Before tube removal

• Removal of gastrostomy tubes should only be undertaken by a health care professional who has undertaken the required training and been verified as competent in the Tubes should not be removed before 8 weeks of insertion to ensure the stoma tract is established.
• Different tubes require different removal Some can be removed by deflating the internal balloon, these can then be removed at home, and some need to be removed endoscopically or radiologically, in hospital.
• Before removing the feeding tube the dietitian will usually assess your nutritional intake and determine when you are ready to have your tube removed as you are able to meet all your needs through oral intake, without using your tube.
• Tube removal may then need to be approved by a medical professional such as GP or, once the decision is made, depending on your tube type, the removal can either be done at home or a referral is requested to have it removed in the hospital.

Removal of a balloon gastrostomy tube

If you have a balloon gastrostomy tube in place this can usually be removed in your own home. Prior to removal you will be asked:

• if you are currently taking any anti-coagulant medication as this may need to be adjusted or temporally stopped to allow for removal to happen more safely
• to be nil by mouth (nothing to eat or drink) for two hours before and after the procedure. small sips of water can be taken if thirsty
• to have some prepared cool boiled water ready for the nurse/dietitian who is removing the tube, to allow them to clean the site
• to make sure your tube stoma site is healthy (no infection or over-granulation present) as these may delay the healing of the site.

Removal procedure

It is best if you are able to be in a lying down, and comfortable position, for the removal of your tube. The healthcare professional will rotate and advance the tube to make sure this moves freely. The balloon water will then be fully removed from the tube and the nurse/dietitian will then carefully remove your feeding tube. Once removed, a dressing is then applied over your stoma site. You may be advised to change this for one to two days to allow healing and until the site is fully dry. The stoma site should heal very quickly.

After removal

Change any dressings as advised by the health care professional removing your tube until the site is dry and healed.

If the site does not appear to be healing after a few days and there are signs of infection such as redness, bleeding and or it continues to leak, please seek further advice from a GP or nurse to ensure check if an infection is present and advise on any next steps.

Removal of PEG tubes in endoscopy or radiology

PEG, and some non-balloon retained tubes, usually need to be removed within the hospital setting and we would request your GP to make a referral for this. An appointment will then be made by the appropriate department for you to get your tube removed.

Discharge

After tube removal you will be discharged from the Home Enteral Nutrition (HEN) Service. You will not receive any more deliveries and we can arrange uplift of any outstanding stock and equipment you may have.

If ongoing supplements are required these can be provided locally by your GP and pharmacy.

Following discussion with your dietitian you may be referred to another dietitian for ongoing follow up.