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G, GJ, J Tube Complications Clinical Pathway – Inpatient – Leaking

G, GJ, J Tube Complications Clinical Pathway – Inpatient

Leaking

  • Enteral tubes may leak for a variety of reasons
  • Identify the content of leakage
    • Bile or gastric contents
    • Stool
    • Formula/feeds
  • Quantify volume of leakage
    • Frequency of dressing changes
    • Degree of dressing saturation
  • Degree of skin irritation

Goal: Determine the underlying cause of leaking and minimize skin damage.

Management of Leaking

Potential Source Recommended Approach Comments
Tubes with Balloons – Low Balloon Volume
  • Ensure appropriate balloon fill volume
  • Exception: Surgically placed low profile balloon jejunostomy tube should not be filled to volume on balloon port
Tube Fit is Too Tight/Too Loose
Against Skin
  1. Check the fit of the tube (tight vs. loose)
  2. Assess the tube securement and secure properly using a securement device and/or dressing
  • Tubes that are too tight can cause the balloon to enter the stomal tract and dilate it
  • Tubes that are too loose can cause stoma dilation
Increased Abdominal Pressure
  1. Determine the source of the increased pressure:
    • Positive pressure ventilation (non-invasive or invasive ventilation)
    • Volume of feeds being delivered
    • Constipation
    • Edema
    • Ascites/abdominal distension
  2. If actively being fed: discuss holding enteral feeds with team
  3. Consider Venting Feeding Tubes Using the Chimney/Syringe Technique or the Farrell Valve System Procedure
  4. Clean the site and place a skin barrier, place foam dressing and secure tube
 

Following Bedside Treatments

If the steps above do not improve the leaking after 5 days, notify the appropriate service.

 

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