ALS From Both Sides, ALS Patient Care
ALS From Both Sides
Care of an ALS Patient
By Diane Huberty, Retired RN, Certified Neuro Nurse
...and ALS Patient

Stoma Care

The skin opening for the feeding tube is called a stoma. The name has nothing to do with the word "stomach" in spite of the spelling. The word stoma refers to any tunnel through the skin and underlying tissue to a place inside the body. Stoma can refer to the opening of a tracheostomy, colostomy, urostomy, and others.

Stoma Cleaning

If you are told to clean around the tube with peroxide, stop using the peroxide after about a week. It is great for breaking down dried blood and gunk and foaming it away, which is why it is commonly used after any surgery. However, continued use also breaks down the "scaffolding" of blood clotting needed for wound healing. The constant disruption of the attempts to heal cause the body to try harder by producing even more healing tissue which is called granulation tissue. This becomes chronic around the feeding tube and repeated bouts of painful, burning, bleeding granulation tissue occur. So stop using the peroxide. It is not effective for preventing infection anyway. Washing once or twice daily with soap and water will do just fine. There is no longer a need to make washing it a sterile procedure (sterile gloves, sterile water, and q-tips) by this time. Even so, care needs to be taken: Use a different washcloth than the one used for the rest of your bath. A thin, cheap or worn out washcloth gets under the bumper much better than a plush expensive one. Antibiotic soap is not necessary (and environmentally bad as it ends up in our water supply). The amount of antibiotic and the time it is on the skin is ineffective anyway. The soap itself has just as much antibacterial action. A split gauze 4x4 or 2x2 under the flange plate will catch any drainage and keep the plastic from irritating the skin. At first Bacitracin ointment should be applied with a q-tip, but can be skipped after a few weeks.

Stoma Problems

Feeding tube stomas (openings) never heal completely so you do need to watch for signs of infection. Infection doesn't usually stay just red for long. It gets increasingly sore, pus begins to drain around the tube or the skin deteriorates to a raw oozing sore. Often there is a bad odor or a fever which may be low. In case of infection a prescription ointment, not a simple over the counter like Bacitracin will be needed.

You can easily tell the difference between infection and granulation tissue. Infection will cause the entire stoma to be red and sore. Granulation appears as raw, red bulges on the stoma itself that bleed easily. Granulation tissue will shrink to nothing in a day (possibly two) by applying a dab of non-prescription hydrocortisone cream. Don't use it daily, just when the stoma has granulation tissue. Doctors are fond of using silver nitrate sticks to burn the granulation away. Ouch. You can get these for home use. There may be some reason why doctors prefer silver nitrate—they can't all be sadists—but I have never heard the reason.

The occasional brownish drainage is pretty normal, as is some dried blood or even fresh blood. Worry only if it is saturating the gauze and won't stop.

Trying a number of things may be necessary for skin problems. You can speed up the process if the red area is big enough to try one thing on half and another on the other. If the redness is irritation from the gauze, Vaseline will help. If it is itchy too, try a cream made for athletes foot. Cortisone is great for granulation tissue but that is usually right on the stoma, not the skin. Cortisone is soothing for other causes even if not a cure. Mylanta or a paste made from crushed Rolaids and water will neutralize any leaking stomach acid. A diaper rash ointment is a good moisture barrier. And sometimes nothing but a bare belly exposed to the air works, especially with sunshine.

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