Magazine article The Exceptional Parent

Care of the Stoma and Tube

Magazine article The Exceptional Parent

Care of the Stoma and Tube

Article excerpt

The surgical opening through which a gastrostomy tube (g-tube) or jejunostomy tube (j-tube) enters the stomach or small intestine is called a stoma. The stoma often becomes moist from gastrointestinal secretions. This may cause the skin to break down, ooze and be sore. Proper care of the stoma site can help to avoid such problems.

It is important to keep the skin around the tube or g-button as dry as possible with a gauze pad or dressing. The dressing should be changed as often as it becomes moist or soiled. This could be once a day or as often as 20 times a day. Tape is not usually used because with constant changes, it may pull and break the skin. Use of an antibiotic ointment may be useful if the site tends to become easily infected. Since some parents find that the dressing also protects and cushions the skin around the tube, they continue to use a dressing whether the site is moist or not.

The skin should be snug around the tube. This helps the tube stay in place and minimizes leakage of secretions. If the skin around the tube appears very pink and bleeds, you should inform your child's doctor. Often the doctor will treat this tissue with a silver nitrate application to seal the blood vessels, which prevents bleeding.

Your doctor may order consultation with an enterostomal therapist (ET). This is usually a nurse who has a wide knowledge of methods and products that can be used to keep the stoma healthy. The cost of ET services is often covered by health insurance policies.

When a tube falls out

A g-tube is usually anchored inside the stomach by a balloon at the tip of the tube just inside the stomach. Frequently, once a g-tube has been in place for some time, stomach acid will cause the balloon to deteriorate and deflate, and the tube will fall out. Because the stoma may close within an hour or two, your child's physician or nurse will have provided a replacement g-tube and shown you how to reinsert it.

Jejunostomy tubes, on the other hand, can be reinserted and positioned only by a physician. If a j-tube falls out, don't panic, just call your child's doctor. As long as the doctor gets the message immediately, he or she can make arrangements to reinsert the tube, based on his or her schedule and the length of time your child can go without fluids.

Stomach distention

Sometimes a child will end up with air in his or her stomach. This can cause discomfort, particularly if the child cannot belch. If the child is obviously uncomfortable and his or her stomach is distended (bloated), you can vent air through the g-tube by opening the end and holding it up, away from the abdomen. …

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