Cecostomy tube: Common problems

What is a cecostomy?

A cecostomy is an opening from the outside of the body on the abdomen to the cecum, the first part of the large intestine. A cecostomy tube (C-tube) is placed through the abdomen into the cecum to help your child empty their bowel and decrease the incidence of fecal incontinence (soiling). C-tubes are inserted using image guidance.

Learn about some common problems you may encounter while caring for your child and their cecostomy tube (C-tube) and how to deal with them.

Please see Cecostomy tube insertion using image guidance and Cecostomy tube: Changing your child's dressing for more information.

What to do if your child's C-tube moves

If the tube looks longer or shorter, it may have moved. This can happen because the C-tube comes in three sizes (small, medium, long), and often children are in between sizes. If the tube is sitting high off the skin, you can push it back in. If there is resistance when you try to push it back in, there may be a coil in the tract. This is not an emergency, but your child should be assessed in the interventional radiology department.

What to do if your child's C-tube falls out or gets pulled out

If your child's C-tube falls out, try to insert a Foley catheter to keep the hole to your child's intestine open until a new C-tube can be put in. The first six weeks after your child first gets their C-tube is the most important time for healing. If your child's C-tube falls out within two weeks of when it was put in, you can try to insert a Foley catheter to stop the hole from closing. This is not an emergency, but the tube needs to be reinserted as soon as possible.

Putting the Foley catheter in when your child's C-tube comes out

In your supplies, you should have a soft tube called a Foley catheter. It will be one size smaller than your child's C-tube. Try to put the Foley catheter into the hole (opening) following the directions below. The sooner you try to put the Foley catheter into the hole, the easier it will be. The longer the tube is out, the smaller the hole will become. If you cannot put the Foley catheter in, call the interventional radiology department during working hours. Go to the Emergency Department on holidays, weekends or at night.

You will need:

• lubricating jelly
• 8 French Foley catheter
• tape
• catheter plug with a protector cap

1. Wash your hands and the skin around your child's cecostomy gently but thoroughly with soap and water.
2. Wet the tip of the catheter with a lubricating jelly such as K-Y Jelly or Muko. DO NOT use petroleum jelly (Vaseline).
3. Put the tip of the Foley catheter about 4 to 6 centimetres (2 or 3 inches) into the hole in your child's abdomen where the C-tube was. Measure the tube against your index finger.
4. Tape the Foley catheter to your child's stomach. Plug it or bend it so stool will not leak out.
5. You can use the Foley catheter to give your child their bowel clean-out.
6. Call the interventional radiology department on the next working day to make an appointment for a C-tube reinsertion. This is done as an outpatient. Your child will not need to stay overnight in the hospital.

When to seek medical help

Go to the Emergency Department if your child has any of the following problems after the Foley catheter is inserted:

• severe pain in the tummy
• sudden high fever
• diarrhea
• severe abdominal distention

What to do if your child's temporary C-tube gets blocked

To unblock your child's temporary C-tube, you will need:

• a 10 mL syringe
• warm water

1. Fill a 10 mL syringe with warm water.
2. Connect the syringe to the end of the C-tube.
3. Push and pull on the plunger of the syringe to move the liquid in and out of the C-tube. That will help clear out any fecal material that might be in the way. You may have to try this a few times before the C-tube is no longer blocked.
4. When the C-tube is no longer blocked, fill the syringe with 10 mL of water and push it into the tube.
5. Take the syringe off the cecostomy tube and close it up.

If you are not able to unblock the temporary C-tube, or your child's trapdoor is blocked, you will need to have the tube replaced in the interventional radiology department on the next working day. Call the IGT clinic nurse to arrange this.

The C-tube may cause skin problems

Red skin

Your child's skin may get sore and red because of:

• acidic juices from the intestine leaking out around the C-tube
• the C-tube moving around too much in its hole
• an incorrect tube size that may be causing pressure on the skin
• infection

Infection

Your child may have an infection if:

• the skin around the C-tube is redder than usual and redness is spreading
• there is a change in the colour and thickness of the liquid leaking around the C-tube
• there is swelling, or you feel warmth around your child's C- tube, or your child is in pain
• your child has a fever
• there is pus draining from the opening

If your child has any of these signs, call their health-care provider.

How can you protect your child's skin?

If there is liquid leaking out from around your child's C-tube that makes the skin burn and feel itchy, then protect the skin with a zinc-based barrier ointment. Zincofax and Ihle's Paste are barrier ointments that you can buy at your local pharmacy.

Granulation tissue

Extra tissue that grows around the C-tube is called granulation tissue. Granulation tissue is not harmful. It looks red, moist and may bleed easily when rubbed. The tissue may have yellow sticky drainage. Pressure and friction from the C-tube and moisture around the site may contribute to the growth of granulation tissue. Granulation tissue can be treated at home with saline soaks. Call your child’s primary health-care provider or referring service to request an appointment for treatment. Do not apply any creams directly to the hole.

How can you treat problems with your child's skin?

