G/GJ tubes: Hypergranulation tissue

Granulation tissue is the new tissue that forms when a wound is healing. It is also the extra tissue that grows around the feeding tube. Hypergranulation tissue is an excess of granulation tissue that is usually bumpy or swollen tissue that is shiny or wet, bleeds easily and can be painful. Hypergranulation tissue is the most common skin issue that occurs in children with G or GJ tubes.

Signs of hypergranulation tissue

Hypergranulation tissue

Granulation tissue generally appears as follows.

• Usually pink to dark red tissue, but it does not spread like an infection
• Can appear open, wet looking or shiny
• Bleeds easily
• Appears bubbly and puffy
• Can be painful
  
  

Causes of hypergranulation tissue

Hypergranulation tissue can form for several different reasons.

• The feeding tube moves in and out of stoma. This can happen when a low-profile tube is incorrectly sized
• The stoma is wet. This coud be from excessive leaking or because the stoma is covered with a dressing, so it is not able to dry completely
• There is too much pressure on the stoma. This may be because a low-profile tube is too tight, the tube has been accidentally pulled out or there was a recent tube change
• There has been trauma to the stoma
• Hypergranulation tissue may form when there is an infection. Hypergranulation tissue is not the same as an infection
• The stoma will usually look worse and hypergranulation tissue may form when a child is sick, for example with a respiratory illness or gastroenteritis, of if they are recovering from surgery

Treatment of hypergranulation tissue

• Apply hypertonic salt water soaks up to four times a day.
• Use hydrocortisone cream for a week to help with skin inflammation. Hydrocortisone 0.5% cream is available over the counter. You may be able to find hydrocortisone 1% cream over the counter but usually it is only available by prescription. Hydrocortisone is a short-term treatment so only use it for one week at time.
• Use an antimicrobial foam dressing on the stoma. At SickKids, you can purchase AMD foam dressing from the Specialty Food Shop.
• Use silver nitrate to burn away the extra tissue and promote healing. You will be taught in the clinic first and then you can continue to apply the silver nitrate at home. Do not apply hypertonic salt water soaks while using silver nitrate.
• Silver dressings may also help manage hypergranulation tissue.

Speak to your G tube specialist if the stoma does not improve or if the hypergranulation tissue gets worse.

How to keep a healthy stoma

Healthy stoma

To keep your child’s stoma healthy, you should:

• Wash the stoma daily with soap and water.
• Allow the stoma to be open to the air.
• Secure the tube well.
• Avoid too much movement of the tube in the tract.
• Address stoma leakage as soon as possible.
• For a low profile tube.
• Make sure your child’s tube is a proper fit.
• Check the volume of the tube’s balloon weekly.
  

Prevention of hypergranulation tissue

• Always secure the feeding tube well to avoid friction against the skin.
• Make sure your child’s low profile balloon-type G tube fits properly. If you think your child’s balloon-type G tube is too loose or too tight, contact your G tube team to re-measure the size of the tube. Check the volume of the water in the balloon weekly.
• Do not put dressings on the stoma unless your medical team advises to do so.
• Keep the stoma open and dry. Do not apply ointments or creams unless your health-care team advises you to do so.
• Manage leaking around the tube.
• Prevent infection.

At SickKids

If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.

G Tube Resource Nurse contact info:

Phone: 416-813-7177

Email: g.tubenurse@sickkids.ca