So what is the difference between a PEG and a button. The easiest place to start is what is a gastrostomy?
“A gastrostomy is a surgical opening through the abdomen into the stomach.”
So in short it is a hole, but in order give a feed supplement you need to place a device in that hole. So what sort of device? Well it has to have three characteristics:
- Something on the inside to stop the device falling out
- Something on the outside to stop peristalsis pulling the device into the stomach
- A tube which connects 1 & 2 and allows the passage of feed.
Has an internal retention balloon which holds about 5mls of water (depending on the manufacturer) and the locking port on the outside. The button is accessed via a removable extension set which is changed every 2 weeks. Buttons come in a range of sizes so that the device fits snugly in the hole.
The water in the balloon must be changed every week to check that the balloon has not popped and the water hasn’t evaporated. If the balloon is empty the button can fall out.
(In a future blog we will talk about how you change the water).
A button will need changing as they wear out. This can be after a few weeks or for some many months (the longest button I know of is 2 years). A button can be changed at home by the child or their parent.
- Can be changed at home
- Can fall out – leads to narrowing of the hole
- Can be pulled out.
Has an internal retention disc the size of a 10 pence piece. On the outside it has a triangle that clips around the tube. The PEG always has a long tube attached so some families find it obtrusive. The PEG is accessed via the connector at the end of the tube.
Unlike the button the PEG remains in for a long period of time normally about 2 years but some PEGs last longer (say 5 years). The child will require another general anaesthetic (GA) to replace a PEG. At this time some families may choose to switch to a button.
PEGs are very simple, if they break they can be repaired by trimming the tube below the break. The PEG only needs to be changed if it becomes too short to trim or the break is too close to the skin to repair.
Once a week the PEG must be advanced (moved into the abdomen) to prevent the internal disc from becoming buried in the gastric mucosa.
On the left is how the internal disc should normally look in the stomach. On the right you can just see the disc under the mucosa.
(In a future blog we will talk about how you advance a PEG).
- Can’t fall out
- Simple to use and repair – ‘plug and go’
- Obvious tube always attached.
- Requires admission and GA to change.
So if you are asked what sort of gastrostomy device your patient has, think of a few simple things.
- Do I have to attach an extension set to use?
- Does it have a balloon port ?
If the answer is yes then the child has a button, if the answer is no then they have a PEG.
There are other types of tubes that don’t fit these rules but you can still ask the same questions and pass that onto the specialist nurse then we will be able to tell you more.
I hope this summary helps you to understand the basic differences between a PEG and a button.