300 Section VII ■ Tube Replacement

Table 42.5 Interventions for Gastrostomy Tube Complications

Complication Interventions

Leaking at insertion site Ensure that tube is properly situated in stomach; pull back gently until resistance is met.

Stoma enlargement Check water volume if balloon-type catheter. Confirm that it is water not Saline or Air

Ensure that tube is firmly secured to prevent erosion of mucosal lining and skin.

Use proper feeding attachment.

Ensure that tube is properly flushed and cleaned.

Protect skin with skin barrier (e.g., Stomahesive wafer or powder [ConvaTec, Skillman, New Jersey], Cavilon No Sting

[3M, St. Paul, Minnesota]; or hydrocolloid dressing).

Use foam dressing (e.g., Hydrasorb [ConvaTec, Skillman, New Jersey], Allevyn [Smith and Nephew, London, UK; Memphis, TN],

Mepilex [Mölnlycke, Gothenburg, Sweden]) rather than gauze to “wick” moisture away from skin.

If not contraindicated, consider H2-blocker and prokinetic agent.

Placing larger-size tube may temporarily control leakage but will not amend problem and is contraindicated.

Place smaller tube and secure well to allow stoma to contract around the tube.

Dislodgement Do not reinsert if <2 wks postop. Contact surgeon immediately.

If >2 wks postop, replace as soon as possible (see Chapter 41).

Bilious residuals Assess for migration of tube (particularly if Foley is being used).

Bilious vomiting

Abdominal distention

Migration results from inadequate stabilization. Tube may migrate upward, causing vomiting and potential aspiration, or downward, causing gastric outlet obstruction. Migration into the small intestine can cause “dumping syndrome.” When using a

balloon catheter and migration is not recognized, inflation of the balloon can lead to esophageal, duodenal, or small bowel

perforation.

Pain Pull back, if migrated, and secure.

Vent tube.

Consult surgeon if problem does not resolve.

Granulation tissue Normal finding; caused by proliferation of granulation epithelial tissue in response to inflammation and irritation by foreign body.

Prevent by stabilizing the tube.

Treat by cauterizing with silver nitrate.

For large amount of granulation tissue, consider applying triamcinolone cream 0.5% 2–3 times daily until resolved.