That was the beginning of our trial-and-error process of figuring out which types of adhesives were better for all of the different things we used them for. This will of course NOT be an exhaustive review of every adhesive out there, but we have 15 different kinds in our medical supply bench and the AWESOME ladies from Feeding Tube Awareness on facebook have pitched in to give their experiences with quite a few more. This will be Part 1: Adhesives & Taping Techniques for nasal tubes (NG/ND/NJ)
(Click here to get Duoderm Extra Thin)
Duoderm is a hydrocolloid dressing that is commonly used for healing and protection of open wounds, but is also very commonly used with NG tubes. (There are other hydrocolloid dressings on the market too: Granuflex, Tegaderm Hydrocolloid, Kendall Ultec Pro, etc.) It is a soft and pliable gel adhesive that sticks well to clean, dry skin and when removed, is very gentle on the skin. (i.e. it doesn't rip any layers of skin off with it :)
When I first was given Duoderm by our GI nurse, I had no idea what I was supposed to do with it. Finally, I was told by somebody (I don't remember who, that time of my life is a total blur :) that it works really well to cut a long, oval-shaped piece of Duoderm, place it on the cheek where the tube needs to be, place the NG tube, and then use a layer of another type of adhesive over the top to secure the tube. That protects the cheek from getting a groove in it from the tube, and is very gentle on the tender skin of the cheeks. We also liked it because it was flesh-toned and not quite as obvious as a giant white piece of Hypafix, and because in the right conditions, (meaning far enough away from her nostril to keep it dry), it would stay on for 5-7 days.
Duoderm is not without flaws. If any water (or snot, formula, puke, etc) works its way under the edge, it will peel off. Once it starts to peel, you have no choice but to take it off and put on a new piece because it will NOT stick again. We also noticed that after it's been on for a few days, it starts to get a little bit stiff. (it wasn't really a problem, just something we noticed) Probably the worst thing about Duoderm is that it is not breathable at all. We alternated cheeks pretty much every 7 days to keep one side from getting too irritated. Even so, the Duoderm+Tegaderm combo worked great for us.
(Click here to get Hypafix)
Hypafix is one of our FAVORITE adhesives. It's a fabric tape that is very soft and breathable, which is one of the reasons it's so great. It's thin and flexible, and has a strong adhesive but is still gentle on the skin. Being a cloth tape, it is also very strong and doesn't rip apart as quickly or easily as others, and because of that, it has to be cut with scissors. It has MANY many uses, including taping down NG tubes, so to my knowledge, most hospitals stock either Hypafix or Medipore, which I'll get to later. Here's what it looks like up close:
When Raya first got her NG tube, this is the tape they used on it at the hospital. Here's what that looked like:
|(kind of melts your heart, doesn't it? :)|
There aren't a whole lot of things I don't like about Hypafix as it relates to NG tubes other than the obviousness of a piece of white tape covering up a little bitty baby cheek. It was a little rough on skin when it was removed compared to other things too. Other than that, it holds great & lasts even after it gets wet and it's a great adhesive.
(Click here to get Durapore)
Anyone who is familiar with Durapore is probably wondering why in the world I'm including it in a post about NG tube adhesives. It's a silk-type fabric tape that is one of the strongest and most unforgiving kinds of tape. You can't pull Durapore off without KNOWING that it's coming off! It comes in different widths and can be torn easily by hand.
We found that it was very useful for taping the NG tube to Raya's clothes to keep it from getting caught on things. When the weather permitted (as in, when it wasn't too hot for her to wear clothes), we would either tape the tube to the back of her onesie or if she was only wearing one layer of clothing, we'd tape it vertically to the back of her shirt in the middle near the top with a 1 or 2 inch long piece of Durapore like so:
You can't see it in the picture (and I can't find a better picture) but we would also bring the tube down to her side (whichever side the tube was on that week) and tape it horizontally with another piece of Durapore. This kept the end of the tube from getting lost underneath her in the carseat, etc. and kept it in a position that was easier to access. Also, sometimes when the tube wasn't in use, we would take the end of it and tape it up so that the hard plastic adaptor was at her shoulder. That kept the tube from leaking as badly if it happened to pop open, and it kept the adaptor from poking her or getting caught on things.
We live in Arizona, so for the last 2 or 3 months that Raya had her NG tube, it was too hot for her to wear much clothing. When that was the case, instead of taping the tube to the back of her shirt, we put a patch of Duoderm on her back in the same place we would have taped the tube to her shirt, and then used Durapore to tape the tube to the Duoderm. We tried Tegaderm over the Duoderm on her back but it wasn't strong enough to hold it for very long at all. Durapore, on the other hand... :) Here's what that looked like:
The other main NG tube-related thing that we used Durapore for was securing the tube close to Raya's nose. The down side of the Duoderm was that the tension from the tube bending to go into the nostril plus the moisture from being close to the nose & mouth made it so that the Duoderm had to be a pretty good distance from the nose. We realized very early on that we couldn't leave a gap there, and Durapore was our solution. All it took was one little 1/4-1/2 inch piece taped close to the nose to close the gap. The durapore was strong enough to withstand the extra moisture for a couple of days and when it got too wet, it would wear off without traumatizing the skin under it. (see above picture under Tegaderm)
And last but not least, we used Durapore for miscellaneous purposes such as taping the end of the NG tube to the kitchen faucet to keep it out of the way during bath time:
That kept the tube neatly out of the way (and out of the water) during Raya's baths in the sink.
