From the Guidelines
To manage jejunal tube site irritation and leakage, start by cleaning the site daily with mild soap and water, then rinse and pat dry thoroughly, and apply a protective barrier such as zinc oxide ointment, petroleum jelly, or a skin barrier film like Cavilon or DuoDERM around the stoma to protect the skin from digestive enzymes that can cause irritation, as recommended by the most recent guidelines 1.
Key Measures to Manage Irritation and Leakage
- Clean the site daily with mild soap and water, then rinse and pat dry thoroughly
- Apply a protective barrier such as zinc oxide ointment, petroleum jelly, or a skin barrier film like Cavilon or DuoDERM around the stoma
- Use absorbent dressings like hydrocolloid or foam dressings, changing them when soiled, to minimize skin breakdown due to leakage 1
- Secure the tube properly using appropriate fixation devices rather than tape, which can irritate skin
- Monitor for signs of infection such as increased redness, warmth, swelling, or purulent discharge; if these occur, contact your healthcare provider as topical or systemic antibiotics may be needed
Additional Considerations
- Ensure the tube is properly positioned and not being pulled, as tension can worsen leakage
- If the stoma has enlarged, a stoma adhesive powder or a tube stabilizing device might help create a better seal
- For severe irritation, your provider might recommend short-term use of a mild steroid cream like hydrocortisone 1%
- In refractory cases, removing the tube for 24-48 hours to allow for spontaneous closure of the tract or placing a new gastrostomy at a new location may be considered 1
Importance of Proper Management
Proper management of jejunal tube site irritation and leakage is crucial to prevent serious complications, such as infection, skin breakdown, and tube loss, and to improve patient comfort and quality of life, as highlighted in recent guidelines 1.
From the Research
Management of Jejunal Tube Site Irritation and Leak
To manage jejunal tube site irritation and leak, several strategies can be employed:
- Stabilization of the tube to prevent movement and irritation of the surrounding skin 2
- Local treatment of the peritubular skin to protect it from caustic effluent and promote healing 2
- Monitoring for signs of infection, such as redness, swelling, and purulent discharge, and treating promptly if necessary 3, 4
- Regular assessment of the tube site for signs of leakage, such as effluent around the insertion site, and taking steps to prevent or manage leakage 3
Prevention of Jejunal Tube-Related Complications
Prevention of jejunal tube-related complications is crucial to minimize the risk of irritation, leak, and other adverse events:
- Proper placement and securing of the tube to prevent dislodgement or migration 3, 5
- Regular monitoring of the tube site for signs of complications, such as infection or leakage 3, 4
- Adequate nutrition and hydration to promote healing and prevent metabolic complications 5
- Patient education on proper tube care and management to prevent complications and promote optimal outcomes 3, 5
Common Complications of Jejunal Tubes
Common complications of jejunal tubes include:
- Tube dislodgement or migration 3, 5
- Infection, such as cutaneous or intraabdominal abscesses 3, 4
- Leakage or effluent around the insertion site 3
- Gastrointestinal complications, such as diarrhea, abdominal distension, or nausea and vomiting 5
- Metabolic complications, such as hyperglycemia, hypokalemia, or water and electrolyte imbalance 5