G tube leaking. explosive leaking

  1. 0
    Just wondering if anyone knows....
    I had a patient who has esophageal cancer. She can swallow fine for now, but they are expecting that at one point she will no longer be able to swallow. So to prepare for this, they placed a G-tube for tube feeds when that time comes. Well, she presented into the ER, apparently she had pulled it out, but Im not sure. They placed a Foley in there to keep the opening open until they then later replaced it with a 24 french G-tube. Well, she has been leaking around the g-tube site for DAYS. Leaking so badly, her entire abdomen and left breast is excoriated....SEVERELY burnt by the stomach acid. They had us packing around the gtube sight with vaseline gauze (I dont understand how that was supposed to help, it only made it worse). They wouldnt do anything to fix it. This lady was miserable. EVERYTHING she ate/drank flowed out around the g-tube site instantly, just like you were pouring it directly onto her. It was horrible, she was in severe pain. Finally today I called the doc and told him that he has to come and do something. I had to advocate for her. They did come and take it out. I placed a urostomy bag to catch all the drainage until it closes so the surrounding skin could heal. But what causes g-tube sites to leak like that. In her case I can possibly understand, but I see it so much. What can be done, as far as nursing care, to prevent this from happening? I felt so badly for her, but I feel badly for all the patients who experience this. I tried drain sponges, Sofsorb, ABD pads, 4x4's, etc, to keep her skin dry.
  2. Get the Hottest Nursing Topics Straight to Your Inbox!

  3. 5 Comments so far...

  4. 0
    Well, if she pulled the original out, the incision site might be too big or uneven. A large tube or bigger balloon didn't help either, huh?

    Still, that's terrible. She can still swallow ok, why did they put it in so early? What if she changed her mind about it as her cancer progressed? Or did they figure it was better to do it now rather than make incisions when she's immunocompromised by chemo?
  5. 5
    thank you for being a patient advocate!!!!

    gastric acid reflx burns and damages the skin, sometimes permanently.
    remember what heartburn feels like...this is 10 times worse!

    immediately:
    flush skin with cool water to remove acid. i've painted skin with antacid to neutralize it...works to cool skin. all caped tubes should be flushed with 50-100cc h2o daily to dilute acid formation around tubes.

    those with severe burn should be treated with thin layer of silvadene cream with 4x4's over top absorb liquids. when tube leaks hourly, time to remove if not eating and use ostomy appliance to contain drainage.

    several recomendations here---re new skin, can only use if slight irriation to skin, not if persistant drainage.

    special child: tips - g-tube tips
  6. 0
    Quote from chenoaspirit
    Just wondering if anyone knows....
    I had a patient who has esophageal cancer. She can swallow fine for now, but they are expecting that at one point she will no longer be able to swallow. So to prepare for this, they placed a G-tube for tube feeds when that time comes. Well, she presented into the ER, apparently she had pulled it out, but Im not sure. They placed a Foley in there to keep the opening open until they then later replaced it with a 24 french G-tube. Well, she has been leaking around the g-tube site for DAYS. Leaking so badly, her entire abdomen and left breast is excoriated....SEVERELY burnt by the stomach acid. They had us packing around the gtube sight with vaseline gauze (I dont understand how that was supposed to help, it only made it worse). They wouldnt do anything to fix it. This lady was miserable. EVERYTHING she ate/drank flowed out around the g-tube site instantly, just like you were pouring it directly onto her. It was horrible, she was in severe pain. Finally today I called the doc and told him that he has to come and do something. I had to advocate for her. They did come and take it out. I placed a urostomy bag to catch all the drainage until it closes so the surrounding skin could heal. But what causes g-tube sites to leak like that. In her case I can possibly understand, but I see it so much. What can be done, as far as nursing care, to prevent this from happening? I felt so badly for her, but I feel badly for all the patients who experience this. I tried drain sponges, Sofsorb, ABD pads, 4x4's, etc, to keep her skin dry.
    We recently had a patient with advanced AIDS, esophagitis. His tube became infected and was leaking around it. The ostomy appliance previously mentioned prevented excoriation around the site. Unfortunately due to his condition he had a very bad outcome, but his skin wasn't compromised. How scary for your patient to think about when she needs nourishment later in her disease process that she can no longer depend on that tube.
  7. 0
    I took care of a patient once who'd had a g-tube placed many years ago, then docs decided she didn't need it anymore because she was no longer aspirating. Nothing had ever been done about her stoma, though, & just like with your patient, as soon as we fed her supper, it all flowed out of the stoma.

    Her skin was incredibly excoriated, too. Didn't reach the breast, though. I remember one of the treatments that was prescribed for her was rubbing Milk of Mag around the skin that surrounded the stoma. I suppose the logic behind that was that it cut down the acidity of the stomach contents that were constantly pouring out of her skin. I think I remember Desitin being prescribed, too. I think the MOM & Desitin made her feel a little better, but eventually, her primary CNA advocated enough for her & she ended up going into the hospital for a procedure to close up the stoma.

    I'm sorry to say she left our care shortly after the operation, so I'm not really sure how successful it was. I did sit with her at the hospital, though, after her procedure & she was just miserable. Could barely breath & they had to place an NG tube for awhile.
  8. 0
    Quote from chenoaspirit
    Just wondering if anyone knows....
    I had a patient who has esophageal cancer. She can swallow fine for now, but they are expecting that at one point she will no longer be able to swallow. So to prepare for this, they placed a G-tube for tube feeds when that time comes. Well, she presented into the ER, apparently she had pulled it out, but Im not sure. They placed a Foley in there to keep the opening open until they then later replaced it with a 24 french G-tube. Well, she has been leaking around the g-tube site for DAYS. Leaking so badly, her entire abdomen and left breast is excoriated....SEVERELY burnt by the stomach acid. They had us packing around the gtube sight with vaseline gauze (I dont understand how that was supposed to help, it only made it worse). They wouldnt do anything to fix it. This lady was miserable. EVERYTHING she ate/drank flowed out around the g-tube site instantly, just like you were pouring it directly onto her. It was horrible, she was in severe pain. Finally today I called the doc and told him that he has to come and do something. I had to advocate for her. They did come and take it out. I placed a urostomy bag to catch all the drainage until it closes so the surrounding skin could heal. But what causes g-tube sites to leak like that. In her case I can possibly understand, but I see it so much. What can be done, as far as nursing care, to prevent this from happening? I felt so badly for her, but I feel badly for all the patients who experience this. I tried drain sponges, Sofsorb, ABD pads, 4x4's, etc, to keep her skin dry.
    Good job! I would want you to be my nurse. Thanks for getting the care she needs.


Top