Tube issues

Blocked tube

Causes:

• Poorly crushed medications
• Not flushing gastrostomy tube when feeds are completed
• Feed too thick or containing lumps of powder  
• Vitamised food being put down tube
• Leaving formula in the tube to curdle

To unblock the gastrostomy tube, flush it with 10 - 20 mL of a carbonated drink such as mineral water or diet cola.  Sometimes the blockage can be aspirated out using a syringe.

Peri-stomal issues

Leakage around the tube

Related to the relative sizes of the tube and stomal tract.  If the tube is too small for the opening, it may need replacement with a larger tube.

Other possible causes include:

1. Deflated or ruptured balloon.
   This can be checked by attempting to drain the balloon.  If there is no fluid the balloon may be deflated or have burst. Injecting water into the balloon and then checking if the volume is the same when draining will indicate if there has been a rupture. If the balloon has burst the tube will need replacing. The only sure way to tell is to remove the tube.
2. Tube deterioration or damage
   Tube may need replacement.
3. Tube Migration
   The tube may have migrated down the stomach and the balloon is not flush with the gastric mucosa. Putting gentle traction on the tube and then adjusting the retention disc to fit snugly against the abdominal wall may help.

Skin excoriation

Gastric secretions leaking around the gastrostomy can result in skin excoriation. There are two methods of minimising irritation to the skin:

1. Use of a barrier ointment (better than cream)
   • Recommended products include Calmoseptine™ ointment, Ilex™ barrier ointment, or a zinc ointment.
   • If the site is affected by thrush, do NOT use a zinc based product as this may worsen the infection.  Suitable alternatives include Orabase™ or Coloplast™ paste.
2. Medications to halt gastric acid production.
   • Ranitidine and/or Omeprazole.
   • These should only be prescribed by the treating unit.

Red, irritated, swollen, oozing skin surrounding a gastrostomy can be treated with:

• A foam dressing, gauze or Sofwick to absorb excess ooze
• Topical Magnesium + aluminium hydroxide preparations (eg Mylanta)
• Hydrocolloid powder to aid in stopping bleeding and absorb excess moisture
• A thin hydrocolloid dressing (eg Duoderm wafer) to protect and aid in healing of excoriated skin

Granulation tissue

Granulation tissue usually occurs about 6 weeks post surgery.  It may be caused by the tube moving too freely.  If this is the case an anchor device eg FlexiTrak can be useful. 

Options to treat granulation tissue:

• A foam dressing to apply pressure to reduce granulation.
• Silver nitrate application daily (to granulation tissue only)
• Application of a steroid cream

Infections

Candida; under the skin flange, use topical antifungal preparations eg clotrimazole or nystatin.

Cellulitis (see photo); is normally due to staphylococcal infection (but can involve enteric flora) and appropriate antibiotics should be given eg oral or intravenous flucloxacillin.  If the site is very swollen, the tube may have to be removed to relieve pain.  If there is discharge from the site, a skin/wound swab should be sent for microscopy and culture prior to commencing treatment.