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Chris's Comments
"Gauze, or no gauze? That's the dilemma.

After over 15 years of taking care of Gtube patients and their families, I've come across one issue that continues to puzzle and challenge me.  Should you put gauze underneath your Gtube?  The answer is not straight-forward, but here is a discussion that might interest you and change your outlook on gauze.

A Gtube is a silicone, plastic and foreign object that was placed in order to sustain you or your loved one nutritionally, hydrationally and medically.  It was not naturally placed there and because of that, it is often an unnatural feeling to have one.  Because it is there, our first instinct is to cushion the skin beneath it with a pad, or gauze.  This is not the "wrong" thing to do, but in a lot of cases I see, it is the most natural and instinctual thing to do.  Even when you have the most perfect stoma that has never had issues, you may feel the need to place gauze beneath the Gtube.  I see this a lot and when I do, I usually mention that the gauze may not be needed.  The problems one can experience with gauze is that it soaks up a lot of moisture.  The very process of soaking up moisture can actually have the opposing benefit to the gastrostomy.  A wet gauze that sits on the skin for long-periods of time may break the skin down and cause the stoma site to degrade.  So if you're saying to yourself, "Chris, the Gtube leaks.  What am I supposed to do?".  I understand.  Managing a Gtube is often frustrating and it can feel like things will never get better.  Saying that, you should ask yourself, or better yet, ask your Gtube care provider, what can be done to improve or eliminate the leaking?  The Gtube is leaking for a reason and here are a few reasons why this could be happening. 

1) The Gtube is the wrong length.

    If there is too much "play" and not enough "snugness", that can leave just enough room for stomach contents to leak in between the Gtube balloon and the outside.

2) The Gtube doesn't have enough water in it.

    Not enough water within the balloon can also cause the tube to not fit optimally.  Just like a tube that's too long, a tube without enough water can leave just enough room to allow leaking.  Fortunately for us, some of the Gtube manufacturers are now printing the recommended water amounts right on the tube.

3) My Gtube patient is ill.

    Believe it or not, I have almost always seen sick or ill Gtube patients with horribly leaking and broken down sites.  As soon as they recover from their illness, their stomas improve and the issues resolve.  Just like we have runny noses from a cold, Gtube sites will may leak and break down when you have a cold.  That's a biologically normal response within your mucous membranes.  The most perfect and pristine Gtube sites can often succumb to the common cold or illness.  So be aware of that!

4) The type of Gtube in place. 

    Low profile, "button" Gtubes are a terrific option and are probably the most desired and requested device for patients.  But they are not the only Gtube that is available or utilized.  Non-low profile Gtubes are long and have a disc, or flange, that slides down the tube to snug it to the belly.  The problem with these tubes is that they can loose their "mu".  "Mu", in physics, is the property of friction.  When the tube looses its friction, that disc that is designed to make a good fit can easily move.  When it moves easily, it will cause the tube to not fit correctly and may lead to leaking.  Putting gauze beneath the flange can accelerate this process of losing friction.

Granulation tissue is a problem that is seen is approximately 60% of patients with enteral feeding devices.  You cannot predict who will get it, or who will respond to treatment, but the best way to decrease the chances of getting it is to make sure the tube is the best fit possible to minimize movement and leaking.  If someone develops it and uses GranuLotion, there are a couple things to consider if you are a "user of gauze".  Just like a gauze soaks up moisture, gauze can wick away GranuLotion away from the tissue.  If it's not optimally on the tissue, then it will not be as effective.  So what do you do?  I would recommend replacing your gauze with one that has the least absorbent properties and one that will not stick to the site.  Telfa sponges are a great option for those using GranuLotion and want a gauze underneath their sites.  They are less absorbent and because of this, they will keep the GranuLotion on the tissue where it belongs.  Not only can you keep something beneath the Gtube, but you can have something that will allow your GranuLotion to work the best way possible."
 
Christopher R. Speaker, RN, MSN, APN, FNP-BC, CPN
Nurse Practitioner - Pediatric Surgery
Co-Founder:  Granulotion Global, Inc.
Email:  chris@granulotion.com
Granulotion Global, Inc.
Office# (708) 381-0334
Fax# (708) 570-1380
G-Tube Site Management Tips

Granulation tissue (GT) is a reactionary tissue overdevelopment that can develop in approximately 60% of individuals with enteral feeding tubes. It is thought that movement, friction and moisture can promote the development of this tissue. If untreated, GT will continue to contribute to further movement and leaking. GT can also make its own secretions which will often bleed.

GT¬†is the body‚Äôs attempt at ‚Äúhealing‚ÄĚ the stoma site closed, since the body is not meant to have a tube in it. When enteral feeding tubes are not properly secured or properly fitted, the tubes can leak and move easily. When a tube site leaks, it is leaking gastric contents that are high in acid. Acidic contents that touch healthy skin can cause the skin to become erythematous (reddened), excoriated (open skin) and very sore. Further untreated irritation that leads to excoriation, or open skin, can promote localized skin infection, worsening the redness and irritation. In order to reverse these problems and promote healing and improvement of the skin, one should consider the following points when it comes to their feeding tube.

1)     Standard recommendations are to change the gastrostomy tube every 3 months. Gastrostomy tubes that are not changed regularly, can have a buildup of bacteria. Bacteria buildup can lead to skin irritation because it causes an inflammatory response.

2)     Regularly confirm the feeding tube balloon water amount. G-tubes are not 100% consistent. They can lose water over time because the balloon valves get old or the water evaporates. For AMT Mini-One, the recommended water amount is printed on the tube valve. For Mic Key products, the recommended water amount is located in the patient handbook. Checking the water in the balloon will ensure a proper fitting tube which will minimize the chance of adverse conditions associated with leaking. For other brands and tubes check the manufacture recommendations. 

3)¬†¬†¬†¬† If you have irritated, sore skin that may be caused by a leaking, poorly-fitting Gtube, follow the recommendations above to improve your Gtube fit. As the skin around your Gtube heals and improves, you should protect that skin diligently with a barrier cream. Creams such as Zinc Oxide, A&D Ointment, Ilex or Desitin will prevent acidic contents and GranuLotion¬ģ from touching the affected skin. GranuLotion¬ģ utilizes many skin-friendly ingredients to help promote a healthy stoma site. However, it also uses micronized Potassium Alum to shrink Granulation tissue. Potassium Alum can cause stinging or mild burning if it comes in contact with severely irritated or excoriated skin. Use a¬†separate skin barrier on any¬†reddened/irritated skin creating a "bullseye" around the site, then pinpoint GranuLotion¬ģ on the GT.¬†

We are happy that GranuLotion¬ģ has helped so many people deal with troublesome G-tube sites. We would invite all of you to contact our Nurse Practitioner chris@granulotion.com or PM on FaceBook if you have concerns or questions. Please email us your Gtube site pictures so we can help with improvement recommendations. Any recommendations provided are solely the opinion of GranuLotion Global, Inc. and should never take the place of the advice from your doctor. Always consult with your doctor prior to starting any new treatment.¬†

 

Team GranuLotion¬ģ