If your child has problems with their skin, you can use a warm saline soak to dry out and soothe the area around the C-tube. Soak the skin with saline solution three to four times a day when your child has a skin problem.

To make a saline soak:

1. Mix 2 teaspoons of table salt with 1 cup of warm water in a clean cup or bowl until the salt dissolves. 
   
2. Cut the shape of a “Y” into a piece of gauze. 
   
3. Soak the gauze in the salt water, then squeeze out some of the water so the gauze is not dripping wet. 
   
4. Place the wet gauze on the skin around the C-tube and leave it there until the gauze cools. This will take about 5 to 10 minutes. Do not let the gauze dry. If the gauze is too dry, it may pull at the skin and cause pain when being removed. 
   
5. Once the gauze is cool, remove it and leave the area open to the air to dry. You do not need to wash the salt off the skin afterward. Your child needs a saline soak three to four times a day when they have a problem with their skin. Reduce how often you give your child a saline soak as their skin heals.
   

If you have trouble taking the tape off your child's skin, put a wet face cloth over the tape for a few minutes before you take it off.

It is also very important to make sure that your child's skin is dried well around and under the C-tube after saline soaks and bathing.

Irrigation problems

Making saline solution for bowel irrigation

You can easily make saline to use for your child’s irrigation. To make saline you will need:

• one clean, air-tight glass bottle or jar with lid
  
• pot with lid
  
• water
  
• table salt (it is best to use non-iodized salt, which does not have iodine in it)
  
• baking soda (optional, but will make the solution less irritating)
  

Instructions

Option 1:

1. Put 1 cup (250 mL) of tap water into a pot and boil for 15 minutes with the lid on.
   
2. Remove from heat and cool until the water reaches room temperature.
   
3. Add ½ teaspoon of salt into the pot and stir to dissolve. Optional: Add a pinch of baking soda and stir to dissolve.
   
4. Carefully pour the salt-water solution from the pot into the jar or bottle and put the lid on.
   
5. Refrigerate solution and use within 24 hours. 
   

You can make larger volumes of this recipe to help save you time. Follow this recipe:

1. Put 4 cups (1 L) of tap water into a pot and boil for 15 minutes with the lid on.
   
2. Remove from heat and cool until the water reaches room temperature.
   
3. Add 2 teaspoons of salt and 1 teaspoon of baking soda into the pot and stir to dissolve.
   
4. Carefully pour the solution from the pot into the jar or bottle and put the lid on.
   
5. Refrigerate solution and use within 24 hours.

Option 2:

You can used distilled water purchased from most pharmacies and grocery stores to make sterile and longer-lasting saline without boiling water. This is an easy and less time-consuming process.

1. Mix 8 teaspoons of salt into 4 L of distilled water.
2. Refrigerate solution and use within one month.

How much saline and glycerin should I use for my child?

All children with C-tubes should cleanse their bowel with a saline solution either every day or every other day. Each child is different and will need different amounts of fluids for irrigation. For children that have hard stools, glycerin can be added to the saline solution. Talk to your child’s health-care provider if you think your child needs this. The amount of saline and glycerin that your child will need depends on two things: how constipated they are and their weight. If you do not know how much saline or glycerin to use, please call the clinic during working hours and ask to speak to a nurse.

• The recommended amount of saline for a child is: 10–20 mL/kg per flush.
• The recommended amount of glycerin for a child is: 0.5–1.0 mL/kg/dose (max dose 60 mL/day).

It is important to remember that as your child grows and gains weight, they will need more saline and glycerin to cleanse their bowel.

What to do if nothing comes out in the toilet after you flush the bowel

Often, irrigating the bowel can take a long time. For most children, it takes 45 to 60 minutes to flush out their bowels.

If you irrigate your child’s bowel and nothing comes out after an extended period, your child may have a blockage in their bowel. There are several things you can try to unblock your child's bowel.

• Massage your child’s abdomen clockwise to help the fluid move through.
• Have your child move around to help encourage the fluid to pass.

If your child is having a lot of cramping or discomfort and is having difficultly passing fluid, they should be seen by their health-care provider or go to the nearest Emergency Department. Your child may need a physical assessment and possibly an abdominal X-ray to see if they have a blockage of stool.

What do I do if my child is having accidents in between flushes?

Accidents can be caused by several things. Your child might:

• be constipated
• need a change to their diet and fluid intake
• have an infection
• need a change to their irrigation regime
• need a stool softener or bulking agent

If your child is having accidents in between flushes, call their health-care provider, the service who referred you or a clinic nurse during working hours to help sort out the cause of accidents. Your child may need to have some tests done if changes to their diet, regime and bulking agents do not help solve the problem.

At SickKids

If you have any questions or concerns about your child after they are discharged home, please call the Image Guided Therapy (IGT) clinic at (416) 813-7654 ext. 201804. Speak to the IGT clinic nurse during working hours or leave a non-urgent message.

If you have concerns and it is after working hours, see your child’s primary health-care provider or go to the nearest Emergency Department.