A leaking feeding tube, known medically as peristomal leakage, occurs when gastric or intestinal contents escape through the stoma, the opening in the abdomen created for the tube. The fluid often contains highly acidic digestive enzymes, which can quickly cause significant skin irritation, breakdown, and infection around the tube site. Addressing this problem quickly is paramount to prevent fluid loss, discomfort, and the stoma tract from enlarging, which worsens the leakage issue. Understanding the rapid steps for containment and the deeper causes is the first move toward resolving this common complication.
Immediate First Steps for Leak Containment
Upon noticing fluid leaking around the tube, the immediate priority is stopping the flow and protecting the surrounding skin. Promptly stop the current infusion of formula or medication to minimize the volume of fluid escaping through the tract. This limits the exposure of the peristomal skin to irritating contents, which is often the primary cause of skin breakdown.
After stopping the flow, gently cleanse the entire area using mild soap and warm water to remove all traces of secretions. Pat the area completely dry with a soft cloth or gauze, avoiding harsh scrubbing that could traumatize the irritated skin. A temporary absorbent dressing, such as a split gauze pad, can then be applied to contain residual drainage while the underlying cause is investigated. Change this dressing frequently to prevent moisture from macerating the skin, which creates a breeding ground for infection.
Diagnosing the Source of the Leak
Identifying the precise cause of the leakage is the only way to implement an effective solution. One category involves mechanical or tube-related problems, such as an improperly inflated retention balloon or a tube that has migrated. For tubes secured with an internal water-filled balloon, partial deflation or rupture allows the tube to shift, widening the stoma tract and permitting fluid to escape. Tube material degradation or a cracked tube can also be the source of the leak, though this is less common than retention device issues.
Another major category centers on issues at the stoma site, frequently involving the overgrowth of granulation tissue. This tissue is moist, red, and friable, and forms around the opening. This excess tissue can prevent the external fixation device from sitting flush against the skin, creating a gap for leakage or increasing tube movement that irritates the tract. Less commonly, an active infection or an already enlarged stoma tract due to chronic leakage can be the primary reason for fluid escape.
The third common cause relates to increased internal abdominal pressure, which forces stomach contents out around the tube. Conditions such as chronic coughing, persistent vomiting, or severe constipation can create sufficient pressure to push gastric fluid through the space between the tube and the stoma wall. Rapid infusion rates during feeding or delayed gastric emptying (gastroparesis) can also temporarily increase pressure and result in significant leakage. Understanding which category is responsible guides the corrective action.
Corrective Measures for Common Leak Causes
The most frequent source of leakage is a problem with the tube’s retention device, requiring a check of the internal balloon volume. For balloon-retained tubes, gently aspirate the water using a syringe to measure the residual volume, then reinflate it with the recommended amount of sterile water. If the aspirated volume is significantly less than the amount injected, the balloon is actively leaking and the tube must be replaced.
After confirming proper balloon volume, the fit of the external bumper or retention disc should be assessed and adjusted. The external device must be positioned to allow a small amount of movement, typically 1 to 2 millimeters, between the skin and the bolster. Adjusting the device too tightly can cause tissue damage and Buried Bumper Syndrome, while a loose fit permits excessive tube migration, stoma enlargement, and leakage. If leakage is linked to high internal pressure, modifying the feeding protocol, such as switching from rapid bolus feedings to slower, continuous infusions, can be effective.
If leakage persists despite tube and fit adjustments, addressing underlying gastrointestinal issues is necessary. Chronic constipation or delayed gastric emptying should be managed through dietary changes or medication, as these conditions significantly increase gastric pressure. Minor stoma enlargement may be managed by ensuring the current tube diameter is appropriate; upsizing to a larger tube can further dilate the tract and exacerbate the problem. For leakage caused by excess granulation tissue, a healthcare provider may apply silver nitrate to cauterize the tissue, reducing the bulk and allowing the external bumper to sit securely against the skin.
Protecting the Skin and Preventing Recurrence
Protecting the skin from the corrosive effects of leaking digestive fluids is paramount. Gastric contents contain hydrochloric acid and pepsin, which act like a chemical burn on the skin, necessitating the use of specialized barrier products. Zinc oxide-based ointments or thick barrier pastes are effective because they repel moisture and neutralize the enzymes, creating a protective shield on the irritated skin.
For skin that is already moist or weeping due to severe irritation, a barrier powder, such as a hydrocolloid powder, should be lightly dusted onto the affected area. The powder absorbs excess moisture, transforming the weeping surface into a dry base. This allows the subsequent application of a protective skin barrier film or wafer. This protective film, often applied as a spray, seals the powder and provides a non-irritating layer for external dressings to adhere to.
Establishing a consistent, gentle cleaning regimen is important for preventing future leaks and irritation. The stoma site should be cleaned at least twice daily with warm water and a non-alkaline, fragrance-free soap, ensuring the area under the external bumper is thoroughly dried. Gently rotating the tube 360 degrees daily, unless medically advised otherwise, helps prevent the internal retention device from adhering to the stomach lining and causing tract irritation. Regularly checking the tube’s position and the fit of the external device acts as a proactive measure against tube migration and leakage recurrence.
When Urgent Medical Attention is Required
While many leakage issues can be managed at home, certain warning signs indicate the problem requires professional medical intervention. The most immediate concern is the development of signs of a severe local or systemic infection around the stoma site. These signs include spreading redness away from the tube, significant warmth, swelling, and pus-like discharge accompanied by a foul odor.
A fever or the onset of severe abdominal pain alongside the leakage suggests a serious complication, such as peritonitis, and requires immediate evaluation. Complete and accidental dislodgement of the feeding tube is also an urgent situation, especially if the tube has been in place for less than a few months, as the stoma tract can begin to close rapidly. The tube needs to be replaced immediately to maintain the opening, often requiring specialized medical assistance. Any leakage that is profuse, cannot be contained, or is accompanied by uncontrolled vomiting or severe nausea necessitates contacting a healthcare provider.