42 | CN Focus Vol.9 No.3 October 2017

A growing number of patients in the community receive feeds, fluids and medicines

through balloon gastrostomy tubes (BGTs), which can offer a longer-term solution for

nutritional support. Balloon gastrostomy tubes pass through a stoma in the abdomen

directly into the stomach; the balloon on the end of it is then inflated with water and

is used to hold the tube in place, making them very delicate. Due to the nature of

BGTs, some patients, carers and members of the community multidisciplinary team are

concerned about caring for balloon gastrostomy tubes, in particular the potential failure

of the balloon – which can result in inadvertent removal and an unplanned tube change.

Unfortunately, these concerns and uncertainties commonly lead to unnecessary admissions

to hospital or Accident and Emergency (A&E) departments.

However - as Helen Stanton, a Nutricia Enteral Nurse Specialist who works

predominately in the community in South London, explains in the latest of our series of

case studies – working closely with multidisciplinary teams, patients and carers helps avoid

unnecessary admissions associated with balloon gastrostomy tubes. Helen is especially

empathic to the issues facing patients and their families; she helped care for a family

member who had a balloon gastrostomy tube fitted.

Caring for BalloonGastrostomy Tubesin the CommunityCase Study

The Nutricia Homeward Nursing Service Case Study SeriesKeeping you up-to-date on the benefits of the Nutricia Homeward Nursing Service to patients, carers and the NHS byminimising tube-related readmissions into hospital, helping to keep as many patients as possible safely managed at home.

CNF October Vol9 No3 2017_210x297 08/09/2017 14:38 Page 42

Nutricia Homeward Nursing Service | Case Study

CN Focus Vol.9 No.3 October 2017 | 43

For further information visit: www.nutricia.co.uk

Training:The foundation of careFor Helen, training is the foundation of

caring for a balloon gastrostomy tube.

Patients and carers need to understand,

for example, how to change the water

inside the balloon, which may occur as

often as on a weekly basis. It is important

to realise when a balloon has failed as soon

as possible, as this may require an entire

tube change. In addition to these specific

challenges, they also need to be able to

deal with any common issues that can

arise when using the tube to administer

feed and medications. Helen finds, for

example, that patients and carers often

do not appreciate the importance of

flushing the balloon gastrostomy tube with

water before and after each use to prevent

blockage. Patients and carers also need

to understand how to care for the stoma

site and tube to reduce the risk of infections

and unplanned removal. Educating and

supporting the patients and carers generally

resolves any issues and addresses any

misunderstandings.The growing use of balloon gastrostomy

tubes in the community means that Helenalso educates an increasingly diverserange of members of the multidisciplinaryteam, including district nurses and nursinghome staff. “Many district nurses andnursing home staff lack the training, timeand confidence to deal with these issues

or change balloon gastrostomy tubeswithout referral to A&E,” she says. “So,educating the multidisciplinary teamreduces admissions. Ensuring that themultidisciplinary team knows who to callif they have any issues can be a greathelp. These calls from the team offer us theopportunity to address the issues and soavoid admissions.”

Tailored training and follow upHelen tailors her training for carers, patients

and multidisciplinary teams depending on

their level of understanding and experience.

She uses a mannequin to demonstrate

balloon gastrostomy tube management

and to allow patients and carers to practice.

“I can observe what they are doing,

address any issues and ensure that they’re

comfortable using the tube,” Helen

comments. “Surveys and feedback from

patients, carers and the multidisciplinary

team suggest that they really value the

education and support and the time that

the Nutricia Nurses can spend with them.”

Helen also uses follow up appointments

to reduce the risk of admissions. She makes

the first post-discharge visit within five

days of the patient being sent home from

hospital. “This ensures that the patient and

carers are managing the pump and feeding

tube well,” she says. Balloon gastrostomy tubes need to be

changed every 3-6 months, which allowsHelen to stay in touch with the patientsand address any concerns or answer anyquestions that have arisen. During the tubechange process, a risk assessment tool isused to ensure the change is as safe aspossible. “When it’s time to change theballoon gastrostomy tube, we speak tothe patient and their families explaining theprocedure. We also take a pH reading withthe existing tube in place,” Helen explains.“Provided they’ve not experienced problemswith the initial insertion and we can get apH measurement we will change the tube.If the tube has become blocked, we would

need to change the tube without obtainingan initial pH reading. We would, however,need to follow the policy for such cases,such as checking that there are nocontraindications and that the balloongastrostomy tube has been in place for atleast 12 weeks.”

Balloon gastrostomy tubes are used for

long-term nutritional support. So, over the

months and years, the routine visits offer

Helen the opportunity to develop long-

standing relationships with patients and

their carers. She particularly values these

relationships as a member of her family

needed a balloon gastrostomy tube. “I knowwhat patients and carers go through. Iknow how emotional patients and theircarers can feel. I have considerable empathyfor what they are going through and I knowhow important it is for patients and theircarers to feel that they are not on their own.When I receive a call asking me to see apatient to troubleshoot an issue I try to visitthe same day and if that’s not possible, I’llvisit within 24 to 48 hours; it all depends onthe issue. But I will always call to see if theissue can be resolved over the phone. I alsostress that support is available at any timeon the helpline.”

Reducing admissionsThe combination of effective education to

address specific challenges surrounding

balloon gastrostomy care, responsive follow

up and building long-term relationships with

patients, carers and the multidisciplinary

team reduces the number of admissions

associated with balloon gastrostomy tubes.

“The service agreement with the Trustdescribes the expected role that the nursesplay,” Helen explains. “This can then lead toa reduction in admissions, which can resultin considerable savings, and establishes arobust procedure that my colleagues and Iadhere to aspects of their job. But despitefinding the training and relationshipsrewarding, I only feel I’ve succeeded if Ireduce the number of admissions.”

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