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Gastrostomy (G, GJ, J) Complications — Enlarged stoma/keyhole — Clinical Pathway: Inpatient

G, GJ, J Tube Complications Clinical Pathway — Inpatient

Enlarged stoma/keyhole

Tensed securement example
Tensed Securement

Appropriate securement, no tension
Appropriate Securement
(no tension)

An enlarged stoma that 'keyholes' occurs when the tube pulls or tugs along the stoma, slowly widening the stoma over time. This is the result of pull on the stoma from tension on the tube from:

  • Extension sets
  • Tubes taped repeatedly in the same position
  • Improper grip lock application
  • Tensed securement

The goal is to relieve the tension to begin to heal the stoma and prevent further enlargement.

Potential Source Recommended Approach Comments
Tension on the tube
  1. Identify area of the stoma with the most tension
  2. So the tube does not pull:
    • Remove extension set when feeding is not in process
    • Position the patient to relieve tension
    • Secure the tube away from environmental hazards (i.e. bedrails, IV pole, wheelchair & stroller wheels, etc.) using a securement device/dressing that is appropriate for tube.
  3. Document the site with images in Epic Media tab.
  4. Notify the appropriate service.
  5.  

Moderate Enlargement

Moderate enlargement example 1

Severe Enlargement

Severe enlargement example 1Severe enlargement example 2Severe enlargement example 3

 

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