A BGT is the term used for a Balloon Gastrostomy Tube.

A BGT is used to feed a person straight into their stomach if they have a problem feeding by mouth, cannot maintain their weight or are unable to digest food. It can be used either to meet all of their nutritional needs or to supplement the diet.

BGTs can be used either temporarily or permanently. Manufacturers’ guidelines suggest that each tube placed can be used for up to six months. Liquid feeds are given through the tube either with a syringe or via a feeding pump.

A BGT is a flexible feeding tube usually made from silicone.

On the outside of your body, the tube is visible with two ports at the end and a fixation plate.

One port is for feeding and this is where your feeding equipment will be connected. The other port is the balloon inflation valve and is used to deflate and re-inflate the balloon which secures the tube inside your stomach.

How is a BGT inserted?

A BGT can be:

1. inserted straight into the stomach via a procedure called gastropexy or Radiologically Inserted Gastrostomy (RIG)
2. used as a replacement tube after a Percutaneous Endoscopic Gastrostomy (PEG), RIG or gastropexy. Where there is already is an opening formed through to the stomach (known as a stoma).

If you have recently had a RIG or BGT inserted via gastropexy please refer to our introduction and care of RIG and gastropexy leaflet which will have more detailed information.

Important note: If you experience pain on feeding or external leakage of stomach contents or fresh bleeding is noted within the first 72 hours after tube insertion insertion, stop feeding and seek urgent medical advice.

What should my stoma site look like?

Once your incision stoma has completely healed, your stoma should be dry and clean with:

• no leakage
• no redness around the tube
• no pain.

Caring for your BGT

Each day you will need to provide the following care for your BGT.

Checking position

Get to know which cm marking sits at skin level, monitor this at least daily, because it is important the posistion of your tube doesn’t move. If you notice a different centimetre marking at skin level or the tube moves excessively in and out of the stoma the tube may have become displaced. In which case please contact your enteral feed company nurse or community nurse for advice.

Cleaning your BGT

Once you have an established stoma site, which is usually after 10 to 14 days make sure you do the following.

• Wash your hands according to the hand hygiene leaflet.
• Carefully clean around the gastrostomy site, with mild soap and water and then dry.
• You may have a shower. Cap off the tube and avoid directing water directly at the stoma site.
• You may have a deep bath or go swimming after the site has healed, generally after about two to three weeks. Make sure the tube is secured and capped for example with waterproof dressing over the site.
• Do not use creams or talcum powder near or around the stoma site to reduce the risk of irritation and breakdown of the tube silicone.
• A dry stoma requires no dressing, sometimes there may be a small amount of discharge around the stoma if this persistent or increases please ask your enteral feed company nurse or community nurse for advice.

If you are experience any of the following symptoms It could indicate that the site is infected:

• oozing or odour coming from the stoma site
• redness
• soreness
• raised area
• you have a temperature or feel unwell.

Please contact your GP, enteral feed company nurse or community nurse for advice if you have any of these symptoms.

Rotating and advancing your tube

It is important to rotate and advance the BGT to prevent the tube sticking to the stoma tract and embedding in the stomach wall. This is called buried bumper syndrome and could result in a hospital admission.

Rotation

Each day (from day 14) you should rotate the tube through a full circle (360°).

Advancing

Do not move the external fixation plate for the first 14 days to allow the stoma tract to heal. On day 14, the external fixation plate can be moved away from the body and the tube advanced 2cm into the stoma. Return external fixation plate to its original position of 0.5 to 1cm away from the skin. This needs to be done at least once a week, unless you are advised to do something different by a health care professional and have a care plan to support this.

Important note: If you cannot advance or rotate your BGT, stop using the tube and seek advice from your enteral feed company nurse, GP or HEN Team. It is important you report any problems as it could lead to a complication called buried bumper syndrome which could result in an hospital admission.

How to check the water in your BGT

You need to check the correct amount of water is in the balloon weekly. You or your carer can be trained to do this at home, or your community nurse can support you in some circumstances.

If the balloon is damaged or has burst, there may be less water or no water in the balloon. If you find this is the case, tape down the tube to stop it falling out and either replace the tube or contact the person who replaces the BGT. If you find it difficult to remove the water or notice any difference in the amount of water you remove from the balloon please contact your enteral feed company nurse or community nurse for advice.

How is the BGT replaced?

Tubes are usually changed every four to six months. This usually will happen in your home by a qualified professional such as your enteral feed company nurse or community nurse. You may wish to learn how to do this yourself with support of your enteral feed company or community nurse will be able to continue to do this for you.

Please make sure you know where and when your tube should be replaced. If you are unsure please contact your enteral feed company nurse who will be able to help you.

The tube will need to be changed if it is blocked, beginning to deteriorate or if the duration of use has been reached as advised by the manufacturer.

What should I do if my BGT falls out?

It is important to carry a spare tube with you so that you or your carer can re-insert your tube quickly should it fall out. The stoma in which the BGT. This may happen within one to two hours or sometimes even sooner.

Please see our what to do if your gastrostomy tube comes out leaflet: www.kentcht.nhs.uk/leaflet/what-do-to-if-your-gastrostomy-feeding-tube-comes-out/

Flushing your BGT

If you are not using your gastrostomy tube for feeding please ensure you flush the tube at least once a day with fresh tap water to reduce the risk of the tube blocking. Please contact your dietitian to advise you on the amount required.

Method

• Wash your hands according to the hand hygiene leaflet.
• If you are caring for someone, apply gloves and an apron.
• Place all the equipment you require on a clean surface, such as a 60ml syringe and measured water in a jug or cup.
• Make sure the position of the feeding tube has not moved by checking the skin level centimetre marking.

1. Remove the cap from the end of your BGT .
2. Remove the plunger from the syringe and attach it to your feeding tube.
3. Use your syringe as a funnel to slowly pour the correct amount of water into your feeding tube, keeping the syringe higher than the stoma site.
4. Remove the syringe and recap your tube.

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5. Draw up the required amount of water into your syringe.
6. Remove the cap from the end of your BGT. Attach the syringe to your BGT and slowly press down the plunger in the syringe to flush water into the tube.
7. Remove the syringe and recap your BGT.

• When flushing your tube, try to avoid emptying the tube completely by closing the clamp before all the water has gone through. If you do not do this air can then enter your stomach and make you feel uncomfortable and bloated.
• Try to remain upright for at least 30 minutes after a feed or flush to reduce the risk of reflux and regurgitation.
• Clean the syringe following the cleaning and storage of reusable syringes advice.

Further assistance

If you feel that you have exhausted all advice in this leaflet and you are still concerned, please contact your nurse or HEN Team.

Information for carers

Remember to document your observations and care given.