What topical creams can be used to reduce irritation around a Gastrostomy (G) tube site?

Topical Creams for G-Tube Site Irritation

Zinc oxide-based skin protectants are the first-line topical treatment for reducing irritation around gastrostomy tube sites. 1

Understanding G-Tube Site Irritation

Irritation around gastrostomy tube sites is common and can be caused by several factors:

• Leakage of gastric contents
• Excessive movement of the tube
• Moisture accumulation
• Hypergranulation tissue formation
• Fungal or bacterial infections

First-Line Management Options

1. Zinc Oxide-Based Products

• Primary recommendation: Apply zinc oxide-based barrier creams or pastes to protect the surrounding skin 1, 2
• These create a protective barrier against gastric acid and digestive enzymes
• Apply after each site cleaning or as needed when irritation occurs

2. Proper Cleaning Protocol

• Clean the site daily with mild soap and water 1, 3
• Dry thoroughly to prevent moisture accumulation
• Avoid hydrogen peroxide after the first week post-placement as it can irritate the skin 3

3. Dressing Selection

• Use foam dressings rather than gauze when leakage is present 1
• Foam lifts drainage away from skin while gauze can trap moisture against skin
• Consider Y-compress under the tube to prevent moisture accumulation 3

Management of Specific Complications

For Peristomal Leakage

1. Verify proper tension between internal and external bolsters 1
2. Apply zinc oxide-based skin protectants 1
3. Consider proton pump inhibitors to decrease gastric acid secretion 1
4. Stabilize tube using a clamping device if side torsion is present 1

For Hypergranulation Tissue

1. Clean site daily with antimicrobial cleanser 1, 3
2. Apply high-potency topical corticosteroid cream (e.g., clobetasol 0.05%) directly to the tissue for 7-10 days 3, 4
3. Consider silver nitrate application for chemical cauterization 3
4. Apply foam dressing over the area to provide compression 3

For Fungal Infections

• Apply topical antifungal agents when fungal infection is confirmed 1, 3
• Do not use nystatin cream for general redness without confirmed fungal infection 3

Important Considerations

• Avoid excessive pressure between internal and external bolsters, as this increases risk of irritation, infection, and buried bumper syndrome 1
• Allow approximately 1 cm of play between the skin and external bolster to maintain proper tension 1
• Monitor the site daily for changes in appearance and seek prompt medical evaluation if redness worsens 3
• Limit topical steroid application to 7-10 days to prevent skin atrophy 3, 4
• Avoid occlusive dressings as they can lead to skin maceration and breakdown 3

Common Pitfalls to Avoid

1. Using nystatin cream for general redness without confirming fungal infection
2. Applying hydrogen peroxide for routine cleaning after the first week
3. Using gauze instead of foam dressings when leakage is present
4. Failing to address the underlying cause of irritation (e.g., excessive tube movement, improper bolster tension)
5. Applying excessive tension between internal and external bolsters

By following these evidence-based recommendations, irritation around gastrostomy tube sites can be effectively managed and patient comfort improved.