What should the site look like?
Feeding tube sites (G/J and J tube) tend to drain a lot. As long as the drainage is clear or tan, moderate in amount, and not particularly smelly, it is probably normal. Don't be surprised if you find crusted drainage around the site. At times, drainage may contain a small amount of blood. If the drainage smells putrid or unusual, or is oddly colored, copious, or extremely bloody should be evaluated by your doctor.
As the new site heals, it forms a stable tract or tunnel between the skin and the stomach or intestine where the tube is placed. A stable tract is important, as it decreases pain, promotes healing, and prevents leakage and granulation tissue to some degree. The best way to create this stable tract is to keep the new feeding tube secure
How should I clean the tube site?
- Tube sites can usually be clean with just water. The area can be cleaned gently with Q-Tips, a washcloth or gauze or during showers with just with regular soap and water.
- After cleaning the area, it should be dried thoroughly with a clean towel. The area can also be left open to the so it can dry completely.
What is granulation tissue?
Granulation tissue is a common problem with tubes and is typically caused by irritation or moisture at the stoma site. Granulation tissue is pink or red and tends to be soft, fleshy and blobby. A slight tannish, odorless discharge may also occur. It tends to bleed easily and can be extremely painful.
Ideas for treatment (please check with your physician before attempting any of these methods):
- For mild granulation tissue, try dabbing aloe vera juice on the site or rubbing a piece from an aloe vera plant around the site.
- Miracle Mist Plus spray or gel also helps treat mild granulation tissue.
- Triple paste, made by mixing an over-the-counter antibiotic cream, an over-the-counter hydrocortisone cream, and an over-the-counter antifungal, works well as a preventative.
- Calmoseptine lotion may help mild cases.
- Cholestyramine ointment is highly effective, and is available by prescription through compounding pharmacies.
- Triamcinolone steroid cream is available by prescription and treats mild to severe granulation tissue. Treatment can be started with low-strength and increased to the high-strength formulation if no response.
- Silver nitrate sticks literally "burn" the granulation tissue off. These are only available by prescription. Make sure to cover the healthy skin around the site with barrier cream or Vaseline to prevent it from being "burned." Note that silver nitrate will get rid of granulation tissue but will not prevent it from coming back.
- In rare cases, surgical removal of the tissue is required.
Can medications go through an NJ, G/J, or J tube?
Yes, almost all medications can be put through these tubes. Most medications are absorbed into the small intestine and can be given through any type of J tube.
The exception is medication that is in bead form or tablets that do not dissolve smoothly. These are likely to clog the tube, which is particularly a problem with the narrower size of NJ and G/J tubes.
In general, it is best to give medications in liquid or suspension form. Tablets should be crushed well or allowed to dissolve completely before administering.
What type of feeds may be used for J feeding?
Because the jejunum is a smaller diameter than the stomach and lacks an expandable area or fundus, continuous or slow feeds using a pump are mandatory in J feeding. Some people may need to be on feeds 24 hours a day, while others may be able to feed at a faster rate for 16-20 hours per day. Medications may also be given as small boluses.