G/GJ tubes: Preventing and managing infection

What is a G tube?

Gastrostomy tubes (G tubes) are feeding devices that provide liquid nutrition, medication and other fluids directly into the stomach. G tubes are placed through a surgical opening in your child's tummy (abdomen) called a stoma. The tunnel from the outside into the stomach is called the tract.

Signs of infection

Your child may have a stoma infection if you see any of these signs:

• increased and/or spreading redness of the skin around the feeding tube
• thick green or white discharge coming from the stoma and around the feeding tube
• foul smelling discharge from the stoma
• swelling around your child’s feeding tube
• the skin around your child's stoma feels warmer than the rest of their skin
• abscess formation (collection of pus under the skin)
• pinpoint rash (may be due to a fungal infection)
• pain
• fever

Infected stomas can develop granulation tissue. However, it is important to note that granulation tissue is not the same thing as infection. Not all granulation tissue is infected. When the granulation tissue appears without the above signs of infection, it does not need antibiotic treatment. Learn more about granulation tissue.

Treatment of infection

For mild infections with a small increase in redness and discharge, you may apply an over-the-counter antibiotic ointment or cream, such as Polysporin, to the stoma.

If your child has any other signs of infection (spreading redness, fever and pain), your child needs to be assessed for a more serious infection. Your child’s health-care provider may need to prescribe a stronger antibiotic.

Prescription antibiotics that are used to treat the most common stoma infections are:

1. A topical antibiotic such as fusidic acid. This is a cream that you will apply directly to the stoma.
2. An oral antibiotic such as cephalexin. This is a medication that your child will take by mouth or through the tube.

If the antibiotics are not working, your child may need to be sent for a swab of the stoma and the antibiotics they are taking may need to change. An ultrasound may be necessary to diagnose an abscess.

How to keep a 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. Do not put dressings on the stoma unless your health-care team advises you to do so.
• Keep the stoma dry. Do not apply ointments or creams unless your health-care team advises you to do so.
• Always secure the feeding tube well to avoid friction against the skin.
• Avoid too much movement of the tube in the tract.
• Address stoma leakage as soon as possible.
• Prevent infection.
• For a low profile tube :
• Make sure your child’s tube fits properly.
• Check the volume of the tube’s balloon weekly.
• 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.

For more information on treatment of stoma issues, please see the SickKids Enterostomy Tube Stoma Assessment Clinical Practice Guideline.

Despite your best efforts to keep your child’s stoma and the skin around it dry and clean, you may encounter some stoma issues, including infection.

Prevention of infection

• Always wash your hands before handling the tube and stoma.
• Clean the G/GJ tube site with soap and water daily.
• Keep the G/GJ tube site dry and open to the air.
• Do not apply any dressing unless needed to absorb leakage or excessive discharge.
• Prevent skin irritation from excessive gastric content leaking from the stoma.

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