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A child may need enteral nutrition (tube feeding) as part of supportive care during cancer. Feeding tubes may be placed through the nose (NG tube, NJ tube) or through the abdominal wall (G tube, GJ tube, J tube). Proper care of the tube and skin will reduce discomfort and lower the risk of infection and other problems.
Tubes placed through the nose can irritate the inside of the nose and the skin where the tube is taped. Proper care can help prevent discomfort and skin problems.
Gastrostomy (G) tubes, gastro-jejunostomy (GJ) tubes, and jejunostomy (J) tubes are feeding tubes placed through a small opening (stoma) made in the wall of the abdomen. They may be long tubes or low-profile tubes. A long tube may be replaced with a low-profile or button tube after the passage has healed, usually about 6 weeks.
Once healed, the skin around the tube should be painless. The size and shape of the opening should just fit the size of the feeding tube.
Healthy G tube sites don’t need a lot of extra care. Daily baths with soap and water are usually all that is needed to keep the area clean. General care tips for feeding tube sites include:
It is important to know what problems can occur, why they happen, and how to address them if they arise.
Leaking can occur around the tube. If leaks occur from the tube, it can be due to a problem with the balloon fill. Leaks can also be related to neutropenia.
Moisture and acidic stomach fluids can cause the skin to be red and irritated. If this occurs, clean the skin with water several times each day. The area will have to be cleaned more often if drainage increases. Gently dry the skin after cleaning. A barrier powder or ointment may be needed. If the skin does not improve or leaking continues or occurs in large amounts, talk to your care team.
Possible reasons for leaking include:
Medicines that control stomach acid or increase stomach emptying may help reduce damage caused by leaks. Discuss these options with the child’s care team.
Granulation tissue is extra skin tissue that can grow at the site of the stoma. Granulation tissue is common. It usually appears red and moist, similar to the skin inside the mouth. This tissue is delicate, and there may be some bleeding or discharge. Granulation tissue may be caused by friction or chafing as the tube rubs against the skin. Ways to help prevent granulation tissue include keeping the site dry, limiting movement of the tube, and making sure the tube fits properly. Granulation tissue may be treated by applying foam dressings or silver nitrate. In some cases, it may be removed with surgery.
Infection is rare at the stoma or the skin around it in a healthy child. However, children with weak immune systems are at higher risk for infection of the tube site. Signs of a potential infection include:
Although redness and discharge can be signs of infection, they can have other causes as well. Sometimes stomach contents will mix with bacteria on the skin and cause a bad smelling discharge. Redness caused by leaks can usually be treated by cleaning the skin more often. Contact the care team if symptoms do not improve or there are signs of infection.
Bleeding around the stoma can have several causes. The site may bleed after a tube change. Bleeding may also occur due to granulation tissue where the skin is more fragile. A small amount of bleeding is not serious. If bleeding does not stop after a few minutes or gets worse, apply pressure to the area, and call the care team immediately.
Neutropenia occurs when the absolute neutrophil count (ANC) is less than 500. Neutropenia often causes the stoma to become enlarged. Because the immune system is weak, the body stops trying to close the hole and fight off infection. This can cause the site to stay wet, leak, and be painful. Bacteria can form, and an infection can develop. The site will not improve until white cell counts rise again. Sometimes the site will look worse before it begins to look better. The tube site should be treated as recommended by the care team.
Reviewed: February 2019