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Peri-stomal issues

Related to the relative sizes of the tube and stomal tract.  If the tube is too small for the opening, it may need replacement with a larger tube.

Other possible causes include:

  1. Deflated or ruptured balloon.
    This can be checked by attempting to drain the balloon.  If there is no fluid the balloon may be deflated or have burst. Injecting water into the balloon and then checking if the volume is the same when draining will indicate if there has been a rupture. If the balloon has burst the tube will need replacing. The only sure way to tell is to remove the tube.
  2. Tube deterioration or damage
    Tube may need replacement.
  3. Tube Migration
    The tube may have migrated down the stomach and the balloon is not flush with the gastric mucosa. Putting gentle traction on the tube and then adjusting the retention disc to fit snugly against the abdominal wall may help. 

Gastric secretions leaking around the gastrostomy can result in skin excoriation. There are two methods of minimising irritation to the skin:

  1. Use of a barrier ointment (better than cream)
    • Recommended products include Calmoseptine™ ointment, Ilex™ barrier ointment, or a zinc ointment.
    • If the site is affected by thrush, do NOT use a zinc based product as this may worsen the infection.  Suitable alternatives include Orabase™ or Coloplast™ paste.
  2. Medications to halt gastric acid production.
    • Ranitidine and/or Omeprazole.
    • These should only be prescribed by the treating unit.

Red, irritated, swollen, oozing skin surrounding a gastrostomy can be treated with:

  • A foam dressing, gauze or Sofwick to absorb excess ooze
  • Topical Magnesium + aluminium hydroxide preparations (eg Mylanta)
  • Hydrocolloid powder to aid in stopping bleeding and absorb excess moisture
  • A thin hydrocolloid dressing (eg Duoderm wafer) to protect and aid in healing of excoriated skin

Granulation tissue usually occurs about 6 weeks post surgery.  It may be caused by the tube moving too freely.  If this is the case an anchor device eg FlexiTrak can be useful. 

Options to treat granulation tissue:

  • A foam dressing to apply pressure to reduce granulation.
  • Silver nitrate application daily (to granulation tissue only)
  • Application of a steroid cream

Candida; under the skin flange, use topical antifungal preparations eg clotrimazole or nystatin.

Cellulitis (see photo); is normally due to staphylococcal infection (but can involve enteric flora) and appropriate antibiotics should be given eg oral or intravenous flucloxacillin.  If the site is very swollen, the tube may have to be removed to relieve pain.  If there is discharge from the site, a skin/wound swab should be sent for microscopy and culture prior to commencing treatment.

Current treatment issues

Many of the barrier treatments are petroleum silicone or zinc based or can only be used for short periods and only protect the skin and do not absorb or deal with the leakage. They introduce moisture into the area which can cause additional issues.

Some topical barriers such as Ilex™ have been discontinued in parts of the world.

Pastes for ostomy care come under the general category of accessories, which are products that you may or may not need for routine care of your ostomy. Paste is like caulking, filling in gaps and providing a barrier to effluent.  Other treatments can be messy and difficult to clean off once applied. Others care treatments don’t address the underlying issue of the leakage .

Bile leakage onto the skin can pose quite a problem for patients. The caustic nature of bile results in skin irritation, and patients often have to wear a small ostomy appliance at their puncture site. Additionally, diversion of bile from the enterohepatic cycle may cause digestive problems.

After graduating with my Bachelor of Science in Chemistry in 2016 from the University of Redlands, I moved home to deal with the health problems that arose from my Juvenile Onset Parkinson’s Disease and secondary GI dysmotility that required a feeding tube. I have spent my 20s working in various areas of healthcare advocacy and citizen science, often solving my own problems when I come across the complications of living in a body that medical science has not always caught up with. My Jejunostomy feeding tube saved my life, but the bile leakage left my skin in a miserable condition, a source of constant pain that has no relief.

 Like millions of people worldwide, my feeding tube will be in my body for the rest of my life and it will keep leaking indefinitely. Caustic bile leakage has been causing skin breakdown around the site since its placement 6 years ago, and after trying every product I could find, there were no solutions on the market that solved my problem. I decided to tackle this problem in the way I know best- combining my lived experience with my chemistry knowledge. I spent about six months deep in natural products chemistry, looking for ingredients that are readily available, safe, and would provide the most benefit.

The goal was to create a powder that would soak up leakage and draw it away from the skin, so that the leakage causing skin breakdown could not cause further damage, and be able to absorb a significant volume with a small amount. In addition, my powder needed to gel together, not stick to the skin, and be free of irritants and animal products. Once I came up with a formula and tested it, my powder which we lovingly call STOMA SAVER was born.

 I have been using it every day since it was made, and the skin around my stoma is no longer horribly burnt and raw. Going just an hour without it brings the pain back as leakage burns my skin. Realizing that I was not alone in this, my family and I have set out to get it on the market and into the hands of others who need it, and now that we are patent pending, we are so close to being able to do just that. 

Across the world there are people like me, from infants to the elderly, dealing with the leakage from feeding tubes and living with the pain of skin breakdown, just waiting for a solution. STOMA SAVER saved my skin

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