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

G, GJ, J Tube Complications Clinical Pathway – Inpatient

Prolapse

  • Prolapse is when gastric mucosa protrudes through the stoma and is visible on the abdomen.
  • This generally is the result of some form of pressure on the stoma, such as:
    • Increased Intra-Abdominal Pressure
      • e.g., positive pressure ventilation, ascites, obstruction
    • External Pressure on Stoma

Prolapse can be a benign condition causing no discomfort or pain.

Goals of Treatment

  1. Protect the prolapsed tissue from trauma
  2. Protect peristomal skin from irritant dermatitis
  3. Stabilize the tube to prevent further trauma

Stoma prolapse will not resolve without resolution of the underlying cause or surgical revision.

Mild Prolapse Severe Prolapse
Mild prolapse example 1 Severe prolapse example 1 Severe prolapse example 2 Severe prolapse example 3

Management of Prolapse

Recommended Approach Comments
  1. Clean the site, apply a skin barrier, place dry dressing and secure tube
  2. Address potential source if possible
  3. Notify the hospital provider to assess the prolapse
  • New prolapse
    • Consult General Surgery for evaluation
  • Chronic prolapse
    • Maintain steps 1 and 2 above
    • If new concerns arise, escalate to hospital provider
  • Bedside clinicians should not attempt to reduce a prolapsed stoma
  • Bedside RN or hospital provider should not upsize or downsize the tube or replace the tube
  • Silver nitrate is contraindicated in prolapse