Replacing Gastrostomy Button and Tube


  • G-tubes may only be placed in the school setting if the primary tube has been changed. School personnel should verify this by the patient’s care plan or parent/guardian report
  • The primary tube/button is the initial tube placed by General Surgery, Gastroenterology or Interventional radiology.  The primary tube/button change date is dependent on the type of tube/button.  The first change date can be 6 weeks to 3 months after surgical placement
  • If G-tube cannot be replaced, but a catheter has been provided, place the catheter into the GT tract and tape this into place, then call the parents/guardian
  • If G-tube cannot be replaced and a catheter is not available, cover the opening with a clean dressing and tape and then call parents/guardian


  • Provide the student with as much privacy as possible


  • Extra gastrostomy tube
  • Clamp or plug, if used
  • Lubricant
  • Stabilizing device, if used
  • 5-ml syringe
  • Tape
  • 2 clean cloths
  • Distilled water
  • Gloves


  1. Explain the procedure to child at his/her level of understanding
  2. Gather supplies and place on clean surface
  3. Wash hands
  4. Put on clean gloves
  5. Put a mark at the same level with a permanent marking pen
    • This step is not needed with a skin-level device or “button” device
  6. Make sure replacement gastrostomy tube is the same size (French and centimeters) as previous tube
    • Look at sizing information located on device
  7. Check the new gastrostomy tube by filling the balloon with manufacture recommended ml of distilled water
    • Be sure it does not leak and that the balloon is not misshapen
  8. Remove the water from the balloon
  9. Wet the tip of the tube with lubricant
  10. Put the tip into the stoma
  11. Gently push into the stomach until the button is at skin level
  12. Fill the balloon with the indicated amount of distilled water
  13. Gently pull tube to position the balloon against the wall of stomach
    • Pulling the tube too tightly will cause the opening to enlarge and formula may leak out around the tube
  14. Clamp or plug the tube
  15. Apply stabilizing device
  16. Check the tube for correct placement
    • Insert an extension set and aspirate stomach contents to verify placement
  17. Remove gloves
  18. Wash hands
  19. Document assessment, interventions, and outcomes in student’s healthcare record
  20. Follow up with parents/guardian and healthcare provider


Bowden, V. R., & Greenberg, C. S. (2016). Pediatric nursing procedures (eBook) (4th Edition). Philadelphia: Wolters Kluwer Health.

Children’s Hospitals and Clinics of Minnesota.  (2011).  A Guide for Parents G-J tube Care at Home.  Available at:

Children’s Hospitals and Clinics of Minnesota.  (2011).  A Guide for Parents G tube Care at Home.  Available at:

Exit Care.  (2012).  Mosby’s Nursing Consult.  Gastrostomy Tube, Child.

Acknowledgment of Update Reviewers:

Marcy Weidkamp, APNP
Pediatric Gastroenterology
American Family Children’s Hospital

Acknowledgment of Initial Reviewers:

Lori A. Duesing, MSN, RN, CPNP-AC
Advanced Practice Nurse
Department of Gastroenterology
Children’s Hospital of Wisconsin

Kathy Leack, MS, RN, CNS
Advanced Practice Nurse
Children’s Hospital of Wisconsin

Page last reviewed: October 4, 2021
Page last updated: October 4, 2021

The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same.  The information is not intended to substitute for, supplement or replace clinical judgment.  If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider.  The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.