PEG Tube Site Wound Care Order Assessment
Your proposed wound care order is mostly appropriate but needs modification: the frequency should be daily only during the first 5-7 days post-procedure, then reduced to 1-2 times weekly after stoma healing, and the order should specify avoiding occlusive dressings and ensuring no tension under the external bumper. 1
Initial Post-Procedure Period (Days 1-7)
Daily wound care is correct during the first week when the stoma tract is forming and the incision is healing. 1 Your protocol appropriately includes:
- Cleansing with normal saline (0.9% sodium chloride) or sterile water is guideline-concordant 1
- Patting dry is essential to prevent maceration 1
- Using a clean, dry 4x4 drain gauze (Y-dressing/split gauze) placed under the external disc plate is the recommended approach 1, 2
Critical Modifications Needed:
- Explicitly state "avoid occlusive dressings" as they promote moisture and skin maceration 1
- Specify "place dressing without tension" under the external bumper - tension must be avoided 1
- Ensure 0.5-1 cm free distance between skin and external bolster 1
- Monitor daily for bleeding, pain, erythema, induration, leakage, and inflammation 1
After Stoma Healing (After Week 1-2)
Your "every shift" frequency is excessive after initial healing. The order should be modified to:
- Reduce dressing changes to 1-2 times weekly after the stoma tract has healed (typically 5-7 days post-procedure) 1, 3
- Cleanse with soap and water of drinking quality rather than continuing sterile technique 1, 3
- Alternatively, dressings can be omitted entirely and the site left open after healing 1
Additional Essential Care Components Missing from Your Order
To prevent buried bumper syndrome, the order should include:
- Push the tube 2-3 cm ventrally and carefully pull back to the resistance of the internal fixation flange during each dressing change 3, 2
- Ensure the external fixation plate allows free movement of at least 5 mm 3, 2
- Rotate the tube daily once the tract has healed (after about one week) 1
Topical Treatment Considerations
Your phrase "apply topical treatment (if ordered)" is appropriately conditional. However:
- Standard wound care does not routinely require topical antimicrobials during the first week 1
- Glycerin hydrogel or glycogel dressings can be used as an alternative to classical aseptic wound care during the first week(s) 1
- If gastric contents leak causing skin irritation, use a hydrocolloid wafer as a keyhole dressing for skin protection 2
Common Pitfalls to Avoid
- Do not continue daily "every shift" dressing changes beyond the first week - this is excessive and not evidence-based 1
- Do not use occlusive dressings that trap moisture 1
- Do not place dressings with tension under the external bumper 1
- Do not forget to mobilize the tube after initial healing to prevent buried bumper syndrome 1, 3, 2
Recommended Revised Order
"Wound care to PEG tube site: Days 1-7: cleanse PEG tube site daily with NS or sterile water, pat dry, apply topical treatment (if ordered), and place clean, dry, non-occlusive 4x4 split gauze under external disc plate without tension, ensuring 0.5-1 cm free distance between skin and bumper. Monitor for bleeding, pain, erythema, induration, leakage, inflammation. After day 7-14 (once stoma healed): reduce to 1-2 times weekly, cleanse with soap and water, pat dry. During each dressing change after healing: push tube 2-3 cm ventrally and pull back to resistance, ensure external plate allows ≥5 mm free movement. Rotate tube daily after week 1." 1, 3, 2