A Percutaneous Endoscopic Gastrostomy (PEG) tube is a flexible feeding tube inserted through the abdominal wall directly into the stomach. It delivers nutrition, hydration, and medication to individuals who cannot safely consume them orally. The tube is secured internally by a retention device (like a balloon or bumper) and externally by a securement device against the skin. Leakage around the stoma—the opening in the skin—is a frequent complication. This leakage, often stomach contents or formula, causes discomfort and skin irritation if the underlying issue is not corrected promptly.
Causes Related to Tube Position and Integrity
Leakage often results from a failure in the mechanical components designed to seal the tube tract. The internal retention balloon, which keeps the tube snug against the stomach wall, may be under-inflated, deflated, or ruptured. If the balloon volume is compromised, the tube loses its tight seal, allowing gastric fluid to escape around the device. Checking the balloon’s water volume can diagnose this issue, which requires reinflation with sterile water to the manufacturer’s recommended volume, typically 5 to 10 milliliters.
Tube migration or displacement also disrupts the seal. If the tube shifts inward or outward, the retention device moves away from the stomach wall, widening the stoma tract and creating a gap for leakage. Check the tube against its original marking number to ensure it has not moved significantly. If the external bolster or bumper is too loose, it fails to stabilize the tube against the skin, allowing excessive movement that enlarges the tract over time.
The physical integrity of the tube can degrade, leading to leaks that appear to come from the insertion site. Cracks, fissures, or warped material can develop over time due to wear or friction. These structural failures allow fluid to seep into the space between the tube and the stoma, mimicking a peristomal leak. Inspecting the tube for visible damage is a necessary troubleshooting step to rule out the need for replacement.
Causes Related to the Stoma Site and Gastric Pressure
Leakage can signal a physiological problem compromising the stoma tract’s integrity. Peristomal cellulitis, an infection of the surrounding skin, causes inflammation and swelling. This swelling physically enlarges the tract, preventing the retention device from maintaining a tight seal and allowing stomach contents to pass through.
Hypergranulation tissue is an overgrowth of fragile tissue around the stoma, often a response to chronic irritation. This excessive tissue prevents the tube from seating properly against the skin, contributing to tract enlargement and leakage. Excessive growth requires intervention to restore a proper seal.
Increased intra-abdominal pressure can physically force contents out around the tube. Activities such as chronic coughing, straining due to constipation, or repeated vomiting elevate this internal pressure. Rapid administration of formula or bolus feeds can also quickly overfill the stomach, causing reflux and leakage. Additionally, a newly formed stoma tract, especially within the first six to eight weeks after placement, is still maturing and is naturally more prone to leakage.
Immediate Steps for Managing Minor Leaks
Minor leakage can often be resolved with simple adjustments. Check the position and tension of the external bolster, ensuring it is snug but not excessively tight. Maintain a small space (about half a centimeter or a finger-width distance) between the bolster and the skin to prevent pressure injury while stabilizing the tube. If the tube uses a balloon, verify the inflation volume by aspirating and reinjecting the correct amount of sterile water; this should be done weekly as a preventative measure.
Protecting the skin from digestive enzymes is paramount. Clean the peristomal area gently with mild soap and water, ensuring the skin is patted dry. Applying a protective moisture barrier cream, film, or zinc oxide creates a shield against irritating stomach contents. Use a foam dressing or specialized split-gauze pad to absorb drainage and lift fluid away from the skin, reducing the risk of maceration.
Adjusting feeding practices can alleviate pressure-related leaks. Slowing the rate of continuous feeds or reducing the volume and speed of bolus feeds allows the stomach more time to process contents. If gas or bloating is suspected, briefly opening the tube to vent air helps reduce internal gastric pressure. Addressing constipation is also important, as straining contributes significantly to leakage.
Signs That Require Professional Medical Attention
While minor leakage is common, certain signs indicate a serious complication that requires immediate medical evaluation.
- A significant change in the color or consistency of the drainage, such as thick, purulent discharge accompanied by a foul odor, suggesting a severe infection like cellulitis. This is particularly concerning if the patient develops a high fever, chills, or intense pain and tenderness at the stoma site.
- Severe abdominal pain, especially if the abdomen feels rigid or distended, which could signal peritonitis (gastric contents leaking into the abdominal cavity).
- The tube has completely fallen out, which is a medical emergency since the stoma tract can begin to close rapidly, sometimes within two hours.
- Persistent leakage that does not respond to simple at-home troubleshooting, which may indicate a need for tube replacement or a diagnosis of Buried Bumper Syndrome.