Hygiene - Gastric and intestinal tube care: Nursing skills

There are many reasons why a client might encounter problems with eating or drinking. It could be due to difficulties with chewing, swallowing, or digestion as a result of trauma, surgery, or various medical conditions. Several alternative methods of providing nutrients and fluids are available. This might include delivery of fluid and nutrition through a surgically implanted tube like a gastrostomy or jejunostomy tube. As the nurse, you will be responsible for the care and maintenance of these tubes.

There are several types of tubes that your clients may have. Some tubes are inserted through a surgical opening, or stoma, in the abdominal wall and into the stomach, known as a gastrostomy tube or G-tube. A common type of gastrostomy tube is the percutaneous endoscopic gastrostomy tube, or PEG tube for short. Here, an endoscope, or a tube with a light, camera, and guidewire, is inserted through the mouth and into the stomach. Then, a guide wire is used to place the PEG tube through an opening in the abdominal wall, creating a path directly into the stomach from the outside. Tubes can also be inserted into a part of the small intestine called the jejunum, which is known as a jejunostomy tube or J-tube.

So, after a tube is surgically placed and while the incision site is healing, the dressing should be changed regularly using aseptic technique to prevent infection. During dressing changes, first remove the soiled dressing. Then, gently cleanse the stoma and surrounding skin with sterile water and pat the skin dry. Be sure to anchor the tube to the abdomen at an adjacent area.

Finally, place a clean, dry dressing around the tube and secure it with tape as needed.

Once the stoma has healed, clients no longer need the area to be dressed but skin care is still very important since drainage or leakage from the tube often contains gastric secretions, like stomach acid, which can be very harmful to the skin surrounding the stoma. To help keep skin healthy, cleansing with warm soap and water on a regular basis is recommended. A barrier cream or ointment can be used to help protect the skin from exposure to harmful digestive fluids. As the nurse, make sure you check the site daily for signs of irritation or infection like pain, redness, or purulent discharge.