Stoma Care

Greater care is required during the first week the tube is in place, as the surgery has just been performed. Your stoma (the feeding tube site) is, essentially, a stab wound that you don’t ever want to fully heal because that would mean that the stoma is closed and you’ll need another PEG surgery. The area around the wound must be kept thoroughly clean and covered with clean gauze. During this period of time, the tube may occasionally pull away from the abdominal wall, resulting in leakage around the insertion site. Leakage may also occur if the stoma site becomes enlarged.

Healthy stomas for button and G-tube:

stomas button g tubeChronic leakage around the site is NOT normal. If the stoma is oozing blood, food, stomach acids, or any other substance, then you need to see your GI or visit the ER immediately.

The tube is marked at the point where it should be level with the incision and should be checked regularly to make sure it is still properly in place. Excessive tension on the tube may result in pressure necrosis (death of an area of tissue) of the interior abdominal wall. Excessive tension may also cause the tube to be pulled out prematurely.

Should the tube accidentally come out, the original tube–or a replacement–needs to be placed back in the stoma as soon as possible or the incision will begin to heal, and new surgery may be required. Stomas could begin to close up in less than two hours. It behooves you to have a spare, balloon tube (or a Foley Catheter, which also has a balloon) at home in case your tube comes out and you don’t have immediate access to an ER.

Along these lines, you should be familiar with how to replace your own tube. After your first PEG surgery, ask the surgeon for specific instructions for changing the tube. Or, at your next GI visit for a regular tube change, watch your doctor carefully to see how it’s done. Even better, ask your doctor to let you do some of the procedures so you can boost your confidence.

Daily showers should be sufficient to keep the stoma site clean after it has healed from the initial surgery. The site may have occasional ‘crustiness’ or granulation around the edges. This is normal. The body is simply attempting to repair slight pulls, tears or minor infections. The granulation should just be gently washed off.

On the other hand, if you see unnaturally swollen, red, lumpy, moist tissue or flesh around the stoma site, then it is most likely what’s known as hypergranulation tissue. This tissue could also exude yellow, sticky pus. It may be painful, bleed easy, and prevent your stoma from healing the way it should. Hypergranulation can occur for no apparent reason (friction, moisture or irritation may be contributing factors), especially during the first three months after the tube has been placed.

There are different methods for dealing with hypergranulation tissue. Initially, you should keep the site clean and dry in the hope that it will heal by itself. If this doesn’t work, silver nitrate may be an option. Silver nitrate is a caustic substance that burns the offending tissue. It will turn black as a result, scab up and eventually fall off. Note: you should spread petroleum jelly around the stoma before administering silver nitrate because it is extremely painful when it touches the skin. Other ointments have also proven to be effective at getting rid of hypergranulation. Creams intended for ear infections or skin issues (such as Kenacomb) may heal the site. Some G-tube patients report that 4-5 administrations of Kenacomb per day for five days clear up their hypergranulation. As a last resort, some doctors could choose to surgically remove the hypergranulation tissue. Wound care is extremely important after such a procedure to avoid infection or a reoccurrence.

You should regularly rotate your G tube, beginning a few days after initial placement. This makes sure the tissue and skin around the area haven’t stuck to the tube and will give you a good healthy stoma. It’s recommended that you rotate the tube at least a quarter turn once a day. The best time is probably right after you bathe. If the tube feels tight and is difficult to turn, be sure not to force it. Make sure there is a little space in and out for the tube. If it’s too tight against the skin, slide the g-tube bumper up slightly. If your tube is held in place by a balloon, check to see if there is enough water in the balloon (see below). It could be that the balloon has burst or eroded–this necessitates a tube change. If the feeding tube freely moves in and out and the balloon appears undamaged, try lubricating the stoma with a little water-based lubricant. If you don’t have lube, you could try using vegetable oil. Vaseline, or other petroleum-type lubricants, erode the plastic in the feeding tube over time so you should avoid using these. Once the tube is lubricated, try rotating it again. Use as much gentle force as you’re comfortable with but note any pain or discomfort. Don’t panic if your tube won’t rotate. Stomas commonly get tight due to bloating, recent tube placement, or tube changes. However, if you’re unable to rotate your tube more than a few days, ask for medical advice.

How to check the water in your balloon.

peg tubesYour tube should have an access port for the balloon (the colored port on the tubes pictured at right). Insert a syringe into this port (the 60 cc syringe you use for feeding may have a special luer adapter for this purpose). Gently draw back on the syringe while making sure it is firmly attached to the port. Clear water should be drawn into the syringe–the same amount that was put into the balloon when placed. If the water is not clear, or there isn’t enough, or you’re not able to get any at all, then there is a problem with the balloon and you need to get your tube changed. If the water is fine, then you can slowly push it back into the balloon.

Tube Care

To keep the tube clean and unobstructed, you should flush the tube with clear water before and after feedings, or after medications have been administered through the tube. After the tube is placed, you should consult a registered dietitian or a nurse who specializes in nutrition to determine your nutritional needs, the number of calories, protein, and fluids that will be necessary, as well as the most appropriate nutritional formula and how much of that formula will be needed each day. Nutritional products designed for tube feeding are formulated to provide all the nutrients you’ll require including proteins, carbohydrates, vitamins, and minerals. Some even contain dietary fiber and other non-nutritional elements. If you choose to blend food for your meals, you should consult your doctor or nu