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Monday, November 14, 2011

Adhesives Part 2: Adhesives & Taping Techniques for G and GJ tubes

As I mentioned in Part 1, when we started out on our feeding tube journey with Raya, we had never heard of things like Duoderm, Hypafix, Tegaderm, Mepilex, etc. etc. We had no idea that there were SO MANY different kinds of adhesives that could be used for every aspect of tube feeding, let alone which ones were better for what functions. (In case you missed it, ~here~ is the link for Adhesives Part 1: Adhesives & Taping Techniques for NG/ND/NJ tubes.)

Hypafix
Hypafix has been one of our favorite adhesives for Raya's G and GJ tubes. 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.
When she got her first G tube (a non-balloon Bard button), we had the frustrating challenge of a button with no locking mechanism, and with a 9 month old who was on continuous feeds at the time, it wasn't pretty. For 2 months we floundered around with a couple of different options that more or less worked but weren't very kind to her skin. It wasn't until she was admitted to the hospital to get her GJ tube that we were finally reintroduced to Hypafix, and we've been using it ever since. Because GJ (gastrojejunal) tubes have the jejunal portion that goes through the stomach and into the small intestine, they have to be kept still and not rotate or the J portion may dislodge and coil back into the stomach. Hypafix worked well for us because it holds well for up to 4 or 5 days, is breathable so it minimizes skin breakdown, and it is much gentler on the skin than many other adhesives. Here's how we use it:

(In this picture the GJ had been changed and the G port was on top & J port on the bottom.)
When she had her GJ tube, we kept the extension tubes plugged in around the clock because she was being fed & drained around the clock, and because having the extensions taped on securely with Hypafix kept the tube from rotating. An added bonus of keeping the tube from being able to move was that she has not had a problem with granulation tissue in over a year. :)

Microfoam
Microfoam (by 3M) seems to be one of the lesser-known adhesives. It's a soft, thick, pliable foam tape that comes in different widths. (we used 2 and 3 inch) After Raya had gotten her G tube and before we rediscovered Hypafix, we were having a horrible time finding a tape that would stick to her well enough to hold the non-locking Bard extension tube on without ripping her skin off when it was removed. Here's another view where you can kind of see how thick it is:
Our wonderful GI nurse gave us a couple of partial rolls of Microfoam to try and wouldn't you know, it was fabulous. It held the extensions on but was gentle when we took it off. It could also be repositioned a little if I accidentally stuck it where I didn't want it, unlike many of the others. The down side of Microfoam was that it's not very breathable and evidently very difficult to come by. I made several calls back and forth to the insurance company and home health before finally being told once and for all that our insurance wouldn't cover it because it's considered a wound care product and apparently, a stomach wound in the form of a newly-placed G tube doesn't count. :) I really liked the microfoam though and if our insurance would have supplied it, we would have kept using it.

Micropore
Micropore is the absolute hands-down winner of the Most Versatile & Useful Tape Award. If there was such a thing. :) It is a light, thin, breathable paper tape that holds well depending on what it's being used for and doesn't leave sticky residues like some of the others (durapore). It's also very easy to remove. If you soak it with water for a minute or two, it will come off without taking skin with it. Micropore is our go-to tape for just about everything, including the kids taping notes to each other's doors and Donny making the kids "boxing wraps" to protect their knuckles when they're punching the focus mitts (ask me how thrilled I was about that one :).

We started using it when Raya had gotten her first G tube and we couldn't get home health/insurance to provide us with the Microfoam tape. A good friend of mine had just gotten a G tube herself and suggested trying paper tape, so I bought a roll from the drugstore just to try it out. It worked like a charm!
Here's how we used it when she had her Bard non-balloon button with no locking mechanism to keep the extension tube in:
I'll explain. :) At that point (2-3 weeks post-op) Raya's stoma was leaking profusely because it wasn't healed yet and the Bard button was the wrong size, so in order to keep the leaking to a minimum, we had to keep 2 packets (4 pieces) of gauze around it which we taped down with Micropore. (the redness & irritation in the picture is because we had to change the gauze 2-3 times a day so she was constantly getting tape pulled off) She was fed for about 20 hours a day at that point so the extension had to stay in pretty much all the time, so we would put it in, bring it over to the side, put an X of tape across the tube directly over the button, and another X of tape on her side to keep the extension secured. (This is what we liked using the Microfoam for, and Hypafix would have worked great as well.) The Micropore definitely wasn't the strongest tape for holding the extension tube down to her side, so ultimately we stopped using that and started using Durapore, which I'll explain later. :)
Last but not least, one of our current favorite uses for Micropore is this:
(oops, that should say Micropore, not Medipore)
For a long time, we taped the gauze down with Micropore. Then I finally realized that if I just put the piece of tape across the opening on the gauze and folded it over the back, I wouldn't have to keep ripping tape off of her stomach every time I changed the gauze. She's glad I figured that out. :)


