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8.15 Changing the balloon water and checking the volume of a balloon gastrostomy

Essential equipment

  • Personal protective equipment
  • Sterile procedure pack containing gallipot, low‐linting gauze, sterile gloves and sterile field
  • Two 10 mL ENfit syringes (20 mL syringe required if balloon volume is greater than 10 mL)
  • Sterile water

Pre‐procedure

ActionRationale

  1. 1.
    Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
    To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [126], C).
  2. 2.
    Assist the patient to sit in a semi‐upright position in the bed or in a chair. Support the patient's head with pillows.
    To allow for easy access to the gastrostomy tube. E
  3. 3.
    Wash hands with soap and water or alcohol‐based handrub, and assemble the equipment required. Apply personal protective equipment.
    Hands must be cleansed before and after patient contact to minimize the risk of cross‐infection ([115], C).
  4. 4.
    Discontinue the feed.
    To ensure that the procedure can be undertaken without spillage of feed. E
  5. 5.
    Obtain an aspirate from the gastrostomy tube and test pH. If the result is below 5.5, proceed. If it is above 5.5, seek medical advice. For further information see Procedure guideline 8.10: Nasogastric intubation with tubes using an internal guidewire or stylet. If unable to obtain the correct pH then the gastrostomy tube change may need to be done under radiological guidance to ensure it remains in the stomach.
    To ensure that the balloon is inflated in the stomach and not in the tract or another part of the stomach. E
  6. 6.
    Prepare a tray or trolley and take it to the bedside. Clean hands as above, open sterile pack and prepare equipment.
    To reduce the risk of contamination of contents (NICE [119], C).
  7. 7.
    Decontaminate hands and apply sterile gloves.
    To reduce the risk of cross‐infection ([115], C).

Procedure

  1. 8.
    Providing the pH is under 5.5, proceed to slide the external retention flange up the tube, away from the abdomen, and push the tube 2–3 cm into the abdomen.
    To ensure that the balloon is inflated in the stomach and not in the tract. E
  2. 9.
    Following the manufacturer's guidelines, attach an ENFit syringe to the inflation valve of the balloon gastrostomy. Withdraw all the water from the balloon. Discard the water and syringe.
    To ensure that the balloon is completely deflated. E
  3. 10.
    Note the volume on the side of the inflation valve of the balloon gastrostomy. Draw up the required volume of sterile water in a new ENFit syringe.
    To ensure that the correct volume of fluid is inserted into the balloon. E
  4. 11.
    Attach a syringe containing sterile water and reinflate the balloon with the appropriate volume (volume is indicated on the side of the inflation valve).
    To ensure that the balloon is not over‐ or underfilled. E
  5. 12.
    Gently pull back the gastrostomy tube until the balloon can be felt against the stomach wall. Slide the external retention device along the tube until it sits comfortably against the abdomen.
    To ensure that the balloon and the external retention device are returned to the correct position. E

Post‐procedure

  1. 13.
    Ensure that the skin surrounding the tube is clean and dry.
    To promote patient comfort. E
  2. 14.
    Dispose of all equipment in accordance with local policy.
    To reduce the chance of equipment being reused. E
  3. 15.
    Record the condition of the skin surrounding the gastrostomy site.
    To document care and enable evaluation of the gastrostomy site (NMC [126], C).
  4. 16.
    After refilling the balloon, check the pH by aspirating from the gastrostomy (pH should be below 5.5).
    To confirm placement in the stomach (Fletcher [53], E).
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