Some of the common problems with g-tubes are listed with information on how to help you manage these at home.
Granulation tissue is the body’s response to attempt to close the stoma opening. An overgrowth of healing tissue around the base of the stoma can be reddish or spongy, and can bleed easily. Call your doctor for a prescription of 0.1% TriamcinoloneÒ cream. This is a steroid that will help shrink and heal the granulation tissue.
Granulation can occur right after surgery or at any time. Granulation tissue can occur from a wiggly g-tube. To help prevent granulation tissue from developing it is best to keep a dressing in place with the g-tube secured. Some kids can be genetically prone to scar badly and have granulation tissue all the time even when all the right things are done.
To apply Triamcinolone cream, clean g-tube site with mild soap and water, rinse well, and allow to air dry. Appy triamcinolone cream to granulation tissue using a swab stick. Apply a drain sponge and secure with tape. Triamcinolone should be applied 3 times a day for one week. If after this time there is no improvement, call you doctor.
If the problem persists, you may need to try silver nitrate. This will require an order from your doctor.
What should I do if my child’s g-tube is leaking? A g-tube leaks for many different reasons. The first thing to check is the amount of water that is in the balloon.
Follow these step-by-step instructions:
- Gather the following supplies:
- 1 glass of water
- A few wash cloths/ towels
- Mefix tape 2x2 drain sponge
- Barrier cream, if needed
- 2 10cc syringes (fill 1 syringe with 3-5 cc of tap water)
- Place your child lying down in a comfortable position. You may need to have someone help to hold your child if they tend to wiggle.
- Place washcloths around g-tube site.
- Take the empty 10 cc syringe and place it in the existing balloon port. Depending on the type of g-tube button, it will say BAL or will have a black line on it. Make sure the syringe is plugged in tightly!
- Remove water from existing g-tube button. There should be 3cc in the balloon for children up to 12 months of age and 5 cc in the balloon for children 13 months and older. This is a general guide for the amount of water in the balloon. If you are unsure of how much your child has, call your doctor.
- If there is less than 3cc or 5 cc, you will need to add more water. Discard the syringe with the water from the balloon. Using the syringe with water place 3cc or 5cc of water in the syringe and gently push it into the balloon.
- To ensure that the g-tube is still in stomach check for stomach contents. (See How to Place a G-tube button for how to check for stomach contents).
- Dress g-tube normally.
- If the balloon had less than the required amount of water, re-check the amount of water in the g-tube sometime in the next 24 hours. If the amount of water has decreased, then there may be a hole in the g-tube and the g-tube button will need to be replaced. If the amount of water is still 5 cc and the g-tube is continuing to leak, you will need to look of another possible cause of the leaking.
Another reason that a g-tube might leak is if you child is sick. If your child is ill and has lost a bit of weight the g-tube will not lay snugly to the abdomen. Continue to keep a dressing in place and change it frequently, until your child is feeling better. Illness can also cause the digestive system to slow down and your child cannot digest their feedings as well.
If you are feeding your child a large volume too quickly, this can also lead to leaking. Try slowing down the rate of the feed.
Your child’s growth can also lead to leaking. A poorly fitting g-tube will cause leaking. Contact your doctor and schedule an appointment to have the g-tube re-sized.
When was the last time you changed the g-tube? The g-tube may have hole in it or the valve is not working properly. Change out the g-tube for a new one to see if this corrects the problem. See How to Place a G-tube Button.
If you have tried all of the other options and nothing is working, it may be that your child’s digestive system is too slow. Contact your child’s doctor to see if this is a possibility.
Skin breakdown can occur for multiple reasons.
Stomach acid is caustic and causes skin burns and breakdown. If you notice any redness of the skin, clean the skin more frequently (several times a day), change the 2x2 drain sponge often, and apply a barrier cream to the skin.
The stoma (opening) is larger
If there is no dressing in place, the tube may be moving back and forth, causing stretching and leakage. Be certain to anchor the tube securely to the skin.
Actual infection of the stoma or surrounding skin is not a common problem. If the redness on the skin grows when you can’t see evidence of leakage, if the redness persists despite your efforts to keep the skin clean and dry, or if you notice pus, call your surgeon or gastroenterologist immediately.
Often seen as a red splotchy rash around the stoma site. These are often seen as a result of excess moisture under the dressing. Call your MD to prescribe an anti-fungal barrier cream, like Critic-aid Anti-fungal.