How to deal with problems

Skin site red, irritated, or draining. Some redness is normal

 Irritation may result from dampness and/or gastric leakage around the edge of the tube

•  Clean the skin site more often with mild soap and water, keep the site dry
• Apply Stomahesive powder to the skin site, put on a dry dressing, if there is drainage
• Topical (on the skin) antibiotics are not usually needed, you will be told to use topical antibiotics if needed
• Diaper rash creams, such as those made with zinc oxide may be used around the G-tube
• Call the doctor, nurse or clinic if the skin does not clear

Note: If too much Stomahesive powder is used, a crust will build. The crust may be soaked off with warm water.

Leaking at the skin site

If your G-tube has a balloon, it could be deflated. If your G-tube has a mushroom, it may have slipped away from the stomach wall.

The stoma hole is larger than the size of the G-tube. This is often due to movement of the G-tube. 

•  Gently pull back on the tube to be sure that the balloon/mushroom is snug against the stomach wall

If instructed to do so:

• Check the amount of water in the balloon. Re-inflate balloon with sterile or bottled water to proper amount if needed. Do not use air, check balloon only as needed
• Stabilize and secure the G-tube to help decrease movement
• Make sure the tube is the right size for the stoma hole, call the clinic if you have concerns about the size of the stoma hole

• Unclamp the tube

 Blockage due to food and/or medicine

Follow these steps:

• Gently "milk" the tube. Start at the end of the tube and squeeze by rolling the tube between your fingers to dislodge the blockage
• When starting feeding, if the formula does not go down and you have already tried milking the tube, gently give a brief push with the plunger to start the flow
• Never push an entire feeding with the syringe plunger
•  Check the thickness of the formula, to thin the formula, try warming it or add more water to it if approved by the dietician
• Pour a small amount of carbonated or seltzer water into the tube, clamp the tube for 10 to 20 minutes and let the water sit, flush the tube with warm water by gently plunging to dislodge the clog
• After each feeding or medicine dose, always flush with 5 to 10 mL of water before clamping the tube, use less water for babies
• Only use liquid medicine or finely crushed pills diluted in water as ordered by the doctor
• If your child has a button type G-tube, there may be a clog in the extension set, disconnect the extension set and flush it out over the sink
• Make an appointment with the doctor, nurse or clinic to change the tube if you are not able to unclog the G-tube

Note: If your child is on a fluid restriction, it is ok to flush with a small amount of air through the tube.

Skin site is red and itchy with tiny red bumps (rash)

Skin yeast infection from dampness or gastric leakage around the edge of the tube 

Be sure skin is dry. If the rash does not go away, call the doctor, nurse or clinic. A special medicine may be needed.

Note: Mycostatin powder or nystatin cream may be prescribed by your child's doctor for a skin yeast infection.

Extra tissue growth (granuloma/granulation tissue)

This is a normal response of the body. This does not mean there is an infection. It is not painful.

Bleeding around the tube/stoma

• The stoma may be irritated from movement of the tube
• Bleeding may occur after a tube change

•  Stabilize the tube
• Tape the tube well
• Keep the tube out of the child's reach
• Inspect the site for granulation tissue, call the doctor or nurse in the clinic if you see this tissue
• Do not be alarmed at a little bleeding, call the doctor or nurse in the clinic if the bleeding cannot be stopped

Infected site: Skin around stoma has a large amount of redness, swelling, thick, cloudy drainage that isn't formula. Your child may have a fever if site is infected.

• Infection can be caused by many things

• Call your child's doctor

G-tube or button comes out

Possible causes are:

• The tube gets pulled out
• The balloon has broken

Do not panic- this is not an emergency. The tube needs to be put back in within 1 to 2 hours.

1. Put a washcloth or gauze over the hole.
2. If the original tube has not been changed, do not put anything into the tract. Call the clinic for more instructions.
3. If the tube comes out before the first change, a radiology contrast study may be needed.
4. If your child's original tube has been changed, you can try to reinsert the tube.
5. If your child's original tube has been changed and you cannot see an opening in the abdomen, put a washcloth or gauze over the hole. Tape this in place. Call the clinic for more instructions.
6. Call the doctor, nurse or clinic during the daytime hours for further instructions. After office hours, take your child to the
   Emergency Room.