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Introduction

This information leaflet is for patients considering a Monarch (Non-Balloon) Tube. Your healthcare team will explain what is involved and answer any questions you may have.

Why do I need a gastrostomy tube?

Due to your medical condition, you may be unable to take enough food and/or drinks by mouth to meet your nutritional requirements. This may be due to:

• Difficulty swallowing (dysphagia) that arises from changes to the function of muscles involved in swallowing. These changes can increase the risk of food and/ or drinks to your lungs, which can result in a chest infection called aspiration pneumonia.
• Changes to your appetite and/or ability to take food orally due to reduced physical function.

What is a Monarch Tube?

Unlike other gastrostomy tubes, a Monarch tube is not held in place by a balloon. It has an internal retention disc that opens inside the stomach after the tube is inserted to preventing the tube falling out.

What are the benefits of having a Monarch (non-balloon) Gastrostomy Tube

• The internal silicone retention bolster may last much longer than balloon devices.
• It is ideal for patients who do not tolerate balloon buttons due to their anatomy or differences in gastric environment and have frequent balloon failure

This is what your tube will look like:

How long do I need to have my Monarch?

Most people require a Monarch tube long term, but you will be regularly reviewed by a Dietitian to see how much food you require.

How long will my tube last for?

If it is well cared for, the Monarch tube can last between nine to twelve months. You will need to attend an appointment at the Nutrition NurseÎÚÑ»´«Ã½ clinic to have the tube changed.

One way of increasing the life of your tube is to ensure the clamp is left open when the tube is not being used. This prevents the clamp squashing the tube. You can also change the position of the clamp along the tube to avoid squashing the same area each time.

What problems might I encounter at the gastrostomy tube site?

Infection

This can occur if the PEG site is not kept clean and dry but is rarely serious. You will be provided with a PEG treatment kit containing Octenisan antimicrobial wash and Mupirocin antimicrobial ointment to clean the PEG insertion site for the first seven days (for first PEG insertions patients only). After this period patients are usually encouraged to clean with soap and water then dry well. Dressings are not usually required.

Leakage around the gastrostomy site

Occasionally feed or gastric (stomach) fluid may leak around the tube – this commonly occurs if the triangle plate or circular disc is not close to the skin allowing the tube to slide in and out of the stomach causing leakage. This can be corrected by tightening the retention plate (external bumper) close to the skin. The surrounding skin should be cleaned and kept dry. A protective skin barrier spray can be applied to resolve any redness/ skin irritation caused by the leakage. In exceptional circumstances, the tube may need to be replaced or repositioned at a different site.

Over granulation at the gastrostomy site

This is the appearance of light red or deep pink flesh that forms beyond the surface of the stoma opening. Some of the reasons this may develop maybe due to leakage, friction or an improper fitting tube. The treatment plans will depend on the cause and will require an individualised PEG care plan.

How do I clean my Monarch and the skin around it?

It is important to clean the PEG site daily to avoid infection

• Move the T-bar away from your skin to enable easier cleaning around the PEG tube
• Clean the stoma site daily with warm soapy water.
• Dry well after cleaning
• Make sure you replace the T-bar 2-4mm from the skin, so the tube does not slide in and out.
• Do not forget to clean the T-bar and tube. Dry well after cleaning

Can I have a bath?

If the skin around your site is clean, dry and well healed after the first tube placement, you may return to your normal bathing routine.

How do I manage my tube?

It is important to insert and rotate your tube once a week to stop the internal retention disc in your stomach getting stuck.

To do this, follow these instructions:

1. Wash your hands with soapy water and dry well.
2. Move the T-bar 2-4cm along the tube away from the skin.
3. Clean around the stoma, T-bar and along the tube with soapy water.
4. Rinse with water then dry well.
5. Gently push the tube 2-4cm of into the stomach and turn the tube in a complete circle with your fingers
6. Gently pull the tube back until resistance is felt
7. Slide the T-bar back into its normal position to secure the tube and prevent it from moving in and out of the stoma tract

Who to contact about what?

You will be trained in all the necessary techniques to look after the feeding tube and what to do if you do have problems. However, your community nurses, GP, dietitian, and nutrition nurse will be available to help and support you.

1. If you have any concerns about your feed or plastics order (including syringes and dressings) – contact your feed company:

• Nutricia Homeward (Patient Services):0800 093 3674
• Abbott Hospital to Home: 0800 0183799
• Fresenius Kabi: 0808 100 1990

2. If you have any concerns about your PEG site or feeding pump – contact your feed company:

• Nutricia Homeward: (24/7 Support Line) - 0800 093 3672
• Abbott: 0800 018 3799
• Fresenius Kabi: 0808 100 1990

3. Please contact your local dietitian if you have any concerns about:

• Any symptoms that suggest you are not tolerating your feed e.g. bloating, nausea
• Your weight
• The amount or type of feed you take
• Or if you need extra syringes or other supplies ordering
• Or you want to discuss tube removal

4. Contact the Enteral Nutrition Nurses at Addenbrookes Hospital

Monday – Friday (8am –4pm) excluding weekends and Bank Holidays

• Phone - 01223 216037 Option 1 for Enteral Nutrition
• Mobile – 07710 365156