Peg Site unable to heal- what to do?!

[Lynx25, LPN]

I am hoping this is OK to post.

I am a LTC nurse caring for a patient with a perpetually leaking old PEG site. They have had the PEG removed and placed in a different area, and now, the old site refuses to close. It leaks to the point where you must use a towel when flushing his tube, as I am sure that 50% comes right back out of the old site.

The GI doctor is aware

The attending is aware

The ER was not amused when someone sent him out on a particuarly bad day. (The 'fountain' nearly hit the ceiling when they removed the dressing. Doc said to send them out)

Does anyone have any suggestions?

I have tried pressure dressings as was recommended by the GI- does nothing but hold soggy, stomach content laden gauze against healthy skin.

We tried some silver dressings when it got infected- which cleared up the infection, but did not help the leakage.

The doctors here for the most part are not involved in dressings, we generally come up with our own tx and run it by the physicians whenever they come in. I am at a loss- I do not know what to try. The only thing I found through Google was http://journals.lww.com/smajournalonline/Fulltext/2009/06000/Treatment_of_Persistently_Leaking_Post_PEG_Tube.10.aspx

[NicuGal, MSN, RN]

We had a kiddo like that once...they had to take him back to OR and close the insertion site so it would heal...they had to debride a lot of old tissue out of there

[Lynx25, LPN]

We had a kiddo like that once...they had to take him back to OR and close the insertion site so it would heal...they had to debride a lot of old tissue out of there

I'm starting to think this is the only option, but no one is going for it D:

Thanks for the reply!

[VivaLasViejas, ASN, RN]

See if you can obtain orders for a consult with a Wound, Ostomy, and Continence Nurse (WOCN). They are specially trained and certified RNs who deal exclusively with these issues and are the go-to people on wounds, even for physicians who will usually just tell us to "do whatever the WOCN says". :)

[Lynx25, LPN]

See if you can obtain orders for a consult with a Wound, Ostomy, and Continence Nurse (WOCN). They are specially trained and certified RNs who deal exclusively with these issues and are the go-to people on wounds, even for physicians who will usually just tell us to "do whatever the WOCN says". :)

I will attempt to get him a trip to the wound clinic and hope that one of them has some spectacular idea. We do not have a certified nurse at this facility.

I volunteered to go get trained for wounds, even just at the LPN level, and they said it was cost-prohibitive. When the administration recieved 4 tickets for a wound care conference, at a value of ~$150 each, they took the administrator, (no clinical license, 0 wound care responsibility) the DON (does 0% wound care tx) and ADON (again 0% wound care tx) and some supervisor, who afterwards told me she thought wounds were 'icky'.

The nurses that do treatment were invited to go- if we paid. x.x

[amoLucia]

What's the family's perspective on this??? Can they push for a more aggressive approach form the doctors?

[Lynx25, LPN]

What's the family's perspective on this??? Can they push for a more aggressive approach form the doctors?

They are very sweet, very passive people. The patient has been with us for quite a while.

[wooh, BSN, RN]

I remember a patient that had a lot of holes. A ridiculous number of holes. One was an old g-tube site that leaked. We ended up putting an ostomy bag over it to collect the leakage. But if you're have geysers, probably more important than the leaking by itself is how much of his nutrition is actually staying in?

[amoLucia]

I remember a patient that had a lot of holes. A ridiculous number of holes. One was an old g-tube site that leaked. We ended up putting an ostomy bag over it to collect the leakage. But if you're have geysers, probably more important than the leaking by itself is how much of his nutrition is actually staying in?

good point - I wonder what the albumin/prealbumin are? Has the dietician been involved? Any other poor nutrition problems like wt loss, wounds, etc?

[morte, LPN, LVN]

It will not heal, it needs to be surgically repaired. And, the nutrition loss is potentially serious. If they won't repair, can you get an order to reinsert and clamp, to maintain patency of GI tract?

[Tzs1981rn]

If you can't get an order to reinsert and clamp, it might be worthwhile to try a urostomy bag if the drainage is thin enough. If it is a copious amount, you can connect the urostomy bag to a foley drainge bag. At least that way the patient's skin would not be exposed to the harsh fluids that are draining. Also a good way to provide concrete numbers regarding drainage rather than just telling the md it is draining a lot.

[Lynx25, LPN]

You guys are great- I will bring up all of your suggestions in the AM meeting- I appreciate everyone's input