Equipment Corner September 2006

Gastrostomy tubes

When it’s time for a gastrostomy, or feeding, tube, you must decide on the kind of tube, tube size, feeding delivery options, type of food, and how you’re going to affix a tube to your abdomen.

Here are some helpful tips to consider when choosing the equipment that’s right for you.

PEG tubes and buttons

A PEG (percutaneous endoscopic gastrostomy) tube is the most common solution, as it allows you and your caregiver to administer nutrients directly to the stomach.

After you’ve had a PEG tube inserted and the stoma, or tube entrance site, has healed, you have the option of switching to a skin-level, low-profile replacement gastrostomy device, or button. It lies flat against the stomach, and an external extension set is attached to the tube when administering formula or fluids.

G-tubes generally are made of polyurethane or silicone, and have a balloon, mushroom tip or disk to secure them internally.

Ginna Gonzalez, nurse director at the Kessenich MDA/ALS Family Center at the University of Miami, explained that you can make the switch from a PEG tube to a button once the original PEG tube has been in place for a minimum of eight weeks.

The button allows the person to sleep on his or her stomach; remains firmly in place; remains hidden from view underneath clothing; and avoids a long tube hanging from the abdomen.

Gonzalez explained, however, that the main drawback to using a button for people with ALS is that the loss of use of abdominal muscles can make it more difficult to use for tube feeding.

Buttons, including the Bard Button and the MIC-KEY button from Kimberly-Clark/Ballard Medical Products, are held in the stomach by a balloon. After it’s inserted into the existing tract, the balloon is inflated with sterile or distilled water.

When the button isn’t being used, the extension tube is removed and a small plug similar to the plug on a beach ball is put in the hole of the button. A balloon G-tube can be safely and easily replaced at home, according to Amy Ellis, a nutritionist at the Carolinas Medical Center’s Neuroscience and Spine Institute in Charlotte, N.C.

“The only benefit of the button tube is aesthetics, which can be important,” Ellis said. “Other people prefer the standard PEG tube because it allows bolus feedings to be administered more quickly or because they find it easier to use these tubes themselves if their hands are weak.”

Feeding delivery options

Ellis explained that people with G-tubes use three delivery options — bolus method, gravity drip method and mechanical feeding pump. Here’s a quick rundown:

• Bolus method: A 60ml syringe is used to pour a liquid nutrition, or enteral, formula down the tube (and bolus extension set) about four to six times a day. To pass the supplements by gravity, pour a cup of water through the syringe.
• Gravity drip method: A bag filled with canned liquid food is hung from an IV pole and the food dripped through the tube. Ellis said the typical time frame is 30 minutes to an hour. 
• Slow infusion (continuous feeding) by mechanical pump: An electric pump delivers the formula slowly, drip by drip, over hours.

Ellis explained, “The majority of people I know with PEG tubes prefer the bolus method because it’s quick and can be easily adapted to one’s schedule. Many people keep a lunch box with a can of formula, bottle of water and 60ml syringe in order to have a quick meal when they’re out.”

Ellis also said that others with ALS prefer to use the gravity drip method while they’re working on a computer or watching television. And, some people opt for the mechanical pump method because it allows them to take all of their nutrition during the night while they sleep.

G-tubes generally range in size from 12 to 30 French, and Gonzalez said that physicians generally use a 20 French tube. The term French refers to the gastrostomy tube’s diameter.

Liquefied foods

If you prefer using a blender to liquefy foods for tube feeding to the canned enteral formula, however, Ellis cautions that the tube can clog more easily with liquefied foods. To avoid this, the food must be the same consistency as the enteral formula.

“There are people who use a blender food/enteral formula combo,” Ellis said. “If you do that, we recommend that you do a water flush in between each method to prevent clogs.”

The Vita-Mix Corporation (www.vitamix.com) has a Medical Needs Discount Program for qualified applicants offering a factory-reconditioned Vita-Mix 5000, an industrial-strength blender with a high-performance 2+ peak horsepower motor, for $275 plus tax, compared to $399 for a new model.

Contact Vita-Mix at (800) 848-2649, or e-mail household@vitamix.com for more details on how to qualify. Be sure to include the reference code 07-0036-0007 in your request, to ensure program participation.

Additionally, the nonprofit Oley Foundation (www.oley.org/EquipmentExchange.html) offers an equipment exchange program that provides free enteral formula supplies to those in need.

Individuals interested in receiving items through the program are responsible for paying the shipping costs. To learn more about other supplies and equipment available, call (866) 454-7351.

Tape and tube holders

Because surgical tape can cause skin irritation, Ellis and Gonzalez agree that it’s better to use paper tape. Ellis said that some people prefer to use abdominal binders made of soft fabric and Velcro to hold the tube against the abdomen.

“The abdominal binders are great,” Ellis added. “They can be cut with scissors to the perfect size, and they hold the tube securely and comfortably against the stomach so that it can’t be seen underneath form-fitting clothes.

"Also, some medical supply companies, including the NelMed Corp. and Allegro Medical (www.allegromedical.com), offer a washable G-Tube Holder that secures the feeding tube against the abdomen. The one-size-fits-all, adjustable waistband has a pocket that stores the coiled feeding tube.