G tube Care Guidelines
New G-tube insertion sites are inspected daily. The dressing is changed once daily or more often if it becomes wet from drainage around the incision. Other than the initial dressing, which is usually quite thick to protect the incision, all other subsequent dressing should be thin enough to allow air to reach the skin but thick enough to absorb any drainage. Once the incision is completely healed, no dressing will be necessary. However, it is not uncommon to have small amount of yellowish-green mucousy drainage for an extended period of time. A mild odor could be associated with the drainage. It can be expected to diminish as soon as the existing G-tube is replaced by a low profile G-button. For the first 10 days after the G-tube insertion, it is advised to refrain from bathing or swimming. It is safe to shower as long as the G-tube site and the dressing is thoroughly covered by plastic wrap and the dressing is changed immediately after the shower. It is also advised to avoid carrying or moving heavy objects or engaging in any form of rough play during the first few weeks of wound healing.
Inspect G-tube Site daily: a good time is while dressing or showering in the morning.
Observe for signs of inflammation: pink or red discoloring, swelling or tenderness.
Observe nature of drainage: some form of light yellow-greenish mucusy drainage is common and it may have a slight odor. This drainage may persist in a small amount as long as the G-tube is in place, however, it tends to diminish in amount as the G-tube is replaced by a low profile G-button because of less movement against the tract with a well fitted button. Purulent drainage accompany with strong offensive odor is certainly suggestive of infection in and around G-tube site.
Skin Irritation can be caused by the leakage from feeds as a result of an unfit or poorly sealed G-tube or button. The longer the tube, the more rubbing will occur which can widen the tract and weaken the seal which causes leakage. If leakage is due to a defective button or ruptured balloon, changing into a new button will stop the leakage. In case of a Bard button, it may be due to a poorly functioning antireflux valve within the "mushroom" tip. Occasionally, this problem can be resolved by flushing the button via adaptor with 30cc to 50cc of carbonated water or coke. It may restore the function of the valve and stop the leak. Meanwhile, one should apply saline soak to the affected area three to four times a day to promote healing and keep skin area clean. Once skin area is dried thoroughly, a barrier cream containing zinc oxide can be applied to the skin around G-tube site to prevent further damage.
Inflammation can be assessed/identified by changes in discharge and worsening of skin condition around the gastrostomy stoma. Increased discharge will cause skin irritation. Specifically, if the G-tube is poorly fitted there may be leakage of gastric juice which may excoriate an already irritated area of skin and cause redness, tenderness, swelling and infection. Cultures should be done to identify the bacteria and the patient started on an appropriate antibiotic cream or oral antibiotic to treat the infection.
Erosion (or granulomatous changes): with movement of the G-tube, erosions may appear at the mucosal edge of the stoma. It is important to treat this since leakage from the erosions may burn the skin area and cause inflammation. Treatments could include:
a) Changing to a well fitting button
b) Saline soaking three or four times per day and applying alcohol which will shrink the erosions.
c) Losec or Zantac may help if there is discharge and erosions. The balloon buttons (McKey) also lasts longer if the acidity in the stomach is reduced.