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|Nutrition and You: Low-profile G-tube|
Tips for Living with a Low-profile G-tube
Low-profile gastrostomy tubes (G-tubes) are a great option for an active lifestyle. Our guest author, Janelle Flaherty, RD, provides some insights for home enteral (HEN) consumers.
Low-profile G-tubes are an alternative to standard G-tubes. They have seen increased usage in recent years in both the pediatric and adult populations. Key benefits of low-profile tubes are they are less bulky; they lie discreetly under clothing; and some (depending on the internal bolster) can be changed in the home setting by patients or caregivers with the proper training.
Low-profile tubes are available with balloon and non-balloon internal bolsters; they are initially inserted by a physician. Balloon-style tubes are held in place by a balloon that is filled with water; non-balloon devices are held in place by a soft plastic bolster on the end.
Know Your Brand and Size
There are many different brands of low-profile G-tubes available, and it’s important to be familiar with the specifics of the one you have in case you need a replacement. Most low-profile devices are designed to work with specific extension sets, so it’s also important to know what brand you use so you can get the correct supplies from your HEN provider.
In addition to knowing the brand you use, it’s important to know the size. Two measurements determine the size of a low-profile tube: the French size (FR), which reflects the tube diameter; and the centimeter length (CM), which is the length between the inside of the stomach wall and the outside of the stomach. Most low-profile devices range from 12 to 24 FR and 0.8 to 5.0 CM. It’s important for your HEN provider to know both measurements.
The size and reorder number for the low-profile G-tube can be found on the box it came in. Don’t have the box anymore? Both the FR and CM can also be found directly on the device. Typically, they can be found on the device’s closure flap or on the portion of the device that lies on the skin.
If you are unsure what type you have, contact your doctor’s office for this information. Also, your HEN provider is likely to be familiar with the different types of low-profile devices out there, and may be able to determine which one you use from a description or picture.
Size Can Change
The size you need may change over time. Often, as a child grows or a patient gains or loses weight, he or she needs a new size. Having the appropriate size is important. If the CM is too long, there can be excessive leakage from the stoma site, which can be painful and can lead to skin breakdown. Skin breakdown and pain can also be issues if the CM is too short, and the device is too tight against the skin.
The general rule of thumb is that you should have a space the thickness of a dime between the low-profile device and the skin. Your doctor can measure the appropriate CM with a stoma-measuring device.
Expect the Unexpected
A low-profile balloon-style device typically can be in place about ninety days before it needs to be replaced; however, situations may arise when a device needs to be replaced sooner than that. With the balloon type, sometimes the balloon on the device is defective or springs a leak, causing the device to fall out. Sometimes an inquisitive child pulls at the device, causing it to come out. For these situations, it’s important to have a backup low-profile G-tube on hand. Check with your HEN provider to see if they can provide a backup, or to see if a prescription for a backup is needed.
What happens if your device falls out and you don’t have a backup? Don’t panic. The gastrointestinal tract is not a sterile environment, so in most situations the device can be thoroughly rinsed off, put back into the stoma, and held in place with tape until a new tube can be placed. The stoma site can close very quickly, so it’s important to replace the device right away.
Most insurance companies will only cover the cost of a new low-profile device every ninety days. If you find you are going through them more often than this, check with your insurance provider to see what your coverage is. You may also want to contact the device manufacturer or your HEN provider to see if they can help troubleshoot what the issue might be. Or you could consider a different style or brand to see if it works better for you. For example, if you have a child with a balloon-style button and your child keeps pulling it out, a change to a non-balloon–bolster type may be appropriate, as this type is harder to remove.
If you do have a defective low-profile G-tube, don’t throw it away. Contact your HEN provider and let them know. They may be able to report this to the manufacturer and get a replacement at no charge. The manufacturer may send you a box so you can return the defective device so testing can be done for quality improvement.
Low-profile G-tubes can provide a significant improvement in quality of life for people requiring HEN. Making sure you are familiar with your G-tube and you are communicating the relevant information to your HEN provider will help to make life with a G-tube run smoothly.
Guest author Janelle Flaherty RD, CD, CNSC, Clinical Dietitian, Apria Healthcare. Reviewed by Carol Ireton-Jones, PhD, RD; Laura Matarese, PhD, RD; Cheryl Thompson, PhD, RD; and Douglas Seidner, MD.
LifelineLetter, January/February 2013