Gastrostomy (G, GJ, J) Complications — Leaking — Clinical Pathway: Inpatient

G, GJ, J Tube Complications Clinical Pathway — Inpatient

Leaking

Enteral tubes may leak for a variety of reasons. The source should be addressed immediately as the drainage can cause skin irritation and/or may be a sign of a mechanical problem with tube or stoma (e.g., dilated stoma, granulation tissue disrupting fit). The type of content leaking out of the stoma may include:

  • Bile or gastric contents
  • Stool
  • Formula/feeds

The volume of leaking content and the degree to which it is being controlled is important. Bedside providers should be able to describe:

  1. The frequency of dressing changes
  2. Degree of dressing saturation
  3. Degree of skin irritation/compromise

Document the site with images in Epic Media tab. Several common sources of leaking are outlined below.

Potential Source Recommended Approach Comments
Tubes with balloons - low balloon volume
  1. Check the listed balloon volume in the LDA.
  2. Check the actual balloon volume.
  3. If needed, fill the balloon with water to the recommended volume located on the balloon port of the tube.
  • Exception: Do Not fill balloon of surgically placed low profile balloon jejunostomy tube to the volume printed on the balloon port. Fill volume for Surgically Placed Low Profile Balloon Jejunostomy Tube is noted in the LDA. If balloon is filled to the volume listed in LDA and tube continues to leak, call General Surgery.
Tube fit is too tight/too loose against skin
  1. Wiggle the tube to check the fit of the tube (tight vs. loose) against the skin to determine next steps
  2. Assess the tube securement and secure properly using a securement device and/or dressing

 
  • Notify the appropriate service to evaluate size/fit of tube for potential re-sizing for tubes that are too tight or too loose.
  • Tubes that are too loose can cause stoma dilation.
Increased abdominal pressure
  1. Determine the source of the increased pressure:
    • Positive pressure ventilation (non-invasive or invasive ventilation)
    • Volume of feeds being delivered
    • Constipation
    • Edema
    • Ascites/abdominal distension
  2. If actively being fed: discuss holding enteral feeds with team
  3. Consider: sites/default/files/pathways-includes/g-j-tube-complications-venting-feeding-tube.txt
  4. Clean the site and place a skin barrier
  5. Place a foam dressing around the stoma to collect the leakage, Job Aid: Mepilex Foam Dressing Products
  6. Notify the appropriate service.

 
  • Patients with G-J tubes who are transitioning from post-pyloric to gastric feeds: leaking feeds from the stoma may indicate that the gastric feeds and/or secretions are not being well absorbed.
  • If leaking is interfering with patient’s ability to be fed, consult GT nurse for evaluation & troubleshooting.
  • Do not allow foam dressing to make the tube fit too tight, which may displace the balloon into the tract or increase pressure and cause skin breakdown.

Following Bedside Treatments

If all of the steps above do not cease the leaking, notify the appropriate service.