Introduction PEG tube insertion is useful in an appropriately indicated patient but there are some complications to it. Buried Bumper Syndrome is usually a late and rare complication which is normally avoidable but occurs when the stomach lining grows over the internal bumper of a PEG feeding tube and it can lead to infection, inability to administer feeds/medications, peritonitis and admission to hospital. Our literature search of large studies shows the overall incidence of BBS to be 2–4.5%.
Aim The aim was to conduct an audit to ascertain the incidence of BBS in our Hospital Trust (ABMU) and to develop tools to try and reduce the incidence as well as re-audit our practice to assess the improvement.
Methods It was a retrospective data collection to ascertain the incidence followed by development of tools which predominantly consisted of daily PEG care and an action plan. Daily PEG Care mainly included hand hygiene before and after every use, cleaning techniques and pushing the tube approximately 5cm into the stomach and rotating 360˚ before securing it back. Action plan included training in Nursing Homes, increased number of visits and spot checks, completion of VA1 (POVA) where necessary and regular meetings with Nurse Assessors and Commissioners. Re-auditing was carried out after educating the people who are involved in PEG care thereby completing the audit cycle.
Results The incidence in our trust before the implementation of Daily PEG care and the action plan was around 13%. We are pleased to report that since then there have been no new cases of BBS diagnosed during 2013. The training sessions are continuing and audit of PEG care will be carried out annually, with written feedback to each nursing home.
Conclusion Daily PEG care and reinforcement of training the staff and relatives involved will help in the prevention of a serious complication of PEG tube.
References Young and Leedham An audit of incidence and treatment of buried iInternal gastrostomy fixators. Gut 2011;60: A100–A101
Kejariwal D et al. Buried bumper syndrome. Nutr Clin Pract Jun-July; 2008;23(3):322-4
Disclosure of Interest None Declared.
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