Gastrostomy Troubleshooting

Mary Walsh Ann Finlay

Gastrostomy/Stoma CNS

Temple Street Children’s University Hospital

Gastrostomy

P Percutaneous E Endoscopic G Gastrostomy

Primary Button

Balloon-retained tubes Low-Profile Button Mic-Key/Mini ONE Non-low-profile balloon Surgical gastrostomy Gastro-Jejunal tubes: Mic-Key, AMT G-Jet Radiological-inserted tubes

PEG in position

Mic-Key/Mini ONE Button

Mic-Key/Mini ONE Button balloon retained low-profile

COMPLICATIONS

EARLY LEAKAGE

– Stop feed

– Flush tube

–Protect skin

–Refer back to surgeons

Stoma troubles:

• Extremely common

• Stomas become colonised / local infection

• Overgranulation tissue common

• Cellulitis is uncommon

CAUTIONS:

• Immune-supressed patients may not show usual signs and symptoms

• Research based on leg ulcers, adults etc.

• Little advice re: gastrostomy stomas

• Advice here based on clinical experience

When to take a swab?

• Clinical signs of infection when antibiotics are prescribed

• Not healing with treatment

• Infection control screening

• Local policies

• IMMUNE-SUPPRESSED PATIENT

‘A positive wound result from a patient does not, by itself, signify infection’

Guidelines on Infection Prevention & Control 2012 Wound Care HSE South (Cork & Kerry) Page 9 of 12 Community & Disability Infection Control Services

Schematic representation of polymicrobial biofilm formation. Notes: Phillips P, Sampson E, Yang Q,

Antonelli P, Progulske-Fox A, Schultz G. Bacterial biofilms in wounds. Wound Heal S Afr. 2008;1(2):10–12. 20

‘Clinical judgment, a detailed patient history and a comprehensive assessment of the

wound are the pivotal tools to recognise infection in the wound. The routine taking of

wound swabs is not recommended’

National Wound Management Guidelines (2018) HSE

Cellulitis:

Cellulitis:

Swabs for c/s? 2016: Pseudomonas, S,Aureus, Hae. Strep Group B

2015: Staphylococcus aureus

Coagulase Neg Staphylococcus

Diphtheroids

2014: Coagulase Neg Staphylococcus

Diphtheroids

Enterobacter cloacae

Commensals

Staphylococcus aureus

Coagulase Neg Staphylococcus

Candida albicans

Staphylococcus aureus

Coagulase Neg Staphylococcus

Streptococcus milleri

Staphylococcus aureus

Commensals

Sternptromonas

2013: Pseudomonas aeruginosa

Klebsiella oxytoca

Streptococcus Group A

Staphylococcus aureus

Dow G. Bacterial swabs and the chronic wound: When, How, and What do they mean? Ostomy Wound Management, (2003) Vol 49, No. 5

Swabs?? • Oct 2018

• Nov 2018

• Dec 2018

• Jan 2019

• Feb 2019

• April 2019

Crusting:

Infected or not?

Ooze, discharge, odour, granulation:

OVERGRANULATION TISSUE:

• Common

• Pale to cherry red

• Ooze, Bleed

• Can occur after infection, trauma, with moisture?

• Stoma may be colonised/local infection

• Susceptible

• Healthy v. unhealthy?

• Not all need treatment

Spruce P, et al. Exit site wounds Made Easy. Wounds International 2012; 3(2): downloaded from: http://www.woundsinternational.com

TREATMENT:

TREATMENT:

Preventing Problems:

• Washing and drying

• STOP TUBE FROM MOVING

• Let in air

• Anti-microbial dressings – on and off

Leaking buttons:

Leak causing excoriation:

Leak causing excoriation:

• Check water balloon, check correct length

• Constipation? Coughing?

• Poor stomach emptying – dysmotility?

• Protect skin + Absorbent dressing

• Referral to CNS, Surgeon

Candida?

Candida?

• Swab?

• Anti-fungal topically

• Change tube more frequently

• May need oral anti-fungal Rx

Thank You