Our most recent use for Durapore tape was attaching Angry Bird eyebrows & beaks for Halloween costumes:
Medipore is a soft, thin, breathable fabric tape made by 3M. It is very similar in feel to Hypafix, which is why our home health company has sent it to us. I think there have been a few months where they were out of Hypafix or something, and Medipore was the replacement they sent. The rolls we have gotten come 2 in a package and they're 1 inch or 2 inches wide. They are also perforated:
The perforations are great if you don't have scissors handy, but only if you want your tape in 2 inch pieces. :) If we had been sent Medipore back when Raya had her NG tube, I would have used it to tape the tube to her face (especially during the times that her skin was irritated from the Duoderm/Tegaderm and needed some air), and most DEFINITELY would have used it to tape the tube to her back when it was too hot to wear clothes since it is very similar to Hypafix and would have held up well for that purpose. I don't have an NG tube wearer anymore to test that theory, but I'm pretty sure that's what I would have used it for then.
Other NG-friendly Adhesives:
I asked people on the Feeding Tube Awareness facebook page for their opinions on what adhesives worked or didn't work for them, and I got some great responses. Here they are:
Pink Waterproof HY tape
|(photo courtesy of Bruce Medical)|
Alix said, " We also used the pink water proof HY tape, it was great for swimming and keeping the med port closed in baths or playing in the rain." I wish I had known about this tape when Raya had her NG tube!!
Feeding Friends Stickers
Aren't these adorable?!? They're from Kids Hope Chest, which has all kinds of cute things to make hospital stays a little brighter. The stickers come on a 10 yard roll and can be trimmed to any size. In other words, you can either cut them out to the shape you want or you can cut around the shape of the animal. They are gentle on the skin and breathable. I'm not 100% sure but I don't think insurance covers these. The cost is $14.99 per roll and the website says that there are at least 100 stickers per roll.
|(sorry, not a great picture)|
Smith-Nephew Opsite IV3000 is similar to Tegaderm and according to Sandy J, is gentler on skin than Tegaderm. She said, "Little Man got blisters from Tegaderm, so that's what we used instead for his NJ." Amanda T. said, "It's like Tegaderm, but it didn't cause my son to break out like Tegaderm did." Sounds great to me. :) According to product information, Opsite IV3000 is breathable and has a low allergy adhesive, both of which provide for much greater comfort level and less irritation of the skin.
|photo courtesy of http://www.ncmedical.com/|
I've never used or seen Mefix tape, but from the picture & description, it's very similar to Hypafix. I haven't heard anything terrible about it. :)
Coloplast Comfeel is another brand of hydrocolloid dressing that is used for wound care. It is similar to Duoderm but from what I can tell in the pictures I've seen, it has a smooth surface as opposed to Duoderm's textured surface. I'm not sure that the difference in texture would make a difference in performance, and Comfeel is another option for a barrier layer between the NG tube and the skin. Jen M. said that she uses Coloplast Comfeel as the barrier layer and either hypafix or elastoplast over the top of the NG tube.
Sorbaview(Click here to get Sorbaview)
Susan A. said that Sorbaview is another adhesive that's "like Tegaderm but better." :) According to the product information, Sorbaview is latex-free, breathable, and moisture-wicking, all of which make it gentle on skin. Since I've never used it myself, I'm not sure if either of the versions in the picture is the one Susan was referring to, but I can see how this product in the correct size would be effective.
And last but not least: our favorite NG tube taping techniques.
I've already gone over the Duoderm+Tegaderm w/little piece of Durapore combination, and the Duoderm+Durapore on the back or Durapore to the back & side of the shirt techniques, but there's one more thing I wanted to mention. When Raya first got her NG tube at the hospital, they taped it at an angle that pointed the tube up and over her ear. This is a VERY common way to tape NG tubes, but we didn't like it. Here's what that looked like:
It was hard to tape the tube to her back and still allow enough slack for her to turn her head but not end up with a giant loop like in the picture. The extra slack in the tube over her ear gave her little fingers one more place to accidentally grab the tube and it just got in the way more. After discussing this with my friend Missy, whose son had had an NG tube for about 2 years at that point, she told me that they taped his tube so that it ran below his ear and then to the back of his neck. We experimented a little and this is what we ended up with:
|(pay no attention to the pen marks on her face courtesy of sister|
or the crusty hair/sweaty head from her DOC Band head orthotic,
and no, she doesn't like sweet potatoes out of a syringe :)
Well, that's it for Part 1. Stay tuned for Part 2: Adhesives & Taping Techniques for G and GJ tubes!