I'd like to make an important point about managing percutaneous endoscopic gastrostomy (PEG) tubes. An external bumper that's too tight is likely to cause tissue breakdown on the internal (mucosal) layer of the abdomen, not on the visible abdominal wall. Mucosal erosion or ulceration occurs long before you see a buried bumper, which itself can obscure the problem by delaying evidence of drainage.

Mucosal erosion can occur when the inner retaining piece and external bumper fit together too tightly, but it's just as likely to be caused by tube drag. To prevent tube drag, make sure the tube is secured to the patient at another site. Leave slack in the tube between the PEG insertion site and the secured part of the tube. Remember, the healthy stoma closing tight around a tube is what prevents drainage, not the inner bumper against the mucosa.

SAVANNA BORNE, RN, CGRN, BSN, MA

Rochester, Minn.