Tube Talk

Thanks to everyone who sent material for the "Tube Talk" column. We've had an overload of responses lately and don't have room to publish them all in this issue. (We promise to publish as many as we can in upcoming issues.) Anyone who is interested in participating can send their tips, questions and thoughts about tube feeding to: Tube Talk, c/o The Oley Foundation, 214 Hun Memorial A-28, Albany Medical Center, Albany, NY 12208; or E-mail DahlR@mail.amc.edu. Information shared in this column represents the experience of that individual and should not imply endorsement by the Oley Foundation. The Foundation strongly encourages readers to discuss any suggestions with their physician and/or wound care nurse before making any changes in their care. Many thanks to Laura Matarese, MS, RD, LD, FADA, CNSD, Manager, Nutrition Support Dietetics at The Cleveland Clinic Foundation for volunteering her professional opinion in response to the questions below.
Adaptor on G-tube Keeps Breaking Off
I have had a gastrojejunostomy feeding tube for more than five years. I had a problem with the adaptor on the G-tube breaking off, causing leakage from stomach acid and irritating the skin. My physician and I worked together trying to think of a solution so I would not have to have the whole G-J tube replaced. We came up with some unique ideas that have worked well and prevented a tube replacement (so far!).
1. Using an eraser cap that is intended for the end of a pencil.
2. Using the black rubber cap that goes on the end of an eye-dropper(the part that you squeeze).
Weird as these ideas sound, they work. I recommend the eye-dropper caps especially, because they last longer (and therefore need to be replaced less often) than the erasers.

Carol Pelissier
280 Elgin Ave.,
Manchester, NH 03104,
(603) 625-2362


Build up of Granulation Tissue
I also have a question regarding a continuous buildup of granulation tissue around the gastrostomy tube. I have had it cauterized with silver nitrate and surgically cut several times since I have had the tube, with no success. I have tried numerous antibiotic ointments, oral antibiotics, IV antibiotics and daily cautery after surgically being cut to prevent it from growing back. But nothing helps. It is chronically infected and irritated. The only other option suggested to me, was to have the tube removed to let it heal and reinsert it at a different site, but there is no guarantee that it will help. I would appreciate any feedback.

Carol Pelissier
280 Elgin Ave.,
Manchester, NH 03104,
(603) 625-2362

Unfortunately, granulation tissue is very common. It can occur when GI secretions leak up and around the outside of the tube. So making sure you have a "snug fitting" tube is important. Apart from this, there really is not much more that can be done except to continue to cauterize with silver nitrate. I am afraid that it is a problem that is likely to continue to reoccur. Carol is correct in stating that the tube can be resited, but there is no guarantee that granulation will not reoccur.

Painful Scar Tissue Around Stoma
I am looking for some help with painful scar tissue in my stoma. Apparently when I was first on enteral, my surgeon placed a Foley catheter and anchored it in a few places, stitching it to my stoma area. After two months, he took my Foley catheter and stitches out and put in a Mic-key, which I currently use as my J-tube. Nine months later, I now have three very painful raised scars which cause me to feel a sharp pain as the tube starts moving around. (Since I have a motility disorder, my tube moves around.) My dermatologist tried to shrink these scars by injecting them with Triamcinolone Acetonide ointment. I am going to try a pain clinic to see if they can anesthetize the nerves in my stoma. I am wondering if I would be better off if they just removed these scars?

Cathy Tokarz
Bloomingdale, IL
healthyC@worldnet.att.net

Scars around J-tube sites are common, and unfortunately, there isn't much more that can be done. Hollister has a clamp which can be used to anchor the tube and prevent it from moving around, which may help. I wish I had more to offer.