G, GJ, J Tube Complications Clinical Pathway – Inpatient – Granulation Tissue

G, GJ, J Tube Complications Clinical Pathway – Inpatient

Granulation Tissue

  • Granulation tissue is beefy, pink or red connective tissue that forms around the healing enteral tube site
  • It can form as a result of trauma to the stoma site
    • e.g., pulling or snagging of the tube, irritation
  • Thrives in a moist environment
  • Tends to have a high bioburden (lots of microbes and germs), contributing to continued overgrowth

Goals of Treatment

  • Minimize trauma to the site; vascular tissue bleeds easily and re-injury may trigger hypergranulation
  • Treat the growth and shrink the tissue
  • Prevent worsening and progression of the underlying cause
  • This healing process can take several weeks

Management of Granulation Tissue

  Recommended Approach Comments
1st Line Intervention
  1. Secure/stabilize the enteral tube to relieve pulling and tension on the stoma
    • Position the child to relieve tension
    • Secure tube away from environmental hazards (e.g., bedrails, IV pole, wheelchair and stroller wheels, etc.) using a securement device that is appropriate for tube
 Stabilizing the tube with a securement device removes tension, pressure, and tightness that contributes to granulation tissue formation
  1. Manage/reduce moisture to keep the site dry
As granulation tissue tends to weep, the goal is to maintain a dry environment and minimize moisture
2nd Line Interventions
  • There are two second-line options
or
  
  • Triamcinolone 0.1% or 0.5% ointment as follows
    1. Apply 3 times per day x 7 days
    2. Stop use for 7 days
    3. After 7 days, repeat application 3 times per day for 7 days
 Triamcinolone ointment is a topical steroid cream that can thin the surrounding skin. If no improvement after this regimen, discontinue use and notify the appropriate service
3rd Line Intervention  

Following Bedside Treatments

If no improvement after this regimen, notify the appropriate service.