Granulation Tissue, Infection, and Leakageadmin2020-03-13T13:47:23+00:00
This page addresses a number of common site problems, including granulation tissue, infection, and leakage. Most are easily resolved, though some children may have ongoing issues.
Granulation tissue is typically red or pink soft tissue that appears bumpy or almost bubbly in nature. It is the body’s attempt to heal the tube site. It can bleed very easily and may grow quite rapidly. However, while granulation tissue may be bothersome, it is not dangerous and it is not an infection.
Your doctor can use Silver Nitrate to cauterize (or remove) the tissue, or may prescribe steroid creams, such as Triamcinolone (Kenalog) ointment. There are several different strengths of Triamcinolone cream, so ask for a stronger version if the low strength does not work. Silver Nitrate chemically “burns” off the granulation tissue already there, but does not prevent it from growing back. Make sure to cover the unaffected tissue around the stoma with petroleum jelly or a barrier cream to prevent damaging the healthy skin. It is normal for the granulation tissue to look brown and quite awful after having Silver Nitrate applied.
Another option for treatment is GranuLotion, an over-the-counter product that many parents use to help treat granulation tissue. Home remedies that may help include Tea Tree Oil, Maalox or another antacid, Calmoseptine Ointment, or aloe vera (fresh or gel form).
Stabilizing tubes and extensions can help by reducing friction at the tube site. You can tape them to the stomach or create a tab that can be pinned to a diaper or clothing by folding the tape back onto itself.
Keeping the area dry is extremely important to prevent granulation tissue. At first the site may leak. But within 4-6 weeks, the leakage should diminish. Some families prefer to keep the tube site open to air, some use gauze under the button, and some use cloth tube pads. Using G-tube pads can also help reduce friction and absorb leaks to keep the area dry. Certain types of dressings, such as Mepilex, may also be helpful.
Have your doctor check the sizing of the feeding tube, as an incorrectly sized tube can make granulation tissue worse.
Rarely, the stoma or tube site may become infected. Infection is uncommon in children with healthy immune systems.
The signs of infection are:
Angry, red, or red-streaked stoma
Weepy, oozing, or pus-filled stoma
Cellulitis on or near the site
Foul or unusual smell
Pain or sensitivity when the feeding tube is touched
Sometimes stomas can be infected in the tract on the inside, so there may be no visible signs besides pain and tenderness.
Consult your child’s doctor if you suspect an infection. The doctor may perform a culture of the site, and may prescribe topical antibiotics, and in some cases oral antibiotics, to treat the infection.
Granulation tissue is NOT an infection.
There are two types of leakage commonly encountered with feeding tube stomas: leakage of secretions from the stoma, and leakage of formula/stomach contents. Button-style tubes may also be prone to leakage from the button itself.
In general, a small amount of leakage of secretions from the stoma is considered normal. These secretions are usually tan or clear in color, and may become crusty when they dry. Dry secretions can be removed with a wet Q-tip or washcloth. Secretions are usually worse when granulation tissue is present. Drying out the site by keeping it uncovered and open to the air may help diminish these secretions. G-tube pads or gauze may also be used to absorb secretions. Secretions may be increased in children with separate J-tube sites. If leakage is severe or skin irritation is occurring, consult your doctor or a wound care nurse.
Leakage of Formula or Stomach Contents FROM the Tube
Leakage of formula and stomach contents from a button-style tube itself typically signals that the anti-reflux valve is no longer working properly. Note that many buttons have anti-reflux valves that break quite quickly, sometimes within days or hours. If the button leaks every time you open it, try flushing with warm water to see if that stops it. If you give medications directly into the button, sometimes the syringes cause the valve to be stuck open, which can also be fixed with flushing. If flushing does not help, the anti-reflux valve may be worn out and it may be time for a new button.
When only minor leakage is occurring, you can still use the button, but make sure to close the button after use, and cover the opening in the button when connecting and disconnecting the extension set to prevent leakage. You may also want to keep an extension tube attached at all times. Once leakage from the button becomes severe, replace the button.
Leakage of Formula or Stomach Contents AROUND the Tube
Leakage of formula or stomach contents from the tube site (around the tube or button) is more concerning because nutrients may be lost, and the acid from stomach contents may damage skin. Leakage of formula or stomach contents is not considered normal. It may be more likely to occur in children with J-tubes, children with connective tissue or skin disorders, and children with tubes that do not fit correctly.
Common causes of leakage from around the tube:
Wrong size tube or button
Uninflated or partially inflated balloon in a balloon button
Stretched-out or damaged tube site
To eliminate leakage, first make sure your child has the right size tube as prescribed by the doctor, and that the balloon is properly inflated in a balloon-style button or tube. You can learn more about checking the balloon on our G-tube page. If the tube size does not look correct, consult your physician to have your child resized. Information on sizing is available on our G-tube page.
You should always consult your child’s physician if formula or stomach contents are leaking around the tube and you cannot resolve it by replacing the tube or properly inflating the balloon. Sometimes, sites become stretched out and may need to be tightened. In other cases, when extreme dysmotility and pressure causes leakage, venting or draining the stomach may be necessary. Your child’s doctor can help you determine the cause and a treatment. In rare cases, an ostomy or wound nurse, who specializes in the care of stomas or wounds, may be required to treat leakage.