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To Dress or Not to Dress: Securing Enteral Sites While Swimming
The ocean is my natural habitat. I am of Irish descent, and, like my forbearers who came here from an island nation, my life is circumscribed by the ocean. I live on Cape Cod, just five minutes from the ocean. Yet since 1999, I have not been able to go for an ocean swim because of the surgical placement of a J-Tube, in addition to a surgically placed G-Tube. You see, I have two tubes.
The protocol at the hospital where I am treated mandates the securing of all exit sites with a Tegaderm® while swimming. I have followed those instructions since 1999. I would go to the beach and watch others swim, complicated by a life of watching others eat. "Enough of the deprivation!” was my mantra. The concern of the physicians, especially early on during the AIDs epidemic, was that the exposed exit site would come in contact with water that had been contaminated. The Tegaderm would provide a shield over the site, protecting it from exposure to bacteria that might breach the site.
Taping up two sites
If you only have one tube, securing the site with Tegaderm might not be a problem. If it is, ask your physician/radiologist to help eliminate the bulk by replacing it with a smaller tube or surface level device (sometimes called a "button”) which can be covered for swimming. The proliferation of new tubes out there is amazing. Today, there are all kinds of options, but you have to ask and do the research.
However, two tubes make for a complicated the situation. It was impossible for me to secure two exit sites, side by side, covering more than half of my abdomen. There was too much area and too much bulk. Even a number of Tegaderms did not work. I tried every combination. How did I know the Tegaderms had been breached? When I removed them, the area underneath was wet. Wearing a wet dressing for hours under a Tegaderm was deemed more serious than not wearing a dressing at all. The water held close to the site, with the site warm because of summer heat, seemed a set up for bacteria to thrive. I made the decision not to swim any more.
Imagine my glee when years later I networked at a couple of Oley Annual Conventions to find "tubers” who had what I had, and swam without a Tegaderm. Imagine swimming bare bellied!!!!
It was time for me to uncover the why and the how. I went to work pumping the super stars of every ilk in this area, and in every discipline. Needless to say, I learned a tremendous amount of information. The purpose of this article is to share with you the information I found so you will be empowered to make an informed decision.
Let me start by stating the obvious; no two tube-patients are alike. You might be able to take all or part of my advice, depending on your diagnosis, the condition of your immune system, and the advice of your physicians. This is not a carte blanche situation.
The first blanket statement that I would make, that every expert would agree to, is that there is some risk in swimming without a Tegaderm. In their collective opinion, the risk is minimized under certain circumstances.
The second blanket statement I would make is that swimming without a dressing is not possible until the area around the exit site is what the docs call "mature.” Mature means well-healed and covered with scar tissue. This usually takes three to six months. So, swimming for a period of time after your surgery, is out of the question. Your physician should be able to tell you how much time needs to pass to achieve a mature site. Also, care needs to be taken to cover broken, bleeding exit sites.
Given a mature site, swimming without a dressing is the safest in salt water, or ocean water. Salt water, by its very nature, is a cleansing, self-healing saline bath. We all do a saline cleansing when changing dressings. The ocean is one, huge saline bathtub. The constant ebb and flow of the ocean helps eliminate contaminants. It is a self-cleansing environment: waves come in and go out in seconds. The chance of contracting bacterial infections in this environment is minuscule. (Before diving in, use your common sense; some beaches are obviously polluted and should be avoided.)
Swimming at a pool is the next safest. The chemicals put in the water to control bacteria levels make the water pretty safe. It is your job to ask for the bacteria count before swimming. As long as it is within the normal range, you can go for a dip without worrying about dressing the site.
The least safe environment is a lake or a pond because the water is potentially stagnant. On lakes and ponds you have a plethora of bird life: geese, swans, ducks. The fecal material from the birds, floating atop the water, makes swimming without a Tegaderm, a dangerous proposition. Use caution here.
The strongest argument for tube feeders in favor of swimming without the dressing, is the fact that the GI tract is not a sterile environment. Consider the amount of contamination we take into the GI tract when food is eaten. The body has its own way of dealing with GI contaminants. The acids in the GI tract will kill most anything that enters the tract, whether it enters by mouth or through the tube/site. (Note: This is in sharp contrast to TPN patients who need to keep their site sterile. Contact the Oley office toll-free at 800-776-OLEY for information about swimming with a vascular access device.)
Whether you swim with an enteral tube, and whether you do this with or without a dressing, is a personal decision that should be made in conjunction with your medical providers. The bliss I experienced in my first swim, after all those years of deprivation, defies vocabulary. Friends were on the beach to chronicle and celebrate the launching of the proud leviathan. I wish all of you the same blissful experience.
—Diane Owens, HEN Consumer
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