If the existing device is a gastrostomy button , which is being changed to a low profile balloon GJ device, then this can be done awake, and the risks involved in this procedure are low. They will feel the doctor or nurse changing the tube, and may not like having to stay still, but this procedure is not usually painful. Develop comprehension: Record captions for pictures. Allow pupils to match the correct Talking Point to the correct picture. This could make a fine game!

Boot levers are usually a rectangular piece of wood or plastic with a 'V' or 'U' shape at one end. They may assist you to remove your boots or shoes without bending down to hold the shoe or boot. To use a boot lever, place the heel of the boot or shoe into the 'V' or 'U' shaped end of the remover. Your other foot should then be positioned on the other end of the remover to hold it steady while you ease your foot out of the boot or shoe. If you are taking any medicines e.g. Warfarin, Aspirin or Clopidogrel these may need to be altered or stopped before your procedure. You may also need to have blood tests. Please speak to your GP, the assessment nurse or the hospital doctor for advice. Support pupils in positions of responsibility: Pupils can record the messages that they are asked to take to other classrooms or school staff. They can then play them on the way so that they are more reliable and independent in delivering the right message to the right person.If you find it difficult to reach clothes once they are lowered, fit long loops of tape inside the waistband. Keep the loop around your wrist when you are seated on the toilet. When you need to pull the pants/trousers up, you can use the loop. There are also dressing aids, such as trouser clips, which might help Before the procedure it is important that your stomach is empty. Please do not eat or drink anything for at least six hours (preferably overnight) before the procedure. Fastenings for clothing can be used to adapt existing clothing. This includes Velcro fastenings and zips that can be unzipped from either end. These fastenings may be easier to manage than buttons if you have reduced grip or dexterity in your hands and fingers. There are many recordable resources on the market such as Talking Postcards and Talking Pegs. Recordable buttons such as Talking Points offer many solutions to many classroom problems – the ten ideas below are tried and tested, though I’m sure you will come up with many more of your own! Here are my ten favourite ways to use this versatile resource: If you take insulin or other medications for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medication what you should do the morning of your procedure.

If there is a gastrostomy tube in place already, they will have a well-developed tract through the skin to the stomach, so converting the gastrostomy to a GJ tube device carries few risks. After the initial device, you and your child will be able to choose whether to have the same device again or change it to a balloon device – either a low-profile button or a tube held in place with a water-filled balloon. If your child is continuing with a Freka® PEG, they will need to have this replaced under general anaesthetic, but balloon devices can often be inserted while your child is awake.It is equally important to keep having food and drink until those times to keep you well-hydrated, so you may need to wake during the night. If you do not follow these instructions exactly, the operation may be delayed or even cancelled.

The person bringing you to the operation should have ‘Parental Responsibility’ for you. Parental Responsibility refers to the individual who has legal rights, responsibilities, duties, power and authority to make decisions for a child. If the person bringing you does not have Parental Responsibility, we may have to cancel the operation. This is granulation tissue and is common. Call your health care provider if the tissue bleeds, grows in size, or if fluid or pus leaks. Fluid leaks around the button: Continuous feedings (formula given over 8 – 24 hours) are given with a continuous feeding connector, a special pump and feeding bags. Frequent issues Tissue around button is pink-red and moist: Once the larger gastrostomy tube is in place, a thinner jejunal tube is threaded through it from the outside. The doctors use x-rays to guide the jejunal tube through the stomach and into the small bowel, leaving the tip in the jejunum. If children are using the gastrostomy just for medication rather than feeds, the ward team will show you how to use the device before going home.Select slightly larger sized, or loose-fitting clothes to allow easier movement, or if you require more space for incontinence pads or acatheter GJ feeding is rarely the first method of ‘enteral feeding’ (feeding directly into the gastrointestinal tract) used. Nasogastric (NG) and gastrostomy feeding are usually tried first. In some cases, you may need to be started on GJ feeding without trying gastrostomy feeding first, your lead team will discuss this with you if required. If you need fastenings, use poppers or hook and loop velcro-style fastenings to make them easier to manage, either independently or with assistance from a carer Never force fluid through the button. If appropriate for your child’s diet, try a half ounce of cola through the button. Remember to flush with lukewarm water before and after feedings or medications to help prevent clogs. The button came out:

Before the feed- the attachment tube needs to be fixed – the blue mark on the attachment tube needs to be aligned with the blue mark on the button PEG and turned by 90 degrees The nurse will also take details on whether you have any allergies to any medicines, any medical conditions and anything which would require you to be given any further antibiotics before the procedure (for example an artificial heart valve or if you suffer from valvular heart disease). Easy care fabrics are usually easy to wash and need little or no ironing, so are often a good choice Take the B elevator to the 2 nd floor. Turn right and enter the Endoscopy/Surgical Day Hospital Suite through the glass doors. What to expectWhatever your difficulty, you will need clothes that are easiest for you to manage when you want to use the toilet. Consider how you personally use and transfer on and off a toilet. Most people do not want it to be obvious that they are wearing a catheter bag. The factors to consider are ease of access and the desire to hide any possible bulging as the bag fills. You also need to be careful that your clothes do not constrict the flow of urine in the drainage tube, perhaps when you sit down. MSK’s parking garage is on East 66 th Street between York and 1 st avenues. If you have questions about prices, call 212-639-2338. Lee C, Kang H, Lim Y, et al. Comparison of complications between endoscopic and percutaneous replacement of percutaneous endoscopic gastrostomy tubes. J Korean Med Sci. 2013;28(12):1781-7.