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 before checking the tube or giving nutrition or medicines.
• At least once a day, look for changes in the appearance of the skin around the tube. Check for redness, irritation, pain, bleeding, or drainage.
• Limit pressure and movement of the tube against the skin. Follow your care team’s instructions for keeping the tube secure and protecting your child’s skin.

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. Proper care can help prevent discomfort and skin problems.

• Keep the tube secured to limit movement of the tube.
• Only use tape and dressings approved by the care team.
• Use a skin protectant as recommended by the care team.
• Remove the tape and dressings carefully 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.
• Nasal tubes can cause pressure injuries. Watch for redness or irritation where the tube presses or rubs against the skin.
• If skin is irritated by the 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. The important thing is to keep the tube out of the way and prevent it from being pulled out.
• Your care team may switch nostrils when they change the tube to prevent breakdown of skin.

Learn more about nasogastric (NG) tube care.

How to care for G-tube, GJ-tube, and J-tube 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.

Learn more about gastrostomy and G-tube placement.

Caring for the stoma site

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 around the tube site using soap and water at least once a day and whenever there is drainage. Use a cotton swab to clean around the tube.
• Keep the skin around the site dry. Do not use lotions, creams, or ointments unless instructed.
• Turn tubes as recommended. G-tubes and button tubes should be turned one-quarter turn 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.
• New Stomas: A gauze dressing may cover the site for the first few days after the tube is placed. Keep the area clean and dry. Change the dressing if it gets wet or dirty. A small amount of fluid may leak from the site. The fluid often forms a crust as it dries. Clean the area gently to remove the crust. No dressing is usually needed after 2-3 days.

Leaking around the tube

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.

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. Talk to a dietitian or other care team member before making changes to 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.
  Steps to check the water in the balloon:
  • Attach a syringe to the balloon port.
  • Pull back on the plunger to remove all the water from the balloon and note the amount of water.
  • If the balloon has less water than it needs, add the correct amount 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. If the tube is no longer the right size, it may need to be replaced.
• Pressure on stomach or tube. Sleeping on the belly can cause pressure on the tube and trauma to the stomach. Sleeping on the side or back may reduce pressure. 
• Gas and constipation. Gas and constipation can also cause fullness and pressure within the digestive tract. Being physically active and getting enough fluids can help. The care team may also recommend medicines or nutrition adjustments to manage constipation. Your care team may also give your instructions to vent or burp the tube to remove excess air. 

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

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 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

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

Contact the care team if symptoms do not improve or there are signs of infection.

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 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 right away.

Skin changes due to neutropenia

Neutropenia occurs when the absolute neutrophil count (ANC) is less than 500. Neutropenia can cause the stoma to get bigger. Because the immune system is weak, the body stops trying to close the hole and can’t fight off infection. This can cause the site to stay wet, leak, and be painful. Bacteria can form, and an infection can develop. The stoma site will not improve until white 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.

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