Management of Gastrostomy Tube Overflow
Immediate Assessment and Initial Management
When a G-tube is overflowing with gastric contents, first verify proper tension between the internal and external bolsters, check balloon volume (if present), and protect the surrounding skin with zinc oxide-based barrier products while addressing the underlying cause. 1
First Steps: Identify the Cause
- Check tube positioning and tension immediately - excessive tension or side torsion of the tube can cause ulceration and enlargement of the tract, leading to leakage around the tube 1
- Verify balloon integrity and volume - if a balloon retaining device is present, check that the volume corresponds with manufacturer's recommendations (should be checked weekly) 1
- Ensure correct tube length - particularly for button gastrostomy devices, confirm the correct balloon size and tube length are being used 1
- Assess for tube patency - overflow may indicate the tube itself is clogged, causing feeds to back up and leak around the site rather than through the tube 1
Skin Protection (Priority Action)
- Apply zinc oxide-based barrier cream, paste, or film immediately to minimize skin breakdown from gastric acid exposure 1
- Use foam dressings rather than gauze - foam lifts drainage away from the skin, whereas gauze contributes to skin maceration 1
- Avoid occlusive dressings as they lead to peristomal skin maceration and breakdown 1
Address Underlying Causes
Gastric Factors
- Start proton pump inhibitors to decrease leakage by minimizing gastric acid secretion 1
- Consider prokinetic agents if gastroparesis is contributing to increased gastric residuals and overflow 1
- Perform gastric decompression if overflow is severe - in rare cases, enteral nutrition should be delayed or stopped temporarily 1
Mechanical Issues
- Correct side torsion by stabilizing the tube using a clamping device or switching to a low-profile device 1
- Adjust external bolster tension - immediately after placement, the external fixation plate should have very low traction without tension; excessive pressure between bolsters increases leakage risk 1
- Do NOT replace with a larger-diameter tube - this is ineffective and results in an enlarged stoma tract with more leakage 1
Treat Complications Contributing to Overflow
Manage excessive granulation tissue if present, as this is a common cause of leakage 1:
- Clean the affected skin at least once daily with antimicrobial cleanser 1
- Apply topical antimicrobial agent under the fixation device 1
- Consider silver nitrate cauterization directly onto overgranulation tissue 1
- Alternative: topical corticosteroid cream for 7-10 days with foam dressing for compression 1
Treat peristomal infection if signs are present - local fungal infections can be treated with topical antifungal agents 1
Refractory Cases
- Consider temporary tube removal - in refractory cases, remove the tube for 24-48 hours to permit slight spontaneous closure of the tract, then replace with a tube that fits more closely 1
- Place new gastrostomy at different location if all above measures fail 1
Common Pitfalls to Avoid
- Never use hydrogen peroxide after the first week - it irritates skin and contributes to stomal leaks 1
- Avoid checking gastric residuals through the feeding tube - this increases tube occlusion risk 10-fold and can contribute to overflow problems 1
- Don't ignore patient factors - diabetes (hyperglycemia), immunosuppression, and malnutrition hinder wound healing and increase leakage risk 1
- Address increased abdominal pressure - constipation and gastroparesis are modifiable risk factors for peristomal leakage 1