Thursday, February 25, 2010

Why G-tubes are better than NJ-tubes

Seraph has a G-tube for food and meds.  She has lots of oral aversions and doesn't eat orally yet.  You can read about her G-tube here.

Before her G-Tube, Seraph had an NJ-tube which is a tube inserted through the nose and threaded down to the tummy. (NG-tube is to the tummy, NJ-tube is threaded all the way down to the small intestine.  This must be placed under floroscopy at the hospital)

Many preemies have an NG-tube.  It's fine when they're tiny.  But as they get better at grabbing things, they're always taking it out.

When the doctors started talking about a g-tube for Seraph, I searched the blog world for pro's and con's.  I didn't find much.  So, I wanted to weigh in on the subject.

I LOVE LOVE LOVE Seraph's G-tube.
-her oxygen stats are noticeably better without the constant tube in her nose.
-she used to get nosebleeds all the time when she had the nasal tube. (Blood thinners are common for CHD kids, so the bleeds would be hard to stop.)
-it was impossible to suction out her nose for colds (which did lead to worse colds)
-We can easily vent her tummy (this is like burping - but easier to do! plus Seraph can't actually burp now that she's had a Nissan to correct her GERD.)
-easier to place the g-tube--faster and you can do it at home!!!  (Yes, you have to carry the kit with your baby all the time, but after you do it the first time you realize it's not that big of a deal - like putting a ointment and a bandaid on a ouchie)
-her oral aversions have lessened (but not completely disappeared) since giving up the nasal tube.
-no more taping her face -- red, raw, weeping skin on her cheeks
-once she learns to eat orally, the g-tube hole closes up naturally very quickly :)

There have been a few bumps in the road. Here's some tips to help you avoid them
G-Tube Problems and fixes:
1-Dehydration. When Seraph was learning to crawl, she was flat on her tummy a lot.  She was more mobile, so she gained muscle and lost an appropriate amount of weight.  Result: the g-tube was too big.  It leaked while she was sleeping on her tummy.  She lost all her fluids all night long.  In the dark, I just didn't notice the crib sheets were wet.  It cost us a trip to the ICU to get her re-hydrated.

Prevention: Check g-tube size.  It only works if it's snug against the underside of her skin.  If it's snug with 4 gauze pads, that's OK.  If you need more than 4 gauze pads, it's too loose. You can GENTLY pull up on the g-tube to see how far it comes up.  (You'll notice when you're cleaning the site, anyway.)

IF it's too loose, you need to get a new size.  If you can't (like there's a wait-time for how soon your insurance will cover it, or while you're waiting for delivery)....instead of gauze, you can use 2 pieces of toilet paper or ½ a piece of a tissue, rolled up like a cigarette, and then wrapped around the tube.  The idea is to lift the tube enough so it's right next to the under side of her skin even when she's on her tummy.  (don't pop it out)  Wrap the rolled tissue around several times and then tape it down. The kleenex/tissue won't get wet because the site won't leak.

ALSO:  ask your doctor if you can replace spilt feeds with an equal amount of Pedialyte.  This will prevent dehydration and keep your baby out of the hospital. (Pedialyte has powder mixes now, too.)

2-Granulation tissue--raised, sometimes painful, red tissue which can develop at the hole in the skin.  Granulation tissue can bleed and promote leakage of stomach contents through the stoma onto the surrounding skin.

fix/prevention:  Mix 20ml water with 2 drops Eucalyptus Oil.  Use a cotton ball to clean the site with this Eucalyptus-solution every time you clean it.  You can use this instead of soap because it's a natural disinfectant and antiseptic.  The skin will heal, the site will work better.

Write "G-TUBE ONLY" on a tube of your favorite diaper cream.  Use it only for the skin around the gtube.  This protects the skin if some of the stomach acid leaks.

I know it sounds crazy, but it's really so much easier than before.  Plus, she's happier and more mobile.

So if you're in that "should we really get a g-tube" boat, worry less and just go for it :)


Christina Lee said...

wow-- glad it's working out for you. First time here-- off to read more of your story!

Paige said...

Great post.

Lemonade Makin' Mama said...

Just stopping by to thank you for visiting me on my SITS day and leaving me some blog love! Everyone was so sweet and I really enjoyed the day!



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