastrostomy Tube
- The gastrostomy tube must be ‘flushed’ or rinsed with cooled, boiled water before and after any feed or medication is put down the tube.
- This ensures that it will not become blocked. The dietitian will advise you on how much water to use for this.
- The external fixation device (which holds the tube in place on the outside) should be correctly positioned against the skin. It should be adjusted, if necessary (e.g. if weight changes), moving the tube as little as possible. Your nutrition nurse specialist will show you how to do this.
- After two weeks the sutures can be removed, if they have not already dissolved and fallen away. Once the sutures have been removed, the external bumper should be pulled back along the tube away from the skin to allow the tube to be advanced into the stomach by 2-3cm and rotated full circle. Once this has been done, the tube should be pulled back to its original position and the external bumper slid back down to sit closer to the skin. This should be done daily after the site has been cleaned.
Medicines
- If it is necessary to have medication through the tube, make sure these are prescribed in an appropriate format e.g. soluble/dispersible tablets or liquids.
- Please be aware that some liquid medications can be sticky and may need diluting to avoid tube blockage—please discuss with your pharmacist.
- Medication can lead to tube blockages, so your PEG tube must be flushed with cooled boiled water before, between and after each different medication that is given. Usually, this would entail a 50ml flush of cooled boiled water prior to giving the medication, 10ml flushes between each separate medication, followed by a final flush of minimum 50ml cooled, boiled water. The dietitian will advise you of any change to these quantities.
Stopping Feeding
- If for any reason it is not necessary to take feed regularly via the tube, it is recommended that the tube is flushed at least twice a day with 50mls of water to prevent the tube from becoming blocked.
- If you become able to take enough food and fluids by mouth to meet your nutritional requirements, then we can refer you to a member of the Nutrition team to discuss having the tube removed.
Further Information
Additional information on feeding can be obtained from PINNT (Patients on Intravenous and Nasogastric Nutrition Therapy).
This is a support group for patients receiving nutrition via their veins or through a feeding tube.
Telephone 01202 481 625, between the hours of 09.30am and 16.30pm. You may also log on to their website www.
Care of Enteral Feed and Equipment in the Home Environment Feeds
Feeds
- All prescribable feeds have an expiry date on the pack. Check the date and never use feed if the expiry date has passed.
- Before opening feed gently shake the pack.
- Liquid feeds in packs are sterile until opened and therefore do not need refrigeration but should be stored at room temperature (away from heat or direct sunlight).
- In winter months it is advised not to store feed in garages or garden sheds for risk of freezing.
- Rotate stock of feed, using up ‘old’ stock before using a new delivery.
- Powdered feeds should be kept dry and at room temperature.
- Once opened, any liquid feed which is not used immediately must be kept covered and refrigerated for up to 24 hours (feed should be given at room temperature, never given straight from the fridge, so take feed out of the fridge 30 minutes prior to using).
- Any feed not used within 24 hours of opening must be discarded.
| Item | Use for | Cleaning method | Discard after |
| Giving set | 24 hours | Not applicable | 24 hours |
| Feed reservoirs | 24 hours | Not applicable | 24 hours |
| Re-usable syringes (syringes issued on the ward are not re-usable) | Immediately after use, wash and rinse following the instructions below | 7 days | |
| Extension sets | Immediately after use, wash and rinse following instructions below | 14 days |
- Some disposable equipment may be washed and re-used.
- Items which may be re-used after cleaning should be washed well in hot water containing detergent and then rinsed thoroughly in clean water, not put in the dish washer.
- When washing syringes separate the chamber and plunger.
- After rinsing, allow to dry by inverting syringes on a clean surface or kitchen paper. Do not use dishcloths or tea towels.
- Store equipment in a clean container.
- The syringes should be purple oral/enteral syringes. Syringes issued by the wards are not re-usable, but the syringes provided once you are at home, should be re-usable.
- Ensure feeding pump is cleaned regularly with warm soapy water. If feed is spilled onto pump, clean immediately.
Water
- We use cooled boiled water for all patients at home unless advised otherwise.
- Water can be boiled and kept in a covered container in the fridge for a 24-hour period and then changed daily.
- Water should be given at room temperature - never give straight from the fridge.
Handling Feed and Equipment
- Hand hygiene is very important. Effective hand washing will reduce the risk of infection. Prior to handling feeds or equipment, hands should be thoroughly washed with soap and hot water and dried on a clean towel. Wash hands thoroughly. The six-stage procedure described next will help you to effectively decontaminate all areas of your hands.
- Disposable gloves are not needed by family members but should be worn by others (e.g. dietitians, district nurse) when handling feed and equipment.
- Careful, clean handling of feed and equipment will reduce risk of bacterial contamination.
Six Stage Handwashing Guide
| 1. Palm to palm |  |
| 2. Palm to palm with fingers interlaced |
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| 3. Palm to back with fingers interlaced |
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| 4. Fingers clasped |
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| 5. Rotational rubbing of both thumbs |
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| 6. Tips of fingers opposite palms |
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Gastrostomy Tube Feeding – Problems Which May Occur
Tube Blockage
This should not happen if the tube is always flushed as instructed. However, should the tube become blocked:
- First draw back tube contents to remove blockage
- Try to flush the tube with warm water (not hot)
- Use the syringe plunger to apply gentle pressure to withdraw contents of the tube, try a push/pull action
- Gently squeeze/roll blocked section of tube between finger and thumb to help disperse the blockage
- If no success:
- Try to flush the tube with soda water or one teaspoon of bicarbonate of soda mixed with 50ml warm water and leave in the tube for approximately 20 minutes
- Please note – never try to force water into the PEG as this may split the tube
- The tube may not clear on the first attempt. Repeated attempts may be necessary.
