G-Tube Bumpers: Internal and External Fixation Devices
Function and Positioning
- The internal bumper sits against the gastric mucosa on the inside of the stomach wall, and the external bumper rests against the skin on the outside of the abdominal wall, creating compression that holds the anterior stomach wall against the anterior abdominal wall, maintaining the gastrostomy tract 1, 2, 3
Critical Positioning Guidelines
- The external bumper must be positioned approximately 1 cm or more from the abdominal wall to allow free movement of at least 5 mm, as excessive tension between the internal and external bumpers can cause serious complications, including pressure-related skin lesions, local ischemