Routine Care of Gastrostomy Buttons in Infants and Children
By David A. Rogers, MD, MHPE, Pediatric General Surgeon and Cara Dix, RN, Pediatric General Surgery Clinical Nurse Specialist - Dothan Pediatric Clinic
Some children require a gastrostomy tube or button because they cannot eat enough to sustain normal growth and development. The most common device is a gastrostomy button with a low profile and a valve that prevents leakage.
More recent gastrostomy buttons are kept in place with a balloon in the stomach. Here are some useful tips for addressing common problems with these devices.
Leakage: Acidic gastric juice can leak around the button and irritate the skin. This can be addressed by ensuring the balloon has enough water. Another solution is to coat the skin around the gastrostomy button with a thin layer of any oily ointment, like Bacitracin or a zinc-containing diaper rash cream. You can also place a sponge or cloth pad around the tube to improve the balloon’s seal and absorb some of the fluid.
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Granulation Tissue: This can be recognized as a red tissue around the edges of the gastrostomy opening and bleeds easily. It is part of the body’s normal reaction to a foreign material. Our treatment for this is to apply silver nitrate, a chemical agent that will lessen or eliminate it. We also will prescribe a steroid cream to treat smaller amounts of the tissue and is effective in preventing tissue growth once it starts. Placing a sponge or cloth pad sometimes helps as it reduces the amount of trauma. Other options are GranuLotion and Calmoseptine Ointment, both available over the counter. Finally, granulation tissue can become so large that we have to remove it surgically.
Fit Adjustments: Growing children will need to have the device changed to a longer one over time. It will become more difficult to turn the device against the skin. Less commonly, some children will require a shorter tube as they grow. A measuring device will identify the best length, but sometimes the best size can be estimated based on the current gastrostomy button. We generally see these patients every few months until they are older.
Dislodgement: The balloons on these devices will rupture, dislodging the tube. You can insert a new device at home if you have one and have been trained to place it. Tubes that dislodge in the first two months after initial insertion pose special challenges and should be replaced in a specialty clinic or emergency room.
Advances in technology have improved the function of gastrostomy buttons and have made it possible for families, instead of healthcare providers, to care for them.
Author: David Rogers
Dr. David A. Rogers is a professor in the Departments of Surgery, Medical Education and Pediatrics, and the Senior Associate Dean of Faculty Affairs and Professional Development, in the School of Medicine at UAB. He received his medical degree from the University of South Florida and completed his general surgery training at the Medical College of Georgia. He subsequently completed his pediatric general surgery training at the University of Tennessee and a pediatric surgery oncology fellowship at St. Jude Children's Research Hospital. He received a Master of Health Professions Education (MHPE) degree from the University of Illinois at Chicago and has also completed the Surgical Education Research Fellowship program sponsored by the Association for Surgical Education. He sees patients once a month at Dothan Pediatric Subspecialty Clinic for Pre/Post-operative Care.
