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The development of granulation tissue is a common complication of enteral nutrition via a PEG feeding tube. Granulation tissue is caused by the child’s body attempting to fix the skin disrupted by the tube and usually it occurs as part of the wound healing process. Depending on it’s stage it appears as a red, pink or randomly colored bumpy tissue formed on the surface around the tubes’ stoma.
Once granulation tissue has formed and it is not treated appropriately it can lead to a serious chronic wound infection. Thus, it is very important to contact your child’s GP to get his/her opinion plus to care the tube and its stoma adequately.
How to care adequately for the feeding tube?
It is important to check the tube on an everyday basis. Try to protect the skin around the tube and its stoma. It is necessary to keep the skin dry.Make sure that the tube is not leaking. If it’s leaking ask the surgeon in charge if the size of the tube can be altered, or if there is a device which can protect the skin from the acid coming from the stomach. Tube leakage might lead to granulation tissue. Check if the skin texture or color changes, if it’s bleeding or if the skin is turning red. If so, look for an appointment, which, prescribed by the physician, may help. Examine the tube’s fixture. Is it appropriately fixed? If not see a nurse or a MD in order to optimize the local situation.
The tube needs to be cleaned every day to prevent infection. You can use mild soap and water to clean it. Do not use hydrogen peroxide. You should avoid the use of occlusive dressings, because the lack of oxygen locally may lead to complicated infections with fungi or anaerobic bacteria. If you are insecure about how to clean, please ask your pediatrician what cleaning materials/techniques work best.
What to do, if granulation tissue has formed?
Here is some helpful information about what you can do in case granulation tissue arises:
As the granulation tissue is caused by the body trying to heal itself, friction around the tube area is likely to encourage the growth of granulation tissue, so try to use soft textiles and cover the tube outlet. One way to stop friction, try stabilizing your feeding tube’s extensions and see whether the tape, or the plaster cause irritations in itselves.
Medication & Creams
Though it is mainly used to combat psoriasis, triamcinolone (also known as Kenalog®) can work wonders on granulation tissue. It’s great for getting rid of inflammations and itchy conditions. As you need a prescription to buy it your local doctor will be involved, which we strongly recommend. Sometimes antibiotics prior to PEG placement are prescribed to reduce the risk of infection and consecutive the development of granulation tissue. This technique is under discussion in the medical community and we do not advocate it.
Any steps you can take to protect the skin around the tube site and, most importantly, keep it dry are welcome. As mentioned before care for the tube and its stoma adequately. If the feeding tube is leaking and you can’t stop it, a cream like calmoseptine® might help at least to protect your child’s skin.
Silver nitrate helps to reduce excessive granulation tissue. It may be helpful when prescribed and supervised either by a specialised nurse or the doctor in charge. You apply it to the afflicted area and it dyes it a truly dreadful brown color before burning it away. Unfortunately, silver nitrate is not preventive, and so there is nothing to stop the tissue coming back again. In most cases, silver nitrate needs to be used in more than one occasion.
In summary, if your child needs enternal nutrition via a PEG tube always consider its benefits and complications. A PEG tube can be placed surgically or by a gastroenterologist and always needs an appropriate post-placement care. Keep in mind, that when granulation tissue or any other complications arise, early recognition and adequately management help optimizing the outcomes.
The reported methods might help treating granulation tissue, but it is very important to discuss any changes regarding the healing process with your GPs/pediatrician onsite.