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Saturday, November 5, 2011

Adhesives Part 1: Adhesives & Taping Techniques for NG tubes

This series has been a long time in the making. Back when Raya got her NG tube, I had no idea there were so many different adhesives on the market. At the hospital, they had used some kind of fabric tape in a box that had to be cut with scissors and that was the ONLY thing we accidentally left at the hospital. Raya caught her little pinky finger on the tube a couple days after we got home and the only medical tape I had ended up bringing home was Durapore. This tape is VERY sticky, very strong, and definitely not the best option for the tender little cheek of a 2 month old baby. A couple days later, we went to the GI doctor and the nurse saw the tape and told me that Duoderm would be much gentler on her skin and she gave me a couple of 6x6 sheets to try out.
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)

Duoderm:
(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.

*Note: We learned the hard way that there are many different kinds of Duoderm, but the one that is suitable for use with NG tubes is Duoderm Extra Thin CGF. Here's what the regular Duoderm CGF looks like:
You can see in the picture that it is very thick compared to the Duoderm Extra Thin. We had to use this kind in a moment of desperation once and it stuck out from Raya's face, irritated her skin, and just wasn't good. DO NOT let your home health company send you anything other than Duoderm Extra Thin because the others are useless for this purpose!


 
Tegaderm:
(Click here to get Tegaderm)
Tegaderm, aka Duoderm's best friend. :) Tegaderm is a very thin, clear dressing commonly used to cover things like IVs and accessed ports. For us, it was the perfect NG tube adhesive. (well, maybe perfect is a strong word but it worked :)
After a lot of trial & error, the winning combination for Raya's NG tube was a layer of Duoderm, NG tube, and then a layer of Tegaderm on top. Working with Tegaderm can be very tricky. It is very thin and very sticky, and if it sticks to itself at all, it's over and there's no unsticking. Here's what a sheet of Tegaderm looks like:
 You can see that there is a paper border around the Tegaderm, and once it's removed, it's pretty much impossible to maneuver it without ruining it. We found that the easiest way to use it was to cut oval shaped pieces on each end, leaving the paper border in place. I would put the Duoderm on Raya's cheek, lay the tube on top, place the Tegaderm and make sure it was in contact all the way around the edges & through the center, and then remove the paper border. Here's a very grainy shot of what that looked like when all was said & done:
One thing to note about Tegaderm is that it is also not very breathable and was much more likely to irritate Raya's skin than Duoderm. The remedy for that was that when I cut the Tegaderm, I did my best to make sure that the Tegaderm wasn't bigger than the Duoderm so it wouldn't touch her skin.
Another great thing about the Duoderm+Tegaderm combo was the fact that even when the Tegaderm started to peel & needed to be replaced, it was gentle enough that it usually didn't pull the Duoderm off with it.

Hypafix:
(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? :)
We've been addicted to Hypafix pretty much since Raya got her G tube & then GJ tube & now back to G tube, so I'll be going into its other uses in that post.
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.

Durapore:
(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
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)
(Click here to get Pink Waterproof HY tape) 
 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.

Opsite/IV3000
(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.

Mefix
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
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 :)
We still ended up with a little bit of slack just because we had to leave enough for her head to turn, but overall this worked SO much better for us than having it taped over her ear.

Well, that's it for Part 1. Stay tuned for Part 2: Adhesives & Taping Techniques for G and GJ tubes!

10 comments:

  1. What about the Feeding Friends Stickers? Those are super cute!
    http://www.kidshopechest.com/feeding-friends-stickers.aspx

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    1. They're included towards the bottom of the post. :)

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  2. I'm an RD in home health and we just found your blog. I can't wait to read through it all. I can't tell you how helpful we find it to just reading about the tapes! Its these practical tips that I don't know because I haven't lived it. I also find your post on your complaints the tetra- paks so interesting. I have heard that they are going to make the width of the opening bigger to help with pouring. Interesting about her reaction it the formula in the pak. I've had one pt report an intolerance to me, bu no flood of complaints. Thanks for the info.

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  3. We were just discharged with an NG and the nurse slipped me a box of Allevyn Thin bandages. They are padded and breathable and I adhere Hypafix to it. They seem to be helping the eczema on my son's cheeks as well.

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  4. I loved reading through this!! My 19 month old son is on an NG now for chronic aspiration. We've only had it a month & we're experiencing many of the tape trial & error problems you talk about! We should make the decision soon about a G tube and then I'm sure there will be a whole new set of questions! My son also had a helmet so I guess they have alot in common. I also wanted to share with you that my 11 y/o daughters middle name is Raya!!

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  5. Oh wow, I cannot tell you how much I appreciate this post! My daughter was recently fitted with an NG tube, and I have to tell you that inserting the tube is WAAAAYYY easier than working with the stupid tape. I find myself almost in tears over having to cut tape after tape after tape, only to find that 30 minutes later it's all come off and I have to start all over again from square one.

    Thanks for sharing your findings!!!!

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  6. Thank you so much for taking the time to write this!

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  7. This comment has been removed by a blog administrator.

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  8. Thanks so much for compiling this information!

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  9. Thank you so much we were using tagaderm and duaderm...and the tagaderm kept rolling up once it got moist by the nose...I am going to try hypafix.

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