• 
  

  • First change should be performed 6–8 weeks after initial gastrostomy tube placement.

  
  

  • Dislodged gastrostomy tube or gastrostomy button.

  
  

  • Replacing a gastrostomy button.

  
  

  • Blocked gastrostomy tube or gastrostomy button.

Absolute

• 
  

  • Unstable airway.

  
  

  • Hemodynamically unstable patient.

  
  

  • Intestinal perforation.

Relative

• 
  

  • Coagulopathy (prothrombin time > 18 seconds).

  
  

  • Thrombocytopenia (platelet count < 100,000/mcL).

  
  

  • Recent intestinal tract surgery (< 1 month ago).

• 
  

  • Lubricant gel.

  
  

  • Gastrostomy catheter.

  
  

  • Button.

  
  

  • Normal saline.

  
  

  • 10-mL syringe.

• 
  

  • Bleeding.

  
  

  • Perforation.

• 
  

  • Explain indication and risks to the patient and parents.

  
  

  • Inform the patient of the intention of the procedure.