G/GJ tubes: Managing a leaking stoma

It is normal for the stoma to produce small amounts of thin, yellow-green discharge that gets crusty and sticks to the tube. This is not considered stoma leakage.

You may occasionally see small amounts of stomach contents, water or formula leaking from the stoma. This is especially common after tube changes.

While small amounts of leakage are OK, too much leakage can cause skin irritation, skin breakdown and enlargement of the stoma.

Causes of leakage

Leakage can be caused by:

• too much movement of the tube
• granulation tissue
• a broken tube
• infection
• conditions that increase pressure in the stomach, such as GERD, constipation, gas, poor digestion and chronic coughing or vomiting

How to keep a healthy stoma

Healthy stoma

To keep your child’s stoma healthy, you should:

• Wash the stoma daily with soap and water.
• Allow the stoma to be open to the air. Do not put dressings on the stoma unless your health-care team advises you to do so.
• Keep the stoma dry. Do not apply ointments or creams unless your health-care team advises you to do so.
• Always secure the feeding tube well to avoid friction against the skin.
• Avoid too much movement of the tube in the tract.
• Address stoma leakage as soon as possible.
• Prevent infection.
• For a low profile tube :
• Make sure your child’s tube fits properly.
• Check the volume of the tube’s balloon weekly.
• If you think your child’s balloon-type G tube is too loose or too tight, contact your G tube team to re-measure the size of the tube.

For more information on treatment of stoma issues, please see the SickKids Enterostomy Tube Stoma Assessment Clinical Practice Guideline.

How to prevent leakage and protect the skin

Skin breakdown from leakage

Limit the tube’s movement

• If your child has a G tube that has a balloon on the end, make sure that the balloon is filled properly and that the tube does not move too much in and out of the stoma. If you are concerned about the fit of th e tube, reach out to your G tube specialist.
• If your child’s tube has an adjustable device that sits at the stoma (e.g., a crossbar/disk on a PEG tube), make sure it fits well at the stoma (not too loose or tight).

Protect the skin from the leaks

• If the liquid leaking from your child’s G or GJ tube makes the skin burn or feel itchy, protect the skin with a barrier.
• Creams that are zinc-based work best and are available at your local pharmacy. Apply the barrier cream around the stoma to protect the skin.
• Barrier sprays are also an option to keep the leakage off the skin.
• Use dressings that absorb moisture. If the stoma is leaking a lot, gauze may not absorb enough. Thick foam dressing or surgical pads absorb well. There are special dressings with an antimicrobial component to them that you can use, as well.
• When using a dressing, change the dressing when wet to avoid the leakage sitting on the skin for long periods of time.

Other tips

• Do not insert a larger tube. This will make the stoma bigger and cause more leakage
• Talk to your child’s health-care provider about their doses of reflux medications.
• Vent your child’s stomach, through the G tube, to release extra pressure caused from gas.

When to see a health-care provider

If your child’s leakage does not stop or gets worse, contact your child's health-care team or your G tube specialist. Speak to your child’s health-care team if your child experiences leaking and has one or more conditions that increase pressure in the stomach, such as GERD, constipation, gas, poor digestion and chronic coughing or vomiting.

At SickKids

If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.

G Tube Resource Nurse contact info:

Phone: 416-813-7177

Email: g.tubenurse@sickkids.ca

On weekends/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.