Gastrostomy BUTTON...infection

[talonmum]

Hi All,

I haven't been on Bub Hub for quite sometime... My son Talon (20 months) has Short Bowel Syndrome, which basically means he doesn't have enough intestine (small and large) to absorb the nutrients he needs to survive. He is dependent on IV nutrition (TPN) every night through a central line.

However.....we have recently had a button (BARD 18F) placed and it has been pussy/red/irritated now for about three weeks since the operation. A swab test showed golden staph, however this is not uncommon..apparently.. One course of antiobiotics has already been given. Can anyone offer any info or tips from experience on buttons?? The stitches are still in and I have attempted to take these out, as per the nurses instructions, but they won't budge..!

Being the Christmas/New Year period has proved almost impossible to see our Doctors (Gastro Team) at the Royal Childrens (Brisbane), so I'm relying on our wonderful GP for advice.

I have had a bit of a read through some posts in the 'special needs' section and look forward to chatting with you all in the near future....

Happy new year :)

[veve]

Hi

I dont know much about how to deal with the infection itself, however to manage a clean button .. and to maintain it being clean, I always used to use saline solution, and a cotton bud to clean around those that I worked with (at school) after a feed .. especially if it was messy.

A mother that I know used to by the make up pads (the circle ones) and cut a radius into it ... which meant it would fit around the button (so the button could slide into the middle of the pad) ... it meant that the button was always dry.

I know that you can buy a something from the chemist that helps keep proud flesh down from around the button, its kinda like what you would do for wart removal (its the same burning chemical stuff) .. it just minimises the flesh build up if that is an issue too??

Sorry I cant be more helpful - its been a few years since I've worked with a child who has a button ... good luck getting the infection to disappear, I hope it all settles soon for you both ..

xx
Jen

[Nowhere]

Hey

DD gets infections around her stomas all the time, once its in the system its hard not to, With him having in a central line as well I would be getting him to the ED for IV ABs so that the bug doesnt translocate into the blood stream and atatch to the central line. If you have tried the topical creams first IV abs wil be the only option i would imagine.
Has he got temps from it or it is just pusy and red, could it just be the granulation tisue??

[kiwibird27]

Infections are common.... Whenever my DDs site becomes even slightly red I apply CLORSIG (eye ointment) cream and it prevents it from infecting completely, If it is granuloma tissue then would recommend steroid cream.. usually works so u don't have to burn them off. As for the infection now you will have to talk to your doctor.. It sucks!!!

[talonmum]

Thanks everyone for your suggestions....

I have started using the make up pad around the button and it has definitely kept it dry. The stitches are out, except one which is sticking out of a very red part of skin under the button. And I really don't want to pull too hard unless it's attached to something! The reddened skin isn't oozing, so I'm thinking it could be the granulation tissue, as he doesn't have a temp either..

Does anyone know how long stitches are meant to stay in?? The nurses told me they could be trimmed after a week and taken out up to six weeks after..?

I will try get into see our surgeon or gastro Dr next week.

Thanks again for your suggestions,
Kelly :)

[SPC]

The stitches probably won't do any harm, even if one is a bit in-grown and will eventually work it's way out. The skin round a new stoma will often be red, but you're looking for weeping, swelling, hot skin around the stoma and a generally unwell child as signs of infection. It sounds like you're not getting a heap of support considering you're managing TPN at home and have a new stoma. The specialist stoma care nurse at the kid's hospital should be on call and available. If you ring the hospital switchboard and ask them to bleep her, she should have email and you should be able to send her a picture.

[kiwibird27]

Hopefully u have a good CNS up there.. people seem to have some issues in QLD getting good support???

[c38]

Don't put a dressing around it. It actually absorbs the moiture and holds it on the skin creating a moist environment for infection to take hold in. You are best to leave it exposed to the air, just under a clean singlet or top. If it's crusty or ousing a little then you need to clean it frequently with clean water or saline and q-tips similar to how you looked after the cord stump. Some redness at the site is normal as is a little bit of ouzing at first, but it shouldnt be inflammed looking and the ouze shouldnt be green or offensive. If you think it's still infected then you need to contact either your support nurse at the hospital or have it looked at in ED as Miki's mum said you can't risk any bugs getting into the central line. Surely you have some Specialist nurse contacts they have given you...??? a tpn one if not a stoma nurse. They should be able to assess and get you the attention you need.

[talonmum]

Okay, I'm feeling a little better about it! There has hardly been any ooze from the site over the last few days and he hasn't been acting unwell. I've been cleaning it with saline and drying carefully afterwards..

I have emailed a couple of pictures to the stoma nurse, so I shall wait and see what she thinks..

The crazy thing is I have managed home TPN, stoma bags, ng tube feedings and all the rest of it for about 16 months. The doctors (gastro Dr or surgeon) have never given me an out of office number to contact them in an emergency (do they usually do that??), and even trying to get hold of them during business hours is impossible! I haven't been in contact with the CNC for months and months, but she'll certainly be getting a call from me tomorrow :)

Time to get that sorted and get a list of people/numbers to call in times like these!! Luckily, we haven't had many scares or rush trips to the ER. Talon hasn't ever had an infection either, touch wood, so I don't fancy getting his first as a result of the button... I'll be keeping my eye on it for any sign of infection!

Thanks again everyone...