A GJ device is usually suggested after gastrostomy feeding has been unsuccessful. Some people cannot tolerate feeding directly into the stomach, so a GJ device can be helpful as it bypasses the stomach. A GJ device can be helpful for people with gastric motility problems, where food does not pass through the stomach to the intestines as it should.

If you had a low profile balloon button GJ device inserted, you will usually be able to start using it for fluids and feeds straightaway PEG placement is generally a safe and well tolerated procedure. However, the following are potential risks: Misplacement into the colon can also occur. In this situation the initial PEG has been placed through the transverse colon into stomach. Often the initial PEG will function well, but upon exchange the replacement PEG is placed into the colon. Symptoms include pain, infection, feculent leakage, and diarrhea. Treatment is removing the misplaced PEG, waiting for the stoma tract to heal and placement of new PEG. 10 Other complications of PEG replacement include bleeding, pain, infection, and peristomal leakage. Peristomal leakage occurs more often in those with underlying medical conditions that predispose them to delayed wound healing. It is important to evaluate for other causes, such as tube displacement, buried bumper, and delayed gastric emptying. It is also important to minimize sideto-side movement of the PEG tube where it exits the skin as that can enlarge the tract. This can be accomplished by changing to low profile tube or external stabilization with a right-angle bumper or clamp. Good stoma care with zinc oxide-based protectants and consult to woundYour Abbott Nutrition Nurse will be advised of your discharge from hospital and will arrange to visit you at home. appropriate confirmation of intra-gastric tube position if there are any concerns for misplacement. 5

Smooth, slippery fabrics are usually easier to get on and off, as they glide easily over your skin or other layers of clothingSelect slightly larger sized, or loose-fitting clothes to allow easier movement, or if you require more space for incontinence pads or acatheter A sitting position will cause clothes to ride up, so look for trousers with a longer leg length, or longer dresses/skirts 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. If you have a nasogastric tube as a method of feeding you should not have any feed down it for at least six hours (preferably overnight) before the procedure.

Dressing aids are relatively simple to use and can assist with a variety of dressing tasks. We recommend that you seek advice from an occupational therapist before buying equipment, or try them out at your local Equipment Demonstration or Independent Living Centre. For some of these items, practice and correct technique is needed to ensure you can use them effectively.The “Why” of PEG replacement can be divided into scheduled vs. unscheduled PEG replacement. Scheduled replacement occurs when the PEG is replaced before any significant deterioration or complication resulting in malfunction of the existing PEG has occurred. Scheduled PEG replacement is the preferred and most common form of PEG replacement (Table 1).

Limb supports to assist with dressing are designed to provide dressing support to a person who has had an amputation. Take the medications you were instructed to take the morning of your procedure with a few sips of water. As well as the risks of the general anaesthetic, formation of a gastrostomy can cause damage to the foodpipe, stomach or nearby structures. Careful measures are taken to manage these risks. If you are concerned about the risks to your child please discuss with the team performing the procedure.The percutaneous endoscopic gastrostomy (PEG) is the most common enteral feeding tube for long term nutrition support. Multiple guidelines and teaching materials are available for initial PEG placement. While this is beneficial for PEG placement, there is little evidence-based published literature to guide clinicians for PEG replacement. Rather than a “Willy-Nilly” approach, herein we combine the available evidence, published guidelines and expert opinion on PEG replacement. We review the why, when, what, who, and how of replacing PEGs with emphasis on practical clinical guidance. Optimal management of patients with PEG tubes necessarily requires expert PEG replacement practices to provide the best quality of life for these patients. INTRODUCTION