Surgery for G-tube while on Peritoneal Dialysis?

Valerie - posted on 03/23/2010

My son has Down syndrome and was born with a heart defect so he had a g-tube placed when he was 7 months old. We had the NG before that and I hated it he pulled it out at least 2 times a week and it leaked frequently from the tube popping open from pressure.
The G-tube has been easy for us. He has now had it over 2 months and it healed quickly. After about a week it felt good enough he tolerated being on his tummy. We cleaned it 2 times a day with a q-tip and antibacterial hand soap and water for about 4 weeks. Then we just clean it one time a day with his bath with the antibacterial soap and my fingers. It has never been infected and no granulation tissue. In the mornings it tends to be crusty around it and I just gently remove it with my fingers and if it is kind of stuck I use a wet wash cloth. Keep it dry for sure. After baths pat and move the tube in a circle until it is completley dry. We spin it in a cirlce every time we use it too and the surgeon said to always spin it after car rides too or sitting in one position for a while. It is easy to feed through and it doesn't bother my son. He goes swimming with it too.
We did not do the fundo even though my son does have reflux too. His reflux got a lot better when we got the G-tube because the NG was making him gag on the small amounts of reflux and then he would projectile vomit most of his feeds. He has gained more weight with the G-tube too since he is keeping more of his feeds down now. It also helps with oral feeds whether it is through a bottle or spoon foods.
Sorry I don't know anything about being on dialysis with the surgery but this is a pretty minor surgery so hopefully he will do just fine. He should be much more comfortable!

Yvette - posted on 03/21/2010

Thank you for the info. Sounds like a lot of work. I'm sure once we get it it will come naturally. We will find out what the surgeon thinks tomorrow.

Iridescent - posted on 03/20/2010

My daughter does not and has not ever needed dialysis, but it is a very real possibility for her future. She has a urea cycle disorder. One of the things we needed was a g-tube. It was a lifesaver! Really!



Cassie had severe reflux at 8 months when her g-tube was placed. We declined the fundo because we were informed her reflux would likely disappear with treatment of her disease, but we now regret that decision and wish she had it. Does your son's ammonia levels run high? My daughter's were (and can be at any point) and that is a HUGE cause for reflux. Just FYI.



The g-tube causes much less oral aversion than nasal tubes. For hope of having oral feeds, you'll likely want it. His comfort level will be higher, no doubt. Cassie took longer to heal than most children due to her disease and health condition when her tube was placed; it took about 2 weeks. Typical is 5-7 days. Calmoseptine around the site often really helped a lot to relieve pain during that period. We got the button placed immediately instead of dealing with a PEG at all, and with a fundo going along with the tube placement, that should be an option for you (very worth getting that way, avoids an extra sedation later).



Infections - skin infections are pretty typical. Mostly yeast for us, occasionally bacterial but very rare. We check the site frequently and treat PRN. She has no gauze around the site (breeds infection, but when new very needed) and this has cut back on both infection frequency and granulation tissue growth. We also do not use any ointment around the site per doctor's recommendation (new study indicates this is best unless needed for site changes). If she has a yeast infection and it's wet, we put Nystatin Powder around the site 2-3x/day until clear. If she has a yeast infection and it's dry, we use Nystatin Ointment 2-3x/day until clear. If it's just red and sore, not sure what infection is brewing, we put Nystatin/Bactroban (both antiyeast and antibiotic) Ointment around the site 2-3x/day until clear. And if it's looking like growth (red, hamburger-like, drains mucous like snot, sometimes bleeds) we put Hydrocortisone Cream around the site 2-3x/day for 7 days, off 7 days. Really, none of these infections are systemic even with severe health conditions and are easily treated.



Care - we wipe it twice per day with a Huggies Naturals diaper wipe (alcohol free so doesn't hurt), and she has a daily bath with glycerin soap due to allergies/eczema. When we used gauze, we'd change it 2x/day and PRN - just tape the slit shut and no tape to skin, it pops over the button to come off when you want, no pain. With gauze, use vaseline with every gauze change and cleaning (do them all at the same time, even if you're just changing the gauze for it being dirty). If no gauze, no barrier cream necessary when the site is in good condition.



Tether the tube regardless of type - PEG tether at all times, buttons tether whenever the extension is on - so movement and accidents cannot cause the site to be damaged or lost. It also reduces granulation tissue growth because there is less tugging.