G Tube Skin Breakdown and How to conquer it!
We are going to cover the basics of feeding tube stoma care, and some common causes for skin breakdown around the G or GJ tube. I will also cover some ways to try to prevent breakdown from happening in the first place!
Causes of Feeding Tube Skin Breakdown, How to Heal it, and How to prevent it!
G-tube Stoma Care
One of the first things that you need to add to your daily routine is a basic skin care regiment that is followed consistently. The basics of G-tube and GJ-tube stoma care starts with cleaning and washing the site. This can be done 1-2 times a day (think wake-up/morning routine and go to bed/night routine).
All you need is a wash cloth, mild soap, and warm water. Simply wipe down the area and allow to air dry for a few minutes. I like to do this as part of our morning wake up routine that includes diaper change and new outfit for the day. We do the exact same thing again at night before bed with a diaper change and pajamas.
If your using g tube covers, make sure to change them when ever they become moist. Moisture is the #1 reason for skin breakdown and can keep a site from healing properly!
Tube Site Stoma Care
Most irritations around a feeding tube will look like redness around the stoma and under the button. One of the most common causes is leakage. Irritation can also be caused by sweating and would be similar to a sweat or diaper rash. Some home remedy options would be to use baby powder, corn starch, or a diaper rash cream like Desitan. This should clear up relatively quickly in less than 3 days.
G Tube yeast Infection
Sometimes no matter how much you try to keep the area clean and leak free, you end up fighting a redness around the site that just won’t clear up in 3 days. At this point it is probably a yeast infection. These kinds of infections usually are accompanied by a growing rash, soreness, and swelling.
Most g tube yeast infections are treated with Nystatin powder or Nystatin cream. It is an anitfungal agent that creates holes within the wall of the yeast cells to make them die. Sounds like tiny super heroes to me!
Once again, keeping the site dry is going to be a huge factor. The more moisture that sticks around the stoma means that more yeast cells can grow and spread.
A typical g tube yeast infection can last 1-2 weeks.
G Tube Stoma Bleeding
If you notice that the stoma is bleeding around the feeding tube site, this could be the sign of trauma, a stoma stretching, or granulation tissue. If your seeing a small amount of blood on a split gauze or g tube cover, it is more than likely caused by the g tube being yanked or pulled. This is especially true in babies, toddlers, and school age children.
You can prevent trauma to the feeding tube area by using a padded belly band and by securing the extension to the stomach using medical tape.
Usually the bleeding from a small trauma will clear up in a few days!
If your noticing a lot of bleeding or seeing clots of blood, this could be a sign of major trauma or internal bleeding. I would not hesitate, and I would immediately go to your local Children’s Hospital Emergency Room.
The reason I suggest a children’s hospital and not just the closest emergency room, is because most ERs are not well trained or equipped to deal with feeding tubes, especially in children!
I would also make a call to your surgical team or GI doctor even if it is after hours, just to keep them informed of the situation. They may have some instructions for you to follow before going to the Emergency Room.
G Tube Burning
If you or your child is experiencing burning and redness around your feeding tube site, this is usually due to excessive acid reflux/ stomach acid.
If your not currently on any medication for acid reflux, your doctor may prescribe some in order to lessen the amount of acid that your stomach makes.
If your already on acid reflux medicine, it may be time to adjust your dose or try a different medicine.
In my daughter, we noticed that she had g tube site burning if she ate too many foods that were acidic. We would cut back her foods containing mangoes, citrus, pineapple, and tomato products.
Another good way to help the burning around the g tube is to find a good barrier cream. Personally we love Aquafor so much, that we buy it in large tubs. It can get a little pricey for the brand name version, so we pick up the generic store brands when I see them available.
You can place the barrier cream directly on the site or you can put it on the split gauze. If the area is super wet and not drying well, putting it on the split gauze will keep the barrier in place.
When all else fails, and we are still having a lot of burning and irritation, we use a combination of stomahesive and no sting barrier film. We became familiar with these products when my daughter had a colostomy bag. The combination of these two products make a crust on the service of the skin so that way fecal matter didn’t burn the skin around the colostomy site.
One time when my daughter’s stomach was just so irritated that the skin was starting to pore and crack, I tried the combo around her feeding tube site. Within a few days, the site was able to start healing by not having direction contact with the skin.
How to use Stomahesive & No Sting Barrier Film
Thankfully most insurance companies will cover these products under DME (durable medical equipment), so all you need to do is ask your surgical care team or your GI Doctor to call in a prescription to the DME for you.
If your not able to get a prescription, both products are available on Amazon or Walmart.com. The total out of pocket cost will be around $40 but the products will last a good amount of time.
1. Clean the area with warm water, mild soap, and a wash cloth. Allow to air dry for a few minutes.
2. Once the area is mostly dry, sprinkle the stomahesive powder around the red and irritated area and just past the area a little bit (say like 1/4 to 1/2 an inch). I usually use the split gauze to gently tap the powder flat and to spread it where I want it to be.
3. No sting barrier film comes in a preloaded wet sponge or a spray, and they both work the same. Either use the sponge or spray the liquid directly on top of the powder. If using the sponge, don’t rub it into the powder, just dab the powder until you see that it is getting wet. When using the spray, I keep spraying 3-5 times until the entire area is wet.
4. Allow the area to air dry for a few minutes, and then your split gauze around the feeding tube. I would not recommend using a tubie pad in these cases.
5. Keep reapplying the stomahesive and no sting barrier film as needed. I usually reapply every time I change the split gauze due to moisture. The crust that forms does wear down, so it is best to keep reapplying. I would not wipe the old barrier off completely except for at the morning and night time routines.
Conclusion
Hopefully you have realized the that number one cause for skin irritation starts with moisture. Once you have established a consistent stoma skin care routine, this will help a lot! Just know that leaking and moisture are very common issues and knowing how to recognize moisture issues is a daily task.
Once you have identified an irritation, using simple steps at home can keep the irritation from becoming a yeast infection. Prevention is always key but sometimes irritation still happens. So keep some basic supplies like aquafor, stomahesive, and no sting barrier film on hand, just in case!
