Long indwelling tube with water balloon insertion (3008)

Key points below

If your child still has their very first tube, and it was never changed before, then do not change the tube. Your doctor or nurse will tell you when the first tube change will happen. balloon tube

If your child’s tube has been changed and you were shown how to change it, then you can change it yourself. Change the tube every 3 to 6 months. Sometimes the tube needs to be changed sooner if it fails.

If you were never shown how to change a tube, talk with your child’s nurse or doctor.

There are many types of long tubes. Some have a stabilization disc. The tube is held in the stomach by a water balloon. Long tubes are used for different reasons. Your child’s doctor or nurse helps decide which tube is best for your child. Sometimes long tubes are used for a short time.

Helpful tips

Keep a spare tube kit and bottled water in a Ziploc® bag. Take this with you wherever you go with your child. You never know when the tube may fall out. If your child’s tube falls out, try to get it back in as soon as you are able.
Put in a Ziploc® bag:
– Spare tube kit
– Water soluble lubricants like K-Y jelly™ or Surgilube®
– Sterile, distilled or bottled water
– Gauze
When changing the tube, have all your supplies set up and ready to go. This makes it easier and quicker when replacing the tube.
Change the tube on an empty stomach so food does not leak out.
Your child may have a little bleeding or soreness after a tube change. It is helpful to use distraction while changing the tube.
After you use the spare tube at home, call your supply company (DME) so they can send another spare tube to your home.

How do I change the tube?

1. Get your supplies.

Long tube.

Water soluble lubricants such as K-Y jelly™ or Surgilube®.
Slip tip syringes. It is best to have two of these.

2. Sterile, distilled or bottled water for the balloon. Do not use tap water or saline.

3. Wash your hands with soap and water.

4. Get the new tube ready:

Pull the stabilization disc up toward the top of the tube.
Put lubricant on the balloon tip of the tube.
Draw up the correct amount of water into a slip tip syringe. Look on the balloon port for the amount needed.

5. Remove the tube from your child.

Put the slip tip syringe into the balloon port.
Remove all the water from the balloon.

6. Gently pull up on the tube until it is out of the opening. You may put gauze over the opening if stomach juices or feedings are oozing out.

7. Place the new tube.

Gently push the lubricated tube into the opening of your child. Do not force the tube. Stop and call your child’s nurse or doctor if you cannot get the tube in. A little pressure is ok.
Put the slip tip syringe with water into the balloon port.
Push the plunger on slip tip syringe until all the water is out of the slip tip syringe.
Take out the slip tip syringe from the balloon port.

8. Gently pull up on the tube until it feels like it will not come up anymore. This means the balloon is snug against the stomach.

9. Wipe away the extra lubricant from the skin.

10. If there is a stabilization disc, push it down so that it is resting gently against the skin.

11. Secure the tube.

12. Check to make sure the tube is in the right place.

Put an empty syringe into the feeding port.
Pull back on the plunger until you see gastric juices or formula.
Close the feeding port.
If you are unable to pull back any gastric juices or formula, do not use the tube. Call your child’s doctor or nurse to find out what to do.

What problems might happen when replacing the tube?
Problem	Causes	Solutions
Tube fell out	Balloon broke or had water removed. Tube got pulled at or caught on something.	Check the balloon to see if it is broken. If it is not broken, it is ok to put the same tube back in. If it is broken, replace the tube using the spare one. Always try to replace the tube as soon as you can, even if you do not know when the tube fell out. The opening starts to shrink after one hour.
The tube will not go back in	Opening in skin may have started to shrink.	Never force the tube in. Try using more lubricant at site. If you are not able to get the tube in because of too much resistance, stop and call your child’s doctor or nurse.
Balloon will not deflate	Balloon port clogged.	Gently twist the slip tip syringe in the balloon port until the valve is opened. Using a moist cotton-tipped applicator, clean out the balloon port. Attach a syringe and try again. Call the clinic to talk to the nurse or doctor if this does not work. If this is your child’s first tube, you should not check water balloon.
The tube needs changing and no spare button at home	Used the max amount of tubes allowed per year. Forgot to call Supply Company to get another tube.	If the tube needs to be replaced because the balloon is broken, put the broken tube back in the opening and tape in place. Then call your child’s nurse or doctor. If you never got a spare tube sent to your home, call the Supply Company.

Other teaching sheets that may be helpful
- #3067 Bolster Dressing for G-tube or J-tube