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Paediatric gastrostomy stoma complications and treatments: A rapid scoping review
Ashleigh Townley1, Joanne Wincentak1, Kim Krog2,3
1Evidence to Care, Teaching & Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.
Insights
Treatments for pediatric skin stoma complications like infection and leakage are varied, but evidence on effectiveness is limited. More research is needed to guide clinical practice for gastrostomy and gastrojejunostomy tubes.
Area of Science:
- Pediatric Gastroenterology
- Wound Care
- Medical Device Management
Background:
- Skin-related stoma complications are common in children with gastrostomy (G) and gastrojejunostomy (GJ) tubes.
- Nurses need evidence-based guidance for managing these complications.
Purpose of the Study:
- To review treatments for pediatric skin-related stoma complications (infection, hypergranulation, gastric leakage).
- To explore the effectiveness and indications for these treatments.
Main Methods:
- A rapid scoping review approach was employed.
- Systematic searches of CINAHL, MEDLINE, EMBASE, and internet resources were conducted for peer-reviewed articles (2002-2016) on pediatric G- and GJ-tube stoma complications and treatments.
Main Results:
- Twenty-five articles were included, revealing a wide range of treatments used for stoma complications.
- A lack of consensus on treatment strategies was observed, though stepwise approaches were common for infections.
Conclusions:
- Evidence on the comparative effectiveness of treatments for pediatric skin-related stoma complications is sparse, often relying on expert opinion.
- Further research is warranted to establish efficacy and indications for pediatric stoma complication treatments.
Aims And Objectives:
To provide a scoping review of the types of treatments used to address paediatric skin-related stoma complications specific to infection, hypergranulation and gastric leakage, and explore their effectiveness and indications for use.
Background:
Stoma-related complications can be a common occurrence for children with gastrostomy (G) and gastrojejunostomy (GJ) tubes. Nurses require guidance to inform decision-making of the broad spectrum of treatments used in clinical practice.
Design:
A scoping review using a rapid review approach.
Methods:
Working with a multidisciplinary health professional team, search terms were generated. A systematic search of CINAHL, MEDLINE and EMBASE databases was completed, coupled with an Internet search to identify relevant clinical practice guidelines and hand searching of citation lists. Eligible articles were peer-reviewed English publications, focused on paediatric populations aged 18 years and under, dating from 2002-2016 and described complications and treatment approaches related to G- and GJ-tube stomas. Pertinent information was extracted using a standardised template, and a narrative synthesis approach was used to analyse the data.
Results:
Twenty-five articles were included in this review. Study designs varied, and complication management was often a secondary focus. A broad spectrum of treatments was used to manage each complication type. There was a lack of consensus on lines of therapy; however, a stepwise approach was often used for complication management, particularly for infections.
Conclusions:
The evidence on the comparative effectiveness of different treatment strategies of skin-related gastrostomy stoma complications in paediatric practice is sparse. Current evidence is generally limited to expert opinions. Future studies examining efficacy of treatments and their indications for use with children are warranted.
Relevance To Clinical Practice:
Effective management of skin-related stoma complications is important to maintain health and wellness among children who rely on G- and GJ-tubes for nutrition support.
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