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Management of A Gastrostomy Tube: A pouching nightmare

Case Description. 47 year old femaleChronic bowel obstruction secondary to carcinomatosis from a mucinous appendiceal adenocarcinomaPalliative gastrostomy tube for decompression (May 2010)Chronic TPN with liquid diet for comfortAmount of fluid leaking from around tube and into foley bag: at lea

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Management of A Gastrostomy Tube: A pouching nightmare

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    1. Management of A Gastrostomy Tube: A pouching nightmare Karen Durigan and Donna Lehman

    2. Case Description 47 year old female Chronic bowel obstruction secondary to carcinomatosis from a mucinous appendiceal adenocarcinoma Palliative gastrostomy tube for decompression (May 2010) Chronic TPN with liquid diet for comfort Amount of fluid leaking from around tube and into foley bag: at least 2 Liters daily

    3. OP Ostomy Clinic Radiologist insisted on “pouching” of the tube. Saw the patient on March 4 for the first time. Continued to see daily, sometimes twice a day for 10 days straight. Decompression tube much smaller than skin tract opening. Husband had been making a baking soda slurree to “neutralize” the bowel effluent. Made repeated requests for the tube to be changed for a larger sizeMade repeated requests for the tube to be changed for a larger size

    4. Peri-Tubular Skin Worst than what it appearsWorst than what it appears

    5. Crusting Took apart an Eakin fistula pouch and used the wafer sectionTook apart an Eakin fistula pouch and used the wafer section

    6. Wound Pouch

    7. Sturdy nippleSturdy nipple

    9. Post-Op Pouch

    11. Failed, had to start again, due to her working and ambulatory, the piece of Eakin wafer too large, rolling up from her getting up and down out of her chair, flange from pouch too large-if offset center bothered her bra line; leaked from under the eakin barrier distally. Allergic reaction to the stomahesiveFailed, had to start again, due to her working and ambulatory, the piece of Eakin wafer too large, rolling up from her getting up and down out of her chair, flange from pouch too large-if offset center bothered her bra line; leaked from under the eakin barrier distally. Allergic reaction to the stomahesive

    12. Convex Barrier Ring Tried convexityTried convexity

    13. Different Pouch; pouch flange a little more pliableDifferent Pouch; pouch flange a little more pliable

    14. Allergic to the convex barrier ring The 2nd pouch did not adhere to her skin Allergic to the convex barrier ring The 2nd pouch did not adhere to her skin

    15. What Did Work Eakin wafer Convexity Sensicare

    16. Combination Continued leakage, mix and match of pouching items, longest weartime 12 hoursContinued leakage, mix and match of pouching items, longest weartime 12 hours

    17. 2 in 1 Convexity Eakin washer to cover the convex ringEakin washer to cover the convex ring

    18. Outcome Advocacy: “I concluded that if I could only nudge the world a little bit, maybe that would be enough. But nudging isn't enough.” — Jacqueline Novogratz

    19. 48 hours post new tube

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