HINT: How do I manage a red and swollen enteral tube stoma?
Connected Care Quick Hits are up to date and evidence based recommendations for the care of children with medical complexity & technology dependence, from hospital to home.
HINT: How do I manage a red and swollen enteral tube stoma?
SITUATION:
This QuickHit came from a home care nurse who contacted Connected Care to ask for our recommendation on how to treat and monitor this child’s G tube stoma site. This low-profile balloon type tube had been in place for > 8 weeks and was starting to look slightly pink/red, shiny, slightly swollen and wet. This child was comfortable, tolerating feeds and no fever was present.
BACKGROUND:
Enteral tube stomas, especially those used for low profile balloon type gastrostomy tubes, are a potential site for skin breakdown, infection and granulation tissue.
Granulation tissue is the new tissue that forms when a wound is healing, and it’s also the extra tissue that forms around some feeding tubes, over time. Hypergranulation tissue is an excess of granulation tissue that can become a potential site for skin breakdown or infection, or be uncomfortable or interfere with the placement/re-placement or function of a tube.
ASSESSMENT:
Hypergranulation tissue generally appears as follows:
Usually pink to dark red tissue, but it does not spread like an infection
Can appear open, wet looking or shiny
Bleeds easily
Appears bubbly and puffy (sometimes called ‘beefy’)
Can be painful to touch or with tube manipulation
RECOMMENDATION:
In the case that informed this QuickHit, Connected Care suggested the site appeared to be free of infection but showing signs of early hypergranulation tissue and recommended the following:
To treat existing hypergranulation tissue:
1. Apply hypertonic salt water soaks up to four times a day. Hypertonic solution (stronger than ‘saline solution’) can be made by mixing 2 teaspoons of table salt with 1 cup of warm water.
2. Place a Y-cut gauze soaked in the solution (squeeze out excess water before placing) on the skin around the feeding tube for 5-10 minutes up to 4 times /day. Do not wash the salt off the skin afterward.
3. If needed, use hydrocortisone cream for a week to help with skin inflammation. Hydrocortisone 0.5% cream is available over the counter. Hydrocortisone is a short-term treatment only, to be used as per the package label and for only one week at time.
When and how to ask for help?
Consider a consult to Connected Care Live if you want a second opinion about a G-tube site (you can send us a photo or use video)!
NOTE: If a stoma does not improve or hypergranulation tissue is getting worse, reach out to your G-tube specialist directly as there may be other treatments, including silver nitrate that they may recommend.
For more information about stoma care, check out these links!
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