- If still no success
- If you are using the tube to administer fluid or medication as well as feed, it is possible that you may become dehydrated, or suffer from symptoms that your medications usually control
- Contact the nutrition nurses at the hospital where your tube was placed
- If it is outside of working hours, please contact the out of hours GP service who may refer you to your local A & E
If Tube Falls Out
- If you are using the tube to administer fluid or medication as well as feed, it is possible that you may become dehydrated, or suffer from symptoms that your medications usually control
- Please contact the Nutrition Nurses at the hospital where your tube was placed, or the Homeward nurses as soon as possible and they will advise you on what to do next
- If it is outside of working hours, please contact the out of hours GP service who may refer you to your local A&E
- It is necessary to arrange replacement within four hours
- You should have been supplied with EnPlugs, one of these can be placed in the gastrostomy opening to prevent it closing until a replacement can be placed
Dehydration
- This is when the body needs more water. It can be caused by a variety of reasons such as fever, not taking enough water or hot weather
- If you feel thirsty, have dry lips, feel weak and are not passing very much urine, then you may be dehydrated
- Overcome this by flushing the tube with extra cooled, boiled water prior to and at the end of feeding
Fullness or Discomfort During Feeding
- Check that feed is not being given more quickly than is recommended by your dietitian
- Contact the dietitian for advice if the problem persists
Diarrhoea
- Diarrhoea sometimes occurs as a result of taking antibiotics. This may continue for a few days, after the course of antibiotics has been completed. Do not stop taking the antibiotics or feed; discuss with your GP or dietitian
- Additional flushes of water may be required throughout the day to remain hydrated and to replace the losses
- Check that the feeding rate is as recommended by your dietitian
- If diarrhoea does not resolve within a couple of days, contact your GP, dietitian or nutrition nurses for advice
Nausea or Vomiting
- Stop the feed in the case of any vomiting
- Check the feed is not being given more quickly than is recommended by your dietitian, check that the feed given was at room temperature and not straight from the fridge
- Check that the feeding position is correct (i.e. not lying flat), aim for 30–45-degree angle and stay at this angle for at least 30 minutes post feed
- Once vomiting has stopped, recommence with cooled, boiled water at half the rate the feed is usually given at e.g. if feed ran at 100ml/hr, give water at 50ml/hr for 2-3 hours. If bolusing, give 50ml syringe over 10-15 minutes every hour for 2-3 hours
- If water is tolerated, recommence feed at half the rate usually tolerated e.g. if usual rate is 100ml/hr, give feed at 50ml/hr for 6 hours
- If this is tolerated, you can move onto recommencing the original feeding plan
- Since an episode of vomiting can cause a risk of aspiration pneumonia, please ensure to be vigilant of any signs of this, which may include coughing after feeds or vomiting, rapid breathing, ‘gurgling’ when breathing, fever, confusion or a sudden change in alertness
- If feeds continue not to be tolerated or you develop any symptoms described above contact your GP, dietitian or nutrition nurses for advice
Constipation
- Check that sufficient fluid is being given (refer to nutrition plan)
- Discuss with the dietitian, it may be possible to change the feed
- It may be a side effect of other medication or a new medication
- Contact your GP if the problems do not resolve within a few days
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Important Information The Trust may share your information with other NHS health and social care providers to assist in giving you the best care possible. Where we share your information with these organisations, they are subject to strict information sharing protocols and have a legal duty to keep it confidential and secure. Only information that is required and appropriate to support your care and treatment will be provided. |
Future Contact
Once you are at home, the dietitian and/or Homeward nurse will telephone or visit you at regular intervals to review your progress and make any necessary changes to your feeds.
Please contact the dietitians between appointments if you have any queries or problems relating to:
- Your feeding plan
- Your feeding tube or other equipment
- Any problems during feeding (e.g. discomfort, nausea, vomiting, diarrhoea)
The nutrition nurses based at the hospital where your tube was placed, may also be able to assist you with queries regarding your feeding tube or other equipment.
If there are any problems with the delivery of feeds or giving sets, please contact Nutricia Homeward in office hours
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DIETITIANS: Who to contact will depend on the area you live in. The contact details of the dietitian best able to assist you in your area will also be clearly indicated on your feeding regime. Community Dietitians: Berkshire: TEL: 01753 636724 |
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HOSPITAL NUTRITION NURSES: If feeding tube was placed at Frimley Park Hospital: Nutrition Nurses at Frimley Park Hospital: TEL: 0300 613 9087. If feeding tube was placed at Wexham Park Hospital: |
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NUTRICIA HOMEWARD: Nutricia Company Nurse (Surrey area): TEL: 0345 2501 087 The Nutricia Homeward Nurses may be contacted during office hours Monday – Thursday 9am-5pm and Fridays 9am-4pm. Delivery/ Stock related issues: |
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| NUTRICIA OUT OF HOURS ADVICE LINE: Outside office hours, contact the Nutricia out-of-hours advice line, who will put you in touch with the on-call nurse who may be able to advise you over the telephone. TEL: 0800 093 3671 |
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| EMERGENCY: If you are unable to administer your feed for any length of time, your body may become dangerously short of fluid. If this happens outside of working hours, please contact the out-of-hours GP service which may refer you to your local A&E department |
Contact us
If you have any queries relating to this information, please contact the Dietetics service.
About this information
Service:
Dietetics
Reference:
DT/039
Approval date:
1 April 2026
Review date:
1 April 2029
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.