How to treat peristomal skin irritation at a PEG (Percutaneous Endoscopic Gastrostomy) tube site?

From the Guidelines

Peristomal skin irritation at a PEG tube site should be treated with a barrier film or cream to protect the surrounding skin, and the affected skin should be cleaned at least once a day using an antimicrobial cleanser.

Treatment Options

• A wide variety of treatment options are possible, such as the application of a topical antimicrobial agent under the fixation device, or a foam or silver dressing over the affected area which has to be changed only if there is evidence of significant exudate (but at least weekly) 1.
• Another option is to apply cauterization by silver nitrate directly onto the overgranulation tissue.
• Alternatively, a topical corticosteroid cream or ointment can be administered for 7-10 days in combination with a foam dressing to provide compression to the treatment site.

Prevention of Infection

• Prevention of infection consists of first-line aseptic wound care after placement and early detection of signs and symptoms of infection such as loss of skin integrity, erythema, purulent and/or malodorous exudate, fever and pain 1.
• An antimicrobial ointment or a dressing with an antimicrobial agent which delivers a sustained release to the gastrostomy site can be used: these dressings typically get their antimicrobial activity from silver, iodine or polyhexamethylene biguanide and are available in different forms, e.g. foams, hydrocolloids or alginates.

Skin Breakdown due to Leakage

• To minimize skin breakdown due to leakage, a topical skin product as a powdered absorbing agent or a barrier film, paste or cream (containing zinc oxide) can be applied 1.
• Foam dressings rather than gauze can be used to reduce local skin irritation (foam lifts the drainage away from the skin, whereas gauze can contribute to more skin maceration).
• Local fungal skin infections may also be associated with leakage and can be treated with topical antifungal agents.

From the Research

Treatment of Peristomal Skin Irritation

To treat peristomal skin irritation at a PEG tube site, several methods can be considered:

• Topical sucralfate has been shown to be effective in preventing peristomal wound reaction and infection in children with PEG tubes 2
• Covering the PEG tube with a sheath can help prevent peristomal infection by reducing the introduction of oropharyngeal bacteria into the abdominal wall 3
• Using a hydrogel dressing can help maintain a normal moisture level in the stoma region and minimize complications such as erythema and drainage 4
• Conservative management with petroleum-based and sterilizing agents can be effective in treating rare cases of cutaneous myiasis around the PEG tube site 5

Prevention of Peristomal Skin Irritation

Prevention of peristomal skin irritation can be achieved through:

• Proper wound care and dressing changes
• Use of topical agents such as sucralfate to prevent peristomal wound reaction and infection
• Covering the PEG tube to prevent introduction of bacteria into the abdominal wall
• Monitoring for signs of infection or irritation, such as erythema, drainage, or hemorrhage

Complications of PEG Tube Placement

Complications of PEG tube placement can include:

• Peristomal infection or irritation
• Splenic laceration or avulsion, which can result in intra-peritoneal bleeding and hemodynamic compromise 6
• Cutaneous myiasis, a rare but potentially serious complication 5