Gastrostomy Challenges: Common Issues and Solutions

Q: Gastrostomy Challenges: Common Issues and Solutions

Replying to the physician： General Surgery Dr. Chen Rong-Hong. Hello Jelly, since the gastrostomy is part of the upper gastrointestinal tract, I will respond on behalf of Dr. Chang Shu-Hao. 1. First, after feeding, you should flush any residual milk into t

Gastrostomy complications

Dear Dr.
Chang,
I humbly seek your advice regarding some issues I've been experiencing since I had a gastrostomy tube placed two years ago due to my inability to swallow.
I have several questions:
1.
After each feeding, about 20 minutes later, milk flows back out of the tube.
What could be the reason for this? Should I use a clamp to prevent this? Where can I purchase one?
2.
Sometimes, when I strain during a bowel movement, milk leaks out from around the tube's skin.
3.
The skin around the stoma has been red, itchy, and painful for the past two years.
Is this normal?
4.
The wound occasionally has blood and discharge, along with pain.
Is this a sign that the wound has not healed, or could there be another reason?
5.
The stoma sometimes has blood and redness.
Is it safe to shower under these conditions?
6.
The balloon of the gastrostomy tube tends to rupture every few months, requiring me to frequently replace the tube.
Is there something in my abdomen that could be causing this, or are there precautions I should be taking that I might be overlooking?
7.
How should the tube be positioned to avoid causing damage to the stoma? Is it acceptable to secure it with the waistband of my pants, or should it hang freely?
8.
What general precautions should I take to avoid complications and maintain a normal lifestyle? Is this a common experience for others?
I sincerely appreciate your guidance in identifying the causes of these issues that have been troubling me.
Thank you very much for your assistance.

jelly, 60~69 year old female. Ask Date: 2022/06/28

Dr. Zhang Shuhao reply Surgery

Replying to the physician: General Surgery Dr.
Chen Rong-Hong.
Hello Jelly, since the gastrostomy is part of the upper gastrointestinal tract, I will respond on behalf of Dr.
Chang Shu-Hao.

1.
First, after feeding, you should flush any residual milk into the stomach with clear water.
You can observe for one hour after feeding; if you can avoid lying flat, it may help prevent milk reflux.
If reflux still occurs, you may consider using a catheter with a clamp, or inquire at a medical supply store about purchasing a clamp separately.

2-5.
It seems that the stoma site of your gastrostomy tube is larger, which makes it prone to leakage.
Please first check if the flange of the gastrostomy tube is snug against the skin.
If gently pulling the tube outward causes the flange to detach from the skin, it indicates that the flange is not fully seated.
Ideally, the skin around the stoma should be a normal color; redness is often caused by gastric acid leakage leading to skin irritation.
You need to clean the area and use a skin barrier film to help isolate the area from fluids, and change the gauze frequently to keep it dry.
It is advisable to have a physician examine it; if there is no infection but just inflammation, you can still shower, but be sure to change the gauze afterward.

6.
A normal gastrostomy tube can remain in place for six months, so frequent breakage is not typical.
First, confirm whether the tube is actually broken or if the balloon is leaking, causing it to slip out.
If it is indeed broken, consider switching brands or be cautious not to exceed the recommended water volume when inflating the balloon during tube changes.
If it is just a leaking balloon, reinsert it as needed.

7.
If your gastrostomy tube has a flange, it can be either secured or left unsecured, just avoid pulling on it.

8.
The skin around your stoma is inflamed and needs to be addressed to prevent worsening.

Reply Date: 2022/06/28

More Info

Gastrostomy, or the creation of an opening in the stomach for feeding purposes, can present a range of challenges for patients. Your concerns are valid, and addressing them is crucial for your overall health and comfort. Let's break down your questions and provide some insights based on medical knowledge.

1. Reflux of Feedings: The backflow of milk or feeding formula from the gastrostomy tube after feeding can be attributed to several factors. It may be due to overfilling the stomach, the type of formula used, or the positioning of your body during and after feeding. It is generally recommended to keep the head elevated for at least 30 minutes after feeding to minimize reflux. Using a clamp on the tube can help prevent backflow, but it should be done with caution to avoid pressure buildup in the stomach. You can find clamps at medical supply stores or pharmacies.

2. Leakage During Bowel Movements: If milk leaks from the stoma during bowel movements, it may indicate increased abdominal pressure. This can happen if you are straining too hard. It’s essential to maintain a gentle approach to bowel movements and consider dietary adjustments to prevent constipation, which can exacerbate straining.

3. Skin Irritation: Redness, itching, and pain around the stoma site can be common, especially if there is irritation from the tube or leakage of gastric contents. It is crucial to keep the area clean and dry. Using barrier creams or protective films can help reduce irritation. If the symptoms persist, consult your healthcare provider for a possible evaluation of the stoma care routine.

4. Wound Healing Issues: If the stoma site is still bleeding or has discharge after two years, it may indicate an infection or improper healing. It’s essential to have this evaluated by a healthcare professional. They may need to assess the stoma and surrounding tissue for any signs of infection or other complications.

5. Showering with a Stoma: It is generally safe to shower with a gastrostomy tube, but care should be taken to avoid soaking the stoma excessively. If there is bleeding or discharge, it may be advisable to cover the area with a waterproof dressing while showering.

6. Balloon Integrity: If the balloon of your gastrostomy tube is frequently breaking, it could be due to several factors, including the type of tube used, the pressure within the stomach, or even the materials in the tube reacting with stomach contents. It’s essential to discuss this with your healthcare provider, as they may recommend a different type of tube or additional protective measures.

7. Tube Placement: The gastrostomy tube should be positioned comfortably without excessive tension. It is generally advisable to let the tube hang naturally rather than using clips or tight clothing that could cause pressure on the stoma. Proper positioning can help prevent irritation and injury to the stoma.

8. General Care and Lifestyle Adjustments: To maintain a normal lifestyle with a gastrostomy, it’s essential to follow a few guidelines:
- Maintain a balanced diet that is easy to digest.

- Stay hydrated and monitor your bowel habits to prevent constipation.

- Regularly clean the stoma and surrounding skin to prevent infection.

- Keep regular follow-ups with your healthcare provider to monitor the stoma and overall health.

Many individuals with gastrostomy tubes experience similar challenges, and it’s important to remember that you are not alone. Open communication with your healthcare team is vital to address these issues effectively. They can provide tailored advice and interventions to improve your quality of life and manage any complications that arise.

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