Guidance has been issued for nurses on the insertion of balloon gastrostomy tubes, as more patients are receiving enteral feeding.
Author: Linda Warriner is home enteral feeding specialist nurse at County Durham and Darlington Foundation Trust and a member of the NNNG Executive Committee.
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Estimates suggest that the number of patients receiving enteral nutrition has increased by 43% over a 10-year period (Ojo, 2010). Many of these patients, both adults and children, will have a balloon gastrostomy tube in place that requires regular changes or may need to be replaced if the tube is displaced.
The role of the nutrition nurse specialist is to reduce the risk of complications by taking a strategic approach to the management of these patients.
There appears to be limited robust evidence to support best clinical practice when changing a balloon gastrostomy.
The National Institute for Health and Clinical Excellence (2012) acknowledges that, although comprehensive data is available on the use of home enteral tube feeding in the UK, very little information is documented about enteral feeding practices. The authors note that: “Anecdotal reports suggest a wide variation in practice that may or may not be safe” (NICE, 2012).
A range of balloon gastrostomy tubes is available and each manufacturer produces its own advice sheets, which do not apply to all devices.
Good practice guideline
In July 2012, the National Nurses Nutrition Group released its good practice guideline, Changing of a Balloon Gastrostomy Tube (BGT) into the Stomach for Adults and Children (Box 1) (NNNG, 2012).
The guideline gives precise directions to health professionals in safely inserting a balloon gastrostomy tube. This guideline was developed to enhance previous information provided by NICE (2006) and provide a framework that contributed to maintaining consistency, ensuring care standards of an excellent quality and promoting safety.
The guideline recommends that health professionals undertaking this procedure should, as part of the process, include a pre-insertion risk assessment and have the skills and knowledge to carry out safe insertion of the balloon gastrostomy tube.
It offers a clear step-by-step approach to the procedure and includes advice on how to check if the tube has been correctly placed after insertion and how to record the procedure.
The guideline also recommends forward planning and monitoring to reduce the risk of inadvertent extubation and the importance of making arrangements for routine tube changes.
The NNNG is working to support nurses to achieve excellence in nutritional care and is developing good practice guidelines on the care of nasogastric tubes and treatment of granulomas around enteral feeding tubes.
How to obtain the guidelines
The practice guidelines are available to members of the NNNG and can be obtained from the member’s area on the NNNG web site.
Box 1. NNNG guideline contents
- A brief description of a balloon gastrostomy
- The longevity of the device
- How tube patency is achieved and maintained
- How a balloon gastrostomy tube is inserted
- How to replace a balloon gastrostomy
Any nurse or other health professional, who, as part of their role is required to place a balloon gastrostomy tube in primary or acute care.
National Institute for Health and Clinical Excellence (2012) Infection: Prevention and Control of Healthcare-Associated Infections in Primary and Community Care. Clinical guideline 139.
National Institute for Health and Clinical Excellence (2006) Nutrition Support for Adults. Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. Clinical Guideline 32.
National Nurses Nutrition Group (2012) Good Practice Guideline: Changing of a Balloon Gastrostomy Tube (BGT) into the Stomach for Adults and Children. National Nurses Nutrition Group.
Ojo O (2010) Managing patients on enteral feeding tubes in the community. British Journal of Community Nursing; 15: 11, Supplment 6-13.