Gastrostomy Button Care: Expert Answers from a Dietitian

Kim Lunardi is an Accredited Practising Dietitian with more than 17 years’ experience in clinical nutrition and gastrostomy care. As a senior dietitian at a major metropolitan hospital and in private practice, Kim is committed to empowering people, carers, and clinicians with practical, evidence-based approaches to nutrition support. She believes her greatest learning comes from working alongside people living with feeding tubes, whose experiences continue to shape and inspire her practice.

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From your experience, when is the right time for a patient to move from a PEG tube to a low-profile button, and what benefits do they usually notice?

Usually, the first PEG tube that is inserted (the “initial” PEG) stays in for at least 3 months to give the new gastrostomy stoma (the hole in the stomach) time to heal – think of it like an earring hole. After this time, it may be suitable to replace the initial tube with a low-profile button tube. Timing depends on the type of initial PEG tube used, how long the treating health professional recommends keeping it in place and if your weight is stable (fluctuations make affect fit).

Low profile buttons sit flush to the skin, are discreet and provide greater comfort than a long “dangler” or standard gastrostomy tube. They are also helpful for people who may pull at their PEG tube, as the extension set (the tube used for feeding) can be attached and removed as needed.

How do you determine the correct size and fit for a gastrostomy button, and how does proper sizing impact comfort and leakage prevention?

There are two parts to sizing: the tube diameter or French (e.g. 20Fr) – usually the same as the initial PEG and stoma length – the distance from the inside of the stomach to the skin (e.g. 2.5cm). A special device is used to measure stoma length however sometimes this device isn’t available, so an estimate can be made using the centimetre markings on your PEG. Sometimes even with the measuring device it can take some trial and error to find the best fit.

A good fit will mean the button sits comfortably on the skin – not digging in causing pressure areas and not sticking out to far which can get caught on clothing or pull. A button that is too long can also move in and out of the stoma tract, leading to leakage or granulation tissue (“proud flesh”).

What practical tips do you share with patients (and carers) for checking balloon volume and maintaining it at home?

If you’ve been advised to check the button balloon volume, make sure you’ve had training, feel confident and know how often to check. Set up all the equipment you need before starting – remember the syringe to check the balloon is different to the one used for feeding. Use cooled boiled or sterile water and check the manufacturer’s guide for how many ml the balloon takes before you start – different tubes have different balloon fill volumes.

Always keep a spare gastrostomy tube on hand just in case something unexpected happens. And never let go of or turn your back on a gastrostomy tube when the balloon is deflated – keep one hand on it all times so it doesn’t jump out! If the person with the tube is able, ask them to hold it in place while you prepare to reinflate it.

Finally, make sure the tube remains fully inserted through the length of the stoma tract before re-inflating the balloon. Imagine an earring being pushed all the way though the earring hole… don’t inflate the balloon in the stoma tract as it can cause pain and other problems.

If a patient is experiencing leakage around the stoma, what’s your step-by-step approach to identify the cause and resolve it?

Leakage can have many causes – I assess gastrostomy tube size and fit within the stoma, balloon volume, stoma health and consider if constipation or delayed gastric emptying (feed or fluid sitting in the stomach longer than normal) is contributing. A small amount of leakage is normal for some people, so long as it is not irritating skin or causing problems.

It’s also important to identify the type of leakage – is it feed, gastric juice or pus (which would suggest infection)? And does it happen at a particular time of day, or when in a certain position? While it’s tempting to consider simply increasing the tube size, this is usually a last resort. It’s important to find the underlying cause – get in touch with your doctor, nurse, dietitian or a stomal therapist for a review.

A low-profile gastrostomy button. Image for educational purposes only. Always consult your healthcare professional about device choice and suitability.

What advice do you give patients about keeping extension sets clean, unblocked, and in good condition, and how often should they be replaced?

Regular water flushing is the best way to keep extension sets working well. Flush before and after feeds (sometimes also during). Most blockages are caused by medication – crush tablets well and give a water flush before, between and after each medication. Using warm water and a push-pull technique with a small syringe (e.g. 10mL ENFit syringe) can help with blockages. Some services provide long thin cleaning brushes for extension sets to dislodge any build up in the set or small port that connects to the button.

Check the manufacturer’s guidelines for replacement. I suggest washing extension sets in warm soapy water (like you would your dishes), rinse and air dry. Some people store them in a clean zip-lock bag between uses. Avoid boiling or sterilising extension sets as this can cause damage and shorten their lifespan. Cleaning is a time to check the extension set for any damage, cracking or parts you are unable to clean – if you notice this, replace it regardless of time.

What practical guidance do you share with patients who want to keep swimming, playing sport, or staying active with a gastrostomy button?

The whole point of having a feeding tube is to support life and allow people to keep doing what matters to them. A low-profile button makes it much easier to stay active – they are discreet and less likely to catch. For swimming or hydrotherapy, wait until the stoma is fully healed and your health professional has given the all-clear. Some people like to use a waterproof dressing or cover over the button. For contact sports, consider a protective guard and avoid direct impact on the button.

I work with a client who loves golf but was worried her standard long tube would get tangled in her swing – changing to a low-profile button kept her playing comfortably.

**How does balloon volume influence the longevity of the device, and what signs should patients look out for that suggest it needs review or replacement?**

The balloon keeps the button in place, but it is normal for gradual water loss from the balloon over time. Make sure the balloon is inflated with the amount recommended by the manufacturer and record this volume to track any changes. An under-inflated balloon is more likely to leak or fall out.

Signs the button needs review include leakage (this could be around the button or from the center of the button extension set clips in), pain, tube movement out of the stoma site, redness or pressure on the skin, tube breakage or issues with feeding. If you notice these, contact your treating team.

What advice do you have for coordinating care when multiple carers are involved in tube feeding management?

Keep it simple! Complex feeding plans with different volumes, rates or feed types (unless clinically required) increase the risk of error and can cause confusion when working with multiple staff. Simple tweaks like using a larger/smaller feeding bottle, condensing or simplifying feeding times and flushes can make a big difference for everyone involved. Clear, written plans (including photos of equipment used, feeding position etc.) and good communication when multiple carers are involved keeps feeding safe and consistent.

If something isn’t working for you, the person you support or the care team ask for a dietitian review. You don’t have to be stuck with the first feeding plan that was prescribed – especially if it’s impacting on activities, outings, care needs, interrupting sleep or causing stress.