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Peristomal leakage of gastric contents is seen with most G‐tubes. Diabetes, malnutrition, and poor wound healing can increase the likelihood and amount of leakage secondary to poor approximation of skin tissue around the tubing. In addition, a tightly secured retention device, noted by dimpling of the skin, can cause an inflammatory reaction and lead to increased leakage of gastric contents.

Skin irritation from peristomal leakage can be distinguished from infection by the color, which is a faint pink instead of the deep red color of cellulitis (Figure 1.3a). Likewise, the skin is not tender. Finally, crusting around the tube site, that is, dried formula and gastric juices, should easily wipe away.

Treatment options for peristomal leakage include skin barrier creams such as zinc oxide and antacid treatment to decrease the acidity of the gastric contents. If the stoma appears too large for the tubing, do not increase the size of the tube. A larger stoma site is not because the patient grew or gained weight. The stoma size increases secondary to repetitive trauma from the tube moving within the stoma. Increasing the tube size will only stretch the stoma further and lead to greater leakage of gastric contents. Do not make this common mistake. Instead, remove the tube and allow the stoma to shrink in size over the next several hours. A stoma can close within as little as 24 hours, so a smaller catheter should be left in place to maintain patency of the stoma. Once the stoma has decreased to the appropriate size, place the original sized G‐tube into the site.