Abdominal and Digestive Home Care

Bard Button Replacement Gastrostomy Device

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What is a Bard Button?

The Bard Button is a soft silicone tube that has a mushroom-like dome on the end which is placed in the stomach. This dome which is inserted through the gastrostomy stoma is radiopaque (can be seen on an x-ray) and will hold the Button in place. The part of the Button which is seen on the skin of the child has two small wings which keeps the Button from slipping through the skin into the stomach.

The Button opening has a cap which is left in place between feedings. Inside of the Button tube is a valve which keeps the feeding from coming out of the tube. This is called an anti-reflux valve. Because of this valve, you will be unable to aspirate from the Button.

The Button usually is placed only in a well-healed gastrostomy opening. This means that the gastrostomy opening from the skin into the stomach has healed.

Usually the doctor will want to wait at least 3 months after gastrostomy surgery before inserting a Bard Button.

Routine care of gastrostomy site

The skin around the Bard Button should be cleaned with mild soap and water. This can be done in a bath or shower. Skin should be washed one or two times a day. Dry skin well.

Turn Button a full circle during each cleaning to keep it from sticking in one place in the gastrostomy site. If unable to turn tube, call your doctor or nurse.

How do you give feedings through the Button?

The same method of feeding used with the regular G Tube is used with the Button. In each package which contains the Button, there are two types of feeding tubes which connect to the Button:
- The bolus feeding tube is a straight tube which can be connected to a syringe which contains the feeding. The other end of the bolus feeding tube will fit into the Button.
- For children who receive feedings over a period of hours, the continuous feeding tube has a right angle that will "swivel" (turn) and is less likely to be pulled out of the Button during drip feedings.
Other than the kind of tube which is used to connect the feeding tube to the Button, the way a child is fed, the amount given and the other equipment used will be the same as was used with the regular G Tube.
After each feeding, 5-10 ml of water should be run through the tube to flush the Button.
The feeding tubes should be washed with warm water and allowed to air dry after each feeding. Be sure to rinse the feeding tubes well with warm tap water. The tubes will last a long time if they are cleaned in this way.

How are medications given through the Button?

In general, medications will be given through the Button in the same way as a regular G Tube. Pills will need to be crushed and mixed well with water. Whether giving medications alone or before a feeding, be sure to flush the Button with 5-10 ml of water to clear the Button of any medication or formula which is still in the Button.

When will the Button need to be changed?

The Button is reported to be able to be left in place for at least six months. Some Buttons have been left in place for much longer than that.

When it is needed, the Button will be removed by using the obturator (the stick which will stretch the Button). The obturator will stretch the dome of the Button so that the Button can be slipped through the gastrostomy opening. A new Button is then placed in the gastrostomy opening.

Problem solving

Problem	Cause	Solution
Leakage of stomach contents from Button opening.	Leakage may occur when anti-reflux valve is out of place	The obturator or a #5 French feeding tube can be inserted to "flick" the anti-reflux valve back into place. Call doctor or nurse for assistance if tube continues to leak.
Distended stomach / crampy abdominal pain (abdomen feels tight and looks swollen, child may have other signs of illness - i.e. retching, diarrhea, fever and irritability / crabbiness)	Air in the stomach. Feeds given too fast. Insert obturator or feeding tube into the Button, while holding a towel over it. The towel is needed because the contents of the stomach will come out of the Button with great force. The towel will catch the liquids. Special decompression tubes are available. Feed over a longer period of time.	Call the doctor or nurse for help with these problems.
Redness and irritation around the stomach	May be caused by leakage or infection	Continue routine care and contact doctor or nurse.
Plugging of the Button	Clogged from food and / or medication	Call doctor or nurse.
Button pulled out		If the Button comes out, save it and bring it to the doctor. Call doctor or nurse. A new Button needs to be put in within 4 hours.
Pressure Necrosis as seen by redness of skin and skin breakdown	The Button has become too tight between the inside of the stomach and the skin outside. May occur when child gains weight and grows.	Prevention: Check the Button when cleaning skin to be sure the Button rotates easily. If Button appears too tight, call doctor or nurse. The button length may need to be changed.

Important reminders

Never use a cue tip stick or any other kind of stick in place of the obturator. A piece could break off and cause damage. If you do not have the obturator, a #5 or #8 French feeding tube can be used in its place.
Always call the doctor or nurse if you have questions or problems.