Coping with Granulation Tissue...
Granulation tissue is the raised, sometimes painful, red tissue which can develop at the margins of the gastric stoma (the surgical hole into which the gastrostomy tube, or G-tube, is placed). Granulation tissue can bleed and promote leakage of stomach contents through the stoma onto the surrounding skin.
One factor that promotes the development of granulation tissue is the ongoing friction between the G-tube itself and the skin. This friction can be caused by a poorly fitting G-tube or one that is not stable (i.e. rocks back and forth in the stoma.) To prevent the formation of granulation tissue, it is important that your child’s tube is well-stabilized. Means of accomplishing this include making sure the external bolster of the G-tube gently sits against the skin without leaving any marks or indentations on the skin, or ensuring your child’s skin level tube (MIC-Key/Button) is properly fit. If your child has a skin level device, do not leave the feeding adapter on, as this will cause drag on the tube and make it unstable.
Another factor that may contribute to the formation of granulation tissue is improper skin care. Generally speaking, the G-tube stoma area should be left open to air and cleaned only with soap and water during bath time. Ongoing use of hydrogen peroxide may contribute to the development of granulation tissue.
Once granulation tissue is present, it can be tough to eliminate. First, make sure your child’s tube is stabilized and you are caring for the skin properly. Some clinicians may recommend the application of silver nitrate solution to help shrink the tissue. Others may try a course of steroid cream for a short period of time to eliminate it. It is very important to meet with your clinician and have the stoma area evaluated so the best plan for treating and preventing the formation of granulation tissue can be made.
Lori Parker-Hartigan, R.N.