10 OSTOMY WOUND MANAGEMENT JUNE 2011 www.o-wm.com

Enteral feeding tubes have become common-place at facilities caring for pediatric patients

who have swallowing disorders or digestion prob-lems. Among the many tubes available, the threemain types are balloon tip, percutaneous endo-scopic gastrostomy (PEG), and low-profile gastros-tomy tube (G/T).

Common complications that cause skin prob-lems after the placement of the enteral feeding tubeinclude displacement, improper balloon inflation,and inadequate tube stabilization. These complica-tions can cause stomach contents to leak onto theperitubular skin, which in turn may lead to hyper-granulation formation, maceration, denudation,and skin irritation. Hypergranulation or hyperpla-sia is the overgrowth of granulation tissue above thelevel of the skin. This can be the result of the tubemigration and exposure to excessive moisture. Hy-pergranulation tissue tends to bleed easily when thetube is manipulated. The situation can be addressedby stabilizing the tube, using silver nitrate to breakdown any of the hypergranulation tissue, and ap-plying appropriate dressings around the tube tohelp maintain dry skin and absorb leakage.

The clinician can stabilize the tube by anchoringit against the external skin, if applicable; a varietyof stabilization devices is available. The internal an-chor should be secured to the wall of the stomachand the balloon should be properly inflated. Thesedevices can become tight due to abdominalswelling. Rotation can help prevent adherence to thesurrounding skin; rotatable devices can alleviatepressure on the skin.

The clinician also may need to determine thecause of peritubular skin breakdown and treat ap-propriately. Products such as ointments and dress-ings should be age appropriate—treatmentsappropriate for adults may not be appropriate forpediatric patients and their fragile skin. When ap-plying a treatment for skin breakdown, the tractmust not be occluded.

Many treatments are available for these compli-cations. Clinicians should review guidelines on en-teral feeding tube care for pediatric patients. �

Tube Site Care Gina Alessia, RN, BSN, APN-CNS, WOCN, CWCNCedar Lake, Indiana

Pearls for Practice is made possible through the support of Ferris Mfg. Corp, Burr Ridge, IL (www.polymem.com). The opinions and statements of the clinicians providingPearls for Practice are specific to the respective authors and are not necessarily those of Ferris Mfg. Corp., OWM, or HMP Communications. This article was not subjectto the Ostomy Wound Management peer-review process.

PEARLS FOR PRACTICE

Commentary from Ferris Mfg. Corp. It is important in all tube site care to protect the surrounding skin.

In a representative case study,¹ hospital nurses wanted to identify atracheostomy dressing that would improve patient outcomes, pro-tect the surrounding skin, and replace the gauze dressing they wereusing. The gauze was not able to absorb the exudate produced bythe stoma, which resulted in excoriated surrounding skin. Addition-ally, when the mucous secretions dried, the dressing adhered to andleft strands of gauze at the stoma site. Gauze dressing removal waspainful; in addition, the gauze was too bulky under the tube collar,causing patient discomfort.

Multifunctional PolyMem® dressings were implemented to addressthese issues. The dressings’ absorbency eliminated the problems withexcoriation of the surrounding skin. Also, PolyMem dressings containa moisturizer and other components that help prevent the dressing fromadhering to the stoma site, eliminating both trauma and pain to the siteduring dressing changes. In addition, the dressings help reduce ery-thema, swelling, and pain at and around the stoma site, key factors inmaking the patient more comfortable. Because the PolyMem dressingswere also thinner than the thick gauze, patient comfort was increasedboth during the dressing change and while wearing the dressing. �

References1. Lonie G. Polymeric Membrane Tube Site Dressings Improve Tracheostomy Site

Management While Increasing Patient Comfort. Poster presented at the AustralianWound Management Association, Perth, Western Australia. March 22–24, 2010.

Tube site dressings shouldstay in place in order to protect the peristomal area.

PolyMem dressings are easyto apply and change. Thedressings stay in place, pro-tecting the stoma site.

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