Durapore
Durapore is a two-edged sword, in my opinion. If you need something to stick and stay put (and it's not going to get wet), then Durapore is your man, BUT if you want any of your outer layer of skin to remain intact when you remove it, Durapore is not your man. Durapore is a silky fabric tape that looks a lot like grosgrain ribbon, but it can be torn by hand easily and is fairly breathable. It is VERY sticky, but doesn't hold up well when it gets saturated.
The only times I have ever put Durapore on Raya's skin have been moments of desperation when I had run out of other options. It is NOT gentle on skin at all when it's removed and the adhesive leaves residue much more so than the other kinds of tape we've used. As I mentioned before, the Micropore wasn't working for keeping the extension tube securely on Raya's side during her continuous feeds so I NEEDED something stronger, couldn't get more Microfoam, and in desperation resorted to Durapore. The 2 inch wide Durapore was great for holding the extension down. It held great, didn't peel for a couple of days at a time (sometimes more, sometimes less) and kept things pretty stable. However, when it did start to peel or when I needed to take the tube off, the tape was SO rough on her skin and it was awful. The other drawback was the amount of sticky gunk it left on Raya and on the tubing.
Our favorite uses for Durapore are:
*Taping NG tubes to the back of clothing (see this post for more details)
*Mailing packages to cousins (I know, I'm wasteful)
*Stocking the first aid kits for emergencies
*Taping the medicine port on the Mic-Key extension tubes shut so it doesn't pop open and leak all over her bed!! (this is currently our ONLY use for Durapore)

Mepitac Silicone Tape

Mepitac (by Safetac Technology) is a fabric silicone tape that is both hypoallergenic and breathable. It is very gentle on skin and can get wet without losing its ability to stick. I was told by one mom that her son has to have the tape on around the clock every day and Mepitac is the only tape/adhesive they've found that works for him without irritating his skin.


We have tried a couple of alternatives for plain ol' tape as well. This summer, I was getting SO frustrated with how often I was having to peel tape off of Raya's poor, sore little tummy and replace it so I started looking around for other options. I found 3, tested 2, then life got crazy and we went on vacation and then went back to a G tube so I never tested the 3rd. Here they are:

Hollister Tube Attachment Device
When I first heard about it, I was excited to try it out. I emailed the company and they sent me a sample, which I greatly appreciated, but I was disappointed when I got it. First of all, it's HUGE. Second, the adhesive on it is basically a thick non-textured version of Duoderm so I wasn't sure how well it would stay on. Third, the "attachment" part of the device was basically a zip tie with a plastic part that you can squeeze to release the zip tie to take the tube off. Here's how it looked in action:
It pretty much did the job, but it was big. The plastic part stuck out almost as much as her Mic-key GJ tube, which is huge, and there was the tail of the zip tie that I felt was in the way. Anyway, long story short, I decided the Hollister Device wasn't worth the trouble and we went back to Hypafix tape. Then a family member who does trainings for Bard Stat-lock devices suggested looking into their line of products so that's what we did next.

