PEG / Gastrostomy Tube Care

A PEG tube site that looks red and crusty might be normal healing — or the start of a buried bumper. Knowing the difference protects the patient from a surgical emergency.

A percutaneous endoscopic gastrostomy (PEG) tube is placed directly through the abdominal wall into the stomach for long-term enteral access (generally when feeding is needed beyond 4–6 weeks). Daily site care is the nurse's primary responsibility: clean around the stoma with mild soap and water, dry thoroughly, and rotate the external bumper 360 degrees daily to prevent buried bumper syndrome — where the internal bumper erodes into the gastric wall. The external bumper should sit about 1–2 cm above the skin, snug but not tight. Mark the tube at the skin level and document the external length at every shift to detect migration. Before each feeding or medication administration, verify placement by assessing the external tube length against baseline and checking pH of aspirate (expected gastric pH ≤ 5.0); also check residual volume to assess feeding tolerance. Flush with 30 mL of warm water before and after feedings and between medications. Medications must be given in liquid form or thoroughly crushed and dissolved; never crush enteric-coated or sustained-release tablets. Keep the head of bed elevated at least 30–45 degrees during and for 30–60 minutes after feeding to reduce aspiration risk.

Key Distinctions

Don't confuse PEG tube verification with NG tube verification — PEG placement is confirmed endoscopically at insertion, and ongoing checks rely on external length measurement plus pH, not chest X-ray. Students mix up buried bumper syndrome (internal bumper migrates into the gastric wall from excessive external bumper tightness) with tube migration outward (increased external length, risk of peritoneal leak). Granulation tissue at the stoma is common and benign — it is not infection unless accompanied by purulent drainage, fever, or induration.

Clinical Pearl

Rotate, measure, flush — every shift. If the external bumper is flush against the skin, it's too tight and burying the internal bumper. Loosen it before it becomes a surgical problem.