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.

If your child has a cold or another infection, their stoma may look redder or may leak more than usual. This should get better once your child is feeling better.

While small amounts of leakage are okay, 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
• Hypergranulation tissue
• A cracked tube (you will see formula leaking from the stoma)
• Infection
• Conditions that increase pressure in the stomach, such as GERD, constipation, gas, poor digestion, and chronic coughing or vomiting

How to prevent leakage and protect the skin

Skin breakdown from leakage

Limit the tube’s movements:

• 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 your child’s tube has an adjustable device at the stoma, make sure it is fitting 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 cream. 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.
• Use dressings that absorb moisture. Do not use gauze. There are special dressings with an antimicrobial component to them that you can use, as well.

Other tips

• Do not insert a larger tube. This will make the stoma bigger and cause more leakage
• Talk to your child’s doctor about their doses of reflux medications.
• Vent your child’s G tube.

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.
• Secure the tube well.
• Avoid too much movement of the tube in the tract.
• Address stoma leakage as soon as possible.
• For a low profile tube.
• Make sure your child’s tube is a proper fit.
  
• Check the volume of the tube’s balloon weekly.

When to see a doctor

If your child’s leakage does not stop or gets worse, contact your child's health-care team or the G tube team. If the leakage becomes severe, contact the G tube team.

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.