Nurse managers and educators,
As you all may or may not know, my husband and I welcome the arrival of our son, William, on Jan. 3rd. We are all doing well and couldn't be happier. I will be out on maternity leave until April 1st. In my absence, I wanted to share some g tube care tips. Please disseminate this information among your charge nurses, clinical leaders and/or nursing staff as you see fit. My hope is for this to be a resource to help the nurses troubleshoot some of the g tube problems while I am gone. Julie Mansfield, our PA, is extremely knowledgable regarding g tubes, but will be busy in clinic and not readily available for all g tube needs/family education. Your nursing staff can play a very valuable role in g tube education and problem management, as many of them already do. Also please let all nurses know that they are welcome to email me with any g tube questions/concerns.
Here are 10 helpful tips:
1. All new balloon button g tubes will have two stay sutures. These sutures need to stay in place for 2 days. A surgery resident will remove them. DO NOT let a patient go home with these sutures!
2. All new g tubes should be left to gravity drain for the first 24 hours post op (approximately). During this time, patient should have nothing by mouth or g tube, expect for essential enteral medications (you should have an order for this)
3. Clean g tube sites daily with mild soap and water and then dry. We no longer recommend hydrogen peroxide. Daily cleaning and drying is important. Get families involved doing this early on.
4. Clear, tan, slightly goopy, and crusty drainage is normal, particularly in the first few weeks. Clean this drainage off with moist gauze and pat dry. A moist g tube site will cause skin breakdown, irritation, tract dilation…all of which will make leaking/drainage worse.
5. Apply "critic-aid" thick moisture barrier paste to any red, moist or leaky g tube site. The zinc in the cream will help heal the skin and prevent further breakdown. You can order this from central supply without an physician order (white and purple tube). In my opinion I would have a tube at the bedside for every patient with a g tube. If you don't use it…send it home with the patient for future home treatment of g tube site irritation. Applying critic aid is usually one of my first recommendations when I am called about a "yucky" looking g tube site. Most red and goopy g tube sites are all a product of moisture and friction…rarely true cellulitis/infection.
6. If you have a lot of drainage, irritation or a g tube appear to be "loose fitting" you can apply 2 x 2 IV split gauze to protect the skin and "secure" the g tube. The more the button moves/wiggles around in the tract the more the tract the will become dilated…leading to drainage and irritation. Split gauze can help "secure" the g tube and reduce movement. Make sure to change the gauze often to prevent moist gauze from sitting on the skin.
7. It is important to disconnect the extension tubing from the button when you are not using the tube. Please try to do this! The extension tubing is an avenue for the g tube to get pulled out. It also pulls on the button some and cause the button to wiggle around in the tract, promoting tract dilation. Get families involved doing this early on.
8. If a new g tube comes out within 6-8 weeks following initial OR placement…call the surgery resident. They may or may not ask you to put a small red rubber or foley catheter in the tract. Make sure they know how long ago the tube was placed and ask what they would like you to do. If a g tube comes out and it has been more than 8 weeks since initial placement, you may replace the tube or place a small catheter in the tract, then call surgery resident to let them know. After replacing the tube, always aspirate gastric contents to confirm placement in the stomach. If replacement is difficult or you do not get gastric aspirate a g tube contrast study may be necessary before you use the tube. A g tube contrast study is always needed when a g tube is dislodged and replaced within 6-8 weeks after initial OR placement.
9. Granulation tissue looks like a moist red blister. It can have blood tinged or thick yellow goopy discharge. The treatment of choice is typically silver nitrate or topical steroid cream. Call ped surgery to take a look at it. Not an emergency. Can wait till the morning or weekday to call, etc.
10. Central supply has most of the common g tube button sizes, but not all sizes. If you need a size that central supply does not have you can check with the main OR (they stock more sizes).
Key teaching points for families
1. Always remove the extension tubing when you are not using the g tube
2. Clean and DRY the site daily with mild soap and water
3. Some drainage and redness at the site is normal. A lot of drainage or a lot of redness is not…call ped surgery office (843-792-3851)
4. DO NOT attach anything to the balloon port (blue side of the button)
5. If the g tube falls out in the first 2 months after it is placed…go the ER, preferably MUSC peds ER
PLEASE forward this to all the nurse managers in the children's hospital. I do not have everyone's email addresses…I think I am missing the NICU, 7B, 8D, and 5th floor nursery
I hope this helps! Thanks,
Kiften
Kiften Carroll, NP
Pediatric Surgery
MUSC Children's Hospital
Pediatric Surgery
MUSC Children's Hospital
843-792-7127
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