gastrostomy troubleshooting - cork university …hse south (cork & kerry) page 9 of 12 community...
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Gastrostomy Troubleshooting
Mary Walsh Ann Finlay
Gastrostomy/Stoma CNS
Temple Street Children’s University Hospital
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Gastrostomy
P Percutaneous E Endoscopic G Gastrostomy
Primary Button
Balloon-retained tubes Low-Profile Button Mic-Key/Mini ONE Non-low-profile balloon Surgical gastrostomy Gastro-Jejunal tubes: Mic-Key, AMT G-Jet Radiological-inserted tubes
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PEG in position
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Mic-Key/Mini ONE Button
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Mic-Key/Mini ONE Button balloon retained low-profile
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COMPLICATIONS
EARLY LEAKAGE
– Stop feed
– Flush tube
–Protect skin
–Refer back to surgeons
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Stoma troubles:
• Extremely common
• Stomas become colonised / local infection
• Overgranulation tissue common
• Cellulitis is uncommon
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CAUTIONS:
• Immune-supressed patients may not show usual signs and symptoms
• Research based on leg ulcers, adults etc.
• Little advice re: gastrostomy stomas
• Advice here based on clinical experience
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When to take a swab?
• Clinical signs of infection when antibiotics are prescribed
• Not healing with treatment
• Infection control screening
• Local policies
• IMMUNE-SUPPRESSED PATIENT
‘A positive wound result from a patient does not, by itself, signify infection’
Guidelines on Infection Prevention & Control 2012 Wound Care HSE South (Cork & Kerry) Page 9 of 12 Community & Disability Infection Control Services
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Schematic representation of polymicrobial biofilm formation. Notes: Phillips P, Sampson E, Yang Q,
Antonelli P, Progulske-Fox A, Schultz G. Bacterial biofilms in wounds. Wound Heal S Afr. 2008;1(2):10–12. 20
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‘Clinical judgment, a detailed patient history and a comprehensive assessment of the
wound are the pivotal tools to recognise infection in the wound. The routine taking of
wound swabs is not recommended’
National Wound Management Guidelines (2018) HSE
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Cellulitis:
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Cellulitis:
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Swabs for c/s? 2016: Pseudomonas, S,Aureus, Hae. Strep Group B
2015: Staphylococcus aureus
Coagulase Neg Staphylococcus
Diphtheroids
2014: Coagulase Neg Staphylococcus
Diphtheroids
Enterobacter cloacae
Commensals
Staphylococcus aureus
Coagulase Neg Staphylococcus
Candida albicans
Staphylococcus aureus
Coagulase Neg Staphylococcus
Streptococcus milleri
Staphylococcus aureus
Commensals
Sternptromonas
2013: Pseudomonas aeruginosa
Klebsiella oxytoca
Streptococcus Group A
Staphylococcus aureus
Dow G. Bacterial swabs and the chronic wound: When, How, and What do they mean? Ostomy Wound Management, (2003) Vol 49, No. 5
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Swabs?? • Oct 2018
• Nov 2018
• Dec 2018
• Jan 2019
• Feb 2019
• April 2019
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Crusting:
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Infected or not?
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Ooze, discharge, odour, granulation:
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OVERGRANULATION TISSUE:
• Common
• Pale to cherry red
• Ooze, Bleed
• Can occur after infection, trauma, with moisture?
• Stoma may be colonised/local infection
• Susceptible
• Healthy v. unhealthy?
• Not all need treatment
Spruce P, et al. Exit site wounds Made Easy. Wounds International 2012; 3(2): downloaded from: http://www.woundsinternational.com
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TREATMENT:
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TREATMENT:
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Preventing Problems:
• Washing and drying
• STOP TUBE FROM MOVING
• Let in air
• Anti-microbial dressings – on and off
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Leaking buttons:
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Leak causing excoriation:
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Leak causing excoriation:
• Check water balloon, check correct length
• Constipation? Coughing?
• Poor stomach emptying – dysmotility?
• Protect skin + Absorbent dressing
• Referral to CNS, Surgeon
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Candida?
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Candida?
• Swab?
• Anti-fungal topically
• Change tube more frequently
• May need oral anti-fungal Rx
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Thank You