Bard Stat-Lock Device
(somehow I managed to not take a picture of it when we were using it so this is the picture from their website)
This is VERY similar but not exactly the same as what the very nice Bard representative brought to my house. She came over one afternoon and showed me what they had available that might work for our purposes and gave me several samples. The Bard product is DEFINITELY a high-quality product. It comes with a specially formulated skin-prep wipe to help the adhesive adhere to the skin (can I use those words in a row like that??). It has a very soft, silky fabric and the adhesive is VERY strong. So strong, in fact, that it has warnings on the package not to attempt to remove it without rubbing alcohol. When you do use rubbing alcohol though, it comes off really well and with minimal skin irritation, if any.
The skin prep has some ingredient in it that forms a barrier and protects the skin, which is nice, but it also makes it very easy to slip the extension tube into the silicone grip. Once it's in and the little plastic clip has been closed, it stays securely in place.
The advantages of the Bard device were that we could unhook the extension tube from the GJ or G tube button without having to peel tape off of Raya's skin. The Bard made this MUCH easier than the Hollister.
The drawbacks. First, again this product is very large. We trimmed it down like we had with the Hollister device, but it was still really big. The actual plastic clip is pretty large too and stuck out almost as far as the GJ tube as well. Second, after 3 or 4 days, even though the adhesive was still securely fastened to Raya's skin, the plastic clip that was holding the extension tube in place started to peel away from the adhesive layer and once that came off, it was useless.
Once again, I decided that this type of device was not practical or necessary for what I wanted.

Grip-Lok
(this is the one we haven't tried so this is the picture from their website)
The third and final alternative attachment device that I've heard of is the Grip-Lok. It's made by Zefon International. According to their website, Grip-Loks are latex-free and made using hypoallergenic tape (which looks a lot like Hypafix to me) and are breathable and gentle on skin. They secure to the skin with the adhesive tape layer, and then have a self-sticking Velcro-type layer to secure the tube with. Another feeding tube mom told me that her son (who has severe eczema) uses Grip-Loks for both extensions on his GJ tube and that they are great for being able to remove the tubes but leave the adhesive in place.

Zefon Medical also makes a Grip-Lok for securing NG tubes. Here's what it looks like:

The Grip-Lok NG product is a hydrocolloid adhesive (like Duoderm) with a self-sticking layer to secure the tube. I wish I had known about this when Raya had her NG tube. It looks like a nice, tidy version of what I tried to do with the Duoderm & Tegaderm. :)

Other Adhesives
There are a few other miscellaneous adhesives that are commonly used with G and GJ tubes.

Mepilex AG
Mepilex AG is an anti-microbial foam wound dressing that releases silver into the open or raw tissue underneath it. In the case of G, GJ, or J tubes, it is cut into a small square (about 1.5x1.5) and fitted around the tube in order to absorb drainage and help to heal and protect granulation tissue. This is what granulation tissue looks like:
(This is when it had JUST started so it wasn't at its worst yet, and her tube was leaking horribly hence the wet stomach.)
Mepilex is a good alternative to treating granulation tissue with silver nitrate sticks, which I've heard is very painful. I've also been told by several people that they use Mepilex all the time around the tube instead of using gauze or any other type of pads since it does absorb wound exudate. Mepilex only adheres to dry tissue, so it won't stick to the granulation tissue, which is painful and bleeds easily.
We tried Mepilex with Raya's granulation tissue and it was helpful but there was SO much leakage from around her G tube that we had to go back to using just gauze in order to absorb everything. And once again, the insurance wouldn't cover it since it was considered a wound care product so we couldn't get more once we used the samples from the surgeon.

Transpore
I really don't have anything good to say about Transpore. I only included it because I had it in the medical supply bench. It's plastic. I don't like it. I honestly can't think of a good use for it. I've only used it when I was desperately in need of a piece of tape and couldn't reach any other more suitable tape. That's all I have to say about that.

StatLock Foam Strips

StatLock foam strips are FABULOUS!!!! They hold strongly but then when you're ready to remove them, all you have to do is grab one end and stretch it out until the whole thing pops off (like the 3M adhesive hooks that they advertise for hanging Christmas decorations). When the nurse from Bard came to bring me some of the StatLock devices, she pulled these foam strips out and stuck one to my arm, which is rather hairy for a girl. :) Then she showed me how to remove it, and to my absolute delight, it didn't hurt!
The only down side to these fabulous little foam strips is that I have not yet figured out what a good use for them would be.

Okey dokey, that concludes my 10 page term paper on adhesives for feeding tubes. :) I hope someone finds this helpful!

7 comments:

  1. Thanks for such an informative post! Do any of these tapes leave a residue on the tube? I have a huge feeding tube - 24 fr g/j with dual ports at the end that hangs down past my groin. I use a hollister but it's very large. It covers the area from my navel to my 'southern border' and is painful underneath my jeans as the zipper squashes it. I would love to tape the tube up my side but need my tube to stay clean since its changed every 6-8 months. I would love to try these tapes you reviewed, but the thought of gunk on my tube holds me back.

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    1. Unfortunately most tapes do leave a residue. Since Raya had a GJ button instead of the PEG-style tube, we have been lucky and only have to worry about gunk getting on the extension tubes, which we change every week or so. Are you able to switch to a button-style tube? Right now Mic-Key is the only brand that's available on the market but AMT is in the process of releasing their GJ button and I believe if you contact the company they can get the tube to your provider if that's something that interests you.
      To answer your question, the only adhesives we've found that don't leave a residue on the tube are Duoderm and Tegaderm. I have a feeling that Tegaderm over the tube wouldn't be strong enough to hold it though. Having said that, I've only had experience with taping tubes to an active baby/toddler so the combination of Duoderm under the tube and Tegaderm over it might work for you. It might also work to just put a strip of Duoderm over the tube. We really liked the Bard Stat-lock device as well. It's MUCH nicer than the Hollister (in my opinion) and doesn't leave any residue on the tube. It holds to the skin longer than the Hollister too. The down side on those is the cost at about $10 each. However, I contacted Bard and a nurse came out to show me what they had and gave me a whole bunch of "samples" so that might be worth a try too. Grip-Loks would definitely be worth a try for you too. I've heard really good things about them and from what I've heard, they don't leave residue either.
      Good luck, I hope that helps!

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  2. Thank you for posting all your struggles with the tubes and tape! Our son had an NG tube...we could never find a tape that worked well without making his whole face break out! So back in April we decided to get him a g-tube (bard button). We are so happy we did! He's 10 months old now and is so active, I couldn't imagine him with an NG tube. But we found out that the Bard Button has a defect and won't stay closed. We were contemplating taping it down (suggested by the dr) but didn't want to irritate his skin on his belly like his face did when he was little. But we are getting sick of the button just leaking all the time. Plus he has granulation tissue that can be pretty bad some days. I see in one of the pics above that she has a bard button. Did you ever have to tape it shut? I didn't know how tape would irritate the area aroung the button with the granulation tissue. But I am interested in the Mepitac Silicone Tape. Did you like using that? Did it hurt when you had to take it off of her?
    On a side note, just yesterday our son broke out in a rash around his button. The dr I took him to last night said it could be an allergy to the plastic. Did you ever have a problem like that?

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    1. I'm glad you found it helpful. :) We had the same problem with the Bard button. As much as I preferred the G tube over the NG tube, Raya's experience with the Bard button was lousy. She leaked horribly from around the tube most of the time that she had it and we had the same problem you mentioned with the valve not working. She was on continuous feeds of about 20 hours a day then so we just didn't take the extension tube off other than to clean it or it would leak. I've heard of a few people developing an allergy to the material their G tube was made of. Honestly, if it's been 3 months since he had his tube placed, I would ask about changing to a balloon button like a MicKey or AMT MiniOne button. They are MUCH easier to deal with.
      We never actually used Mepitac silicone tape. It was another one that I'd heard of so I included it in the post but we've never tried it. The tape that works best for us with taping extensions down is Hypafix or Medipore 2". It's very breathable and stays on when it gets wet but soaking in the tub makes it easier to peel it off.

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  4. Thank you so much! My son has had an NG tube for 5 months now. I was told, and believed it was going to be temporary ( a couple of months). Well, he has a chromosome disorder that there is obsolutely no literature on anywhere, so now the doctors cannot tell me anything! We tried to take him off the tube, he lost over a pound in 9 days, tube back in, gained it all back plus some in 5 days. Short story long, I am thinking this is not temporary, and was desperate for better ways to tape than what hospital showed me. He has very sensitive skin. I have ordered Hy tape and Hypafix from my home healyh. My question is, how do you use them? Do you always put duoderm under the tube? Thank you again, you are a God send!

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  5. Thank you for introducing us to hypafix! I also thought the Stat Lock foam strips were amazing, until I used them on my kiddo for more than a day or so. They broke him out worse than any other tape we've ever tried. They come in his Broviac Stat Locks, so we gave them a shot, but they definitely weren't a good fit. Just thought I would share our experience. Thank you for this blog! He's had his g-tube for almost a year and you were SO helpful at the beginning. If only someone would have had one informative for Broviac care/tpn, we would have been set. Thank you!

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