G, GJ, J Tube Complications Clinical Pathway – Inpatient – Enlarged Stoma/Keyhole

G, GJ, J Tube Complications Clinical Pathway – Inpatient

Enlarged Stoma/Keyhole

An enlarged stoma that 'keyholes' occurs when the tube pulls or tugs along the stoma, slowly widening the stoma over time. This is the result of pull on the stoma from tension on the tube from:

  • Extension sets
  • Tubes taped repeatedly in the same position
  • Improper grip lock application
  • Tensed securement

Goal: Relieve the tension to begin to heal the stoma and prevent further enlargement.
Healing can take several weeks to months.

Moderate Enlargement Severe Enlargement
Moderate enlargement example 1 Severe enlargement example 1 Severe enlargement example 2 Severe enlargement example 3
Tensed Securement Appropriate Securement
(no tension)
Tensed securement example Appropriate securement, no tension

Management of Enlarged Stoma/Keyhole

Recommended Approach Comments
  1. Identify area of the stoma with the most tension
  2. Avoid tension on the tube by:
    • Removing extension set when feeding is not
      in process
    • Positioning the child to relieve tension
  3. Secure tube to minimize tension by using appropriate securement device/dressing
 Refer to appropriate section of pathway if additional complication has cooccurred with keyholing

Following Bedside Treatments

If the steps above do not improve the enlarged stoma/keyhole after 5 days, notify the appropriate service.