Gastrostomy (G, GJ, J) Complications — Bedside Clinician (RN, MD, APP) Comprehensive Site Assessment — Clinical Pathway: Inpatient

G, GJ, J Tube Complications Clinical Pathway — Inpatient

Bedside Clinician (RN, MD, APP) Comprehensive Site Assessment

CORPAK: Percutaneous Gastrostomy TubePrior to performing any interventions or contacting the service that inserted the tube, bedside clinicians should:

  1. Determine the type of G/GJ/J tubes – See Job Aid: G Tubes, GJ Tubes, J Tubes. The type of tube will determine the potential interventions for various complications.
    • Low profile tubes: A skin level tube placed directly into the stomach
    • Standard/non-low profile tubes: The exterior portion of the tube extends about 6-8 inches from the body
  2. See Care of the Patient with a Gastrostomy, Gastro-jejunostomy, or Jejunostomy Tube
  3. Clean the stoma and site
  4. Assess the site to determine next steps for interventions (see procedure – Letter C)
  5. Document the site with images in Epic Media tab
  6. If the patient is accompanied by a caregiver, discuss the baseline status of stoma and peristomal skin to determine if the current assessment differs from the patient’s baseline status.

A healthy stoma and site that is within defined limits (WDL) includes:

  • Normal color
  • Skin warm and dry
  • Normal turgor
  • No rash or loss of skin integrity

Components of a comprehensive site assessment are outlined below. All information is relevant when notifying the appropriate service for guidance using the sample ISBARQ.

Bedside Clinician (RN, MD, APP) Comprehensive Site Assessment

Assessment Potential Findings Comments
Peristomal skin
(skin around stoma)
Tube securement
  • Tube securement device/technique
  • Presence and type of dressing
  
Drainage
  • Crust
  • Volume (small, moderate, large)
  • Color (white, yellow, clear)
  • Content (purulent, bloody)
  • Drainage originates from a wound in/around the stoma.
  • Scant-to-moderate yellow-brown mucous drainage without signs of infection is normal. Cultures are not routinely indicated. This may dry to a yellow-brown crust.
  • Purulent or bloody drainage may be a sign of infection. Assess for warmth, spreading erythema, induration, tenderness, pain with manipulation of the tube, foul odor, and/or fever.
Leaking
  • Crust
  • Volume (small, moderate, large)
  • Color (white, yellow, clear)
  • Content (formula, gastric content, bile)
  • Leaking content may be due to a variety of factors and may originate from the stoma tract and/or valve of the tube.
Tube fit
  • Tubes that are too tight or too loose may be contributing to the complication.
Active Interventions or Remedies
  • Creams, ointments, home remedies
  • Duration of treatment
  • Degree of improvement seen with treatments (better, worse, same)
  
Current Feeding Status
  • Transitioning to feeding the stomach (G-tube or oral) from post-pyloric feeds (J-tube or ND/NJ)
  • Enteral feedings: rate, frequency, bolus vs. continuous, tolerance of feedings
  • Venting tube and/or Salem sump in place: rate, frequency, manner (Farrell bag vs. Chimney set up)
  • If the patient is NPO but receiving enteral feeds and drainage and/or leakage is seen, this may be due to a mechanical issue such as feeds that are backing up from a lower-GI obstruction.
Common conditions that may affect motility
  • Positive pressure ventilation
  • Abdominal distention
  • Ascites
  • Constipation/stool pattern
  • History of fundoplication (Nissen)
  • Dysmotility
  • This list is not inclusive.
  • Anatomical sources affecting motility:
    • Fundoplication alters the size/volume of the stomach to minimize gastric reflux. This may impact the volume of feeds the patient can tolerate and/or the ability to release gas without an external venting device.
    • Patients with dysmotility and/or delayed gastric emptying may experience leaking.