Skin Care for Feeding Tube Sites

General care for feeding tube sites

• Keep the skin around the tube clean and dry.
• Always wash hands with soap and water or use hand sanitizer before checking the tube or giving nutrition or medicines through the tube.
• At least once a day, look for changes in the appearance of the skin around the tube. Check for signs of redness, irritation, pain, bleeding, or discharge.
• Limit pressure and movement of the tube against the skin.
• Follow your care team’s instructions for skin care and protection.

Caring for nasogastric (NG) tube sites

Tubes placed through the nose (NG, ND, or NJ tubes) can irritate the inside of the nose and the skin where the tube is taped. Your care team may switch nostrils when they change the tube to prevent skin breakdown.

Nasal tubes can sometimes cause pressure injuries. Watch for redness or irritation where the tube presses or rubs against the skin.

Ways to help prevent discomfort and skin problems caused by NG tubes

• Keep the tube secured and limit the movement of the tube against the skin.
• Only use tape and dressings approved by the care team.
• Use a skin protectant as recommended by the care team.
• Be careful when you remove the tape and dressings to avoid harming the skin. Use an adhesive remover if needed.
• Gently clean the skin around the tube with warm water and a soft cloth. Use a mild soap if needed.
• If skin is irritated by the tape or adhesive, change the position of the tape to give skin a chance to heal.
• Secure the loose end of the tube with tape when it is not in use. Take care to prevent the tube from being pulled out.

Learn more about nasogastric (NG) tube care.

How to care for G-tube stoma sites

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.

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 stoma sites include:

• Keep the tube site clean: Clean the area around the stoma with soap and water at least once a day, and whenever drainage occurs. Use a cotton swab to clean around the tube. Dry the area with a clean gauze pad.
• Keep the skin around the site dry: Do not use lotions, creams, or ointments unless instructed to do so.
• Turn tubes as recommended: G-tubes and button tubes should be turned 1 full turn (360 degrees) each day. If your child has a GJ-tube, never turn the tube as this can move the tube out of place and prevent it from working correctly. Ask if and how your child’s tube should be turned.
• Follow care instructions for new stomas: A gauze dressing will cover the site after the tube is placed. The gauze and taping should be removed after 24 hours or as instructed by the care team. Use a sterile water wipe to gently clean the area. Then, pat dry with clean gauze. Apply new tape to secure the tube.

Skin problems that can happen with G-tubes

Skin irritation from leaking around the tube

Leaking can occur around the tube. Moisture and acid in stomach fluids can cause the skin to be red and irritated. If this happens, clean the skin with water several times each day, or more often if needed. Gently dry the skin after cleaning. Your care team may recommend a barrier powder or ointment.

Medicines that control stomach acid or increase stomach emptying may help reduce damage caused by leaks. If the skin does not improve, or if leaking continues or occurs in large amounts, contact your care team.

Reasons for leaking around the feeding tube site include:

• Feeding too much or too fast. The tube can sometimes leak during bolus feedings. Slowing down the rate of feeding or using a different feeding schedule may help. Consult a dietitian or other healthcare team member before making any changes to your child’s nutrition.
• Problems with the internal balloon. Check the amount of water in the balloon. If it has less water than it should, refill with the correct amount. Check the balloon the next day. If the balloon continues to deflate, it may have a leak. Contact the care team for instructions. To check the water in the balloon:
  • Attach a syringe to the balloon port.
  • Pull back on the plunger to remove all of the water from the balloon.
  • If needed, add the correct amount of water to the syringe and put the water back into the balloon.
  • Disconnect the syringe.
• Incorrect fit of the tube. This can sometimes happen if a child gains or loses weight. A weight gain can cause the tube to be buried in the skin fold around the stomach when sitting up. If the stem of the tube can be seen under the button, the tube may be too long for your child. If the tube is no longer the right size, it may need to be replaced.
• Pressure on the stomach or tube. If your child sleeps on their belly, it can cause pressure on the tube. Sleeping on their side or back may help reduce pressure.
• Gas and constipation. Gas and constipation can cause fullness and pressure within the digestive tract. Being physically active and staying hydrated can help manage these symptoms. Your care team may also recommend medicines or nutrition changes. For some types of tubes, you may need to vent or burp the tube to remove excess air.

Granulation tissue

Granulation tissue is extra skin tissue that can form around 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 as the tube rubs against the skin.

Ways to help prevent granulation tissue include keeping the site dry, limiting the movement of the tube, and making sure the tube fits properly. Granulation tissue may be treated by applying silver nitrate.

Bleeding

Bleeding around the stoma can have several causes. The site may bleed after a tube change. Bleeding may also occur due to granulation tissue, which can make the skin 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 right away.

Infection

In a healthy child, infection is rare at the stoma or the skin around it. However, children with weak immune systems are at a higher risk of infection at the tube site. Signs of infection include:

• Skin redness around the stoma that increases, especially if there are no leaks
• Fever
• Pain, soreness, or swelling
• Pus or a bad smell

Although redness and discharge can be signs of infection, they can have other causes. 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.

Skin changes due to neutropenia

Neutropenia occurs when the absolute neutrophil count (ANC) is less than 500. Because the immune system is weakened, the body is less able to fight off infections, and healing may be slower. This can cause the stoma site to stay wet, leak, and be painful. Bacteria can increase and cause infection. In some cases, the stoma site may get bigger.

The stoma site will not improve until blood cell counts rise again. Sometimes the site will look worse before it begins to look better. If this occurs, treat the site as recommended by the care team.

Remember, keeping the site clean and dry will support the healing process.

When to call your care team 

Contact your care team if you notice any of the following:

• Signs of infection, such as fever, pus, bad smell, swelling, tenderness, or redness that worsens or spreads 
• Irritation, pain, or soreness that does not improve or interferes with your child’s daily activities
• Bleeding or leaking that occurs often, in large amounts, or does not stop
• Trouble securing the tube 

Questions to ask your care team

• How should we clean the skin around the feeding tube site?
• What should we do if the skin around the feeding tube becomes red, irritated, crusty, or sore?
• Are there any ointments or creams that can help prevent or treat skin problems?
• How can we keep the feeding tube secure and prevent it from rubbing or pulling on the skin?
• What is granulation tissue, and how can it be prevented?
• What skin problems should we watch for, and when should we seek medical help?

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