The Use of a Cyanoacrylate Skin Barrier in Managing and Preventing Skin Damage at G-tube Insertion Sites

Background and Clinical Problem: Gastrostomy tubes or feeding tubes that are placed through the abdominal cavity are often found to cause damage to the skin from friction and leaking discharge of gasric juice.  There is the need for a robust skin barrier that cannot be easily displaced, and does not need frequent reapplication.  In our institution, we have previously tried to prevent skin damage using solvent containing skin barriers, or skin barrier creams with unreliable results.  In addition, once damage has occurred, it is difficult to undo the damage while the tube is still in place. 

 Methods:  We selected five patients whose abdominal surface showed signs of surface (epidermal) skin damage, as assessed by erythema, tenderness, and exudation. The affected area was then managed by the application of the cyanoacrylate based skin prep.  The patient was assessed daily.  The cyanoacrylate skin prep was applied as needed. 

Results and Conclusion:  The applicator tip was ideally sized for the application on the abdominal surface of the patients.  The application was painless, and the bonding of the prep to the skin, leading to the formation of a light purple, flexible film occurred in 15-30 seconds.  It was found to be easier to apply if the affected area had been patted dry with gauze immediately prior to application.  The purple film stayed on for at least 3 days in all patients, and reapplication was performed on the 4^th day over any remnants of the film.  The polymer film sloughed off naturally, during the wiping of the surface for cleansing purposes following usual nursing procedure.  On each patient, we found that the prevention of damage by the barrier action of the cyanoacrylate film allowed the underlying skin to regain its health naturally.  We believe that a larger study on this patient population is warranted to confirm our results