Replacing Gastrostomy Button and Tube

<< DIGESTIVE

  • 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
  • Whether the student’s G-tube has been changed before should be verified through review of the student’s medical information from the health care provider
  • 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

Considerations:

  • Provide the student with as much privacy as possible

Supplies:

  • Gastrostomy button replacement kit
    • Replacement gastrostomy button
    • 6-mL luer slip syringe
    • Medical tape
    • Water-based lubricant
  • Clamp or plug, if used
  • Stabilizing device, if used
  • 60-mL ENFit/enteral syringe
  • Extension tubing
  • 2 clean cloths
  • Distilled water or sterile water
  • Non-sterile gloves
  • Student’s Individualized Healthcare Plan (IHCP) and healthcare provider’s order
  • Parent/guardian authorization form

This video demonstrates how to replace a Gastrostomy Button

Procedure Download
Skill Competency Download

Procedure for G-button that has been in place for MORE THAN 2 MONTHS:

  1. Review IHCP and healthcare provider’s order
  2. Ensure proper documentation of parent/guardian authorization to perform this procedure
  3. Explain the procedure to child at his/her level of understanding
  4. Gather supplies and place on clean surface
  5. Wash hands
  6. Put on clean gloves
  7. For Long G-tube, place a mark on the tube at the ordered length with a permanent marking pen
    • This step is not needed with a skin-level device or “button” device
  8. Make sure replacement gastrostomy tube/button is the same size (French and centimeters) as previous tube/button
    • Look at sizing information located on device
  9. Check the new gastrostomy tube/button by filling the balloon with manufacture recommended ml of distilled water or sterile water
    • Be sure it does not leak and that the balloon is not misshapen
  10. Remove the water from the balloon
  11. Wet the tip of the tube/butto with lubricant
  12. Insert the tip of the G-tube/button into the stoma
    • Insert the G-tube to ordered length or until the button is at skin level
  13. Fill the balloon with the indicated amount of distilled water or sterile water
  14. Gently pull tube to position the balloon against the wall of stomach
    • For Long G-tube: gently slide the external retention disc to its original centimeter marking
    • Pulling the tube too tightly will cause the opening to enlarge and formula may leak out around the tube
  15. Clamp or plug the tube
  16. Apply stabilizing device, if used
  17. Check the tube for correct placement
    • For Long G-tube:
      • Remove plug from G-tube
      • Attach 60-mL ENFit/enteral syringe with plunger to the G-tube
      • Aspirate stomach contents to verify placement
        • Gastric contents are normally yellow or clear
      • Return stomach contents
      • Remove the ENFit/enteral syringe
      • Insert plug into G-tube
    • For Button/Skin Level Device
      • Attach a 60-mL ENFit/enteral syringe with plunger to the end of extension tubing
      • Remove plug from button
      • Attach extension tubing to button
      • Aspirate stomach contents to verify placement
        • Gastric contents are normally yellow or clear
      • Return stomach contents
      • Remove extension tubing
      • Insert plug into button
  18. DO NOT administer feeding or medications via G-tube/button unless correct placement has been verified
    • If correct placement cannot be verified, contact parents/guardians and healthcare provider, if needed
  19. Remove gloves
  20. Wash hands
  21. Document assessment, interventions, and outcomes in student’s healthcare record
  22. Follow up with parents/guardian and healthcare provider

Procedure for G-tube/button that has been in place for LESS THAN 2 MONTHS

  1. Review the student’s IHCP and healthcare provider’s order
  2. Ensure proper documentation of parent/guardian authorization to perform this procedure
  3. Explain the procedure to the student at their level of understanding
  4. Have another staff person contact parent/guardian to inform them that the student’s G-tube/button has come out and advise them that the student needs to be seen immediately by healthcare provider
  5. Gather supplies and place on clean surfact
  6. Wash hands
  7. Put on clean glove
  8. For a Long G-Tube: Put a mark at the same level with permanent marking pen
    • This step is not needed with a skin-level or button device
  9. Make sure replacement gastrostomy tube/button is the same size (French and centimeters) as previous tube
    • Look at sizing information located on device
  10. Lubricate the tip of the tube/button with water-soluble lubricant
  11. Put the tip of the G-tube/button into the stoma
  12. If inserting button: Gently push into stomach until the button is at skin level
  13. DO NOT inflate the balloon
  14. Tape the tube to the student’s abdomen
  15. DO NOT feed, give fluids, or medications to the student through their G-tube/button or their mouth
  16. The student must be seen immediately by their healthcare provider, if possible, or receive care at the nearest emergency department
  17. Remove gloves
  18. Wash hands
  19. Document assessment, interventions, and outcomes in the student’s health care record
  20. Follow up with parents/guardians and healthcare provider

References:

Avanos Medical, Inc. (2020). MIC* G replacing a tube. Retrieved June 22, 2023, from https://tubefed.com/troubleshooting/

Children’s Hospital St. Louis. (2015, May). Gastrostomy tubes home care manual (corpak, foley catheter, genie, malecot, mic-G). Retrieved June 22, from https://www.stlouischildrens.org/sites/legacy/files/Gastrostomy%20Tubes%20Home%20Care%20Manual.pdf 

Children’s Mercy Kansas City. (2022, December 2). Gastronomy tube (g-tubes): Training for school nurses.. Retrieved June 21, 2023, from https://www.youtube.com/watch?v=_Gif-699CmM

Cleveland Clinic. (2019, November 1). Home tube feeding – Checking residuals. . Retrieved August 22, 2023, from https://www.youtube.com/watch?v=59tusCo2wAI

DeLegge, M.H. (2022, November 11). Gastrostomy tubes: Complications and their management. In Saltzman, J.R., and Seres, D. (Eds.) UpToDate, Retrieved June 20, 2023, from https://www.uptodate.com/contents/gastrostomy-tubes-complications-and-their-management

National Association of Pediatric Nurse Practitioners. (2018). Gastrostomy tube (G-tube) fact sheet. Retrieved June 22, 2023, from https://www.childrensmercy.org/siteassets/media/in-the-community/school-health-support/g-tube-fact-sheet.pdf

Page last reviewed: February 19, 2025
Page last updated: February 19, 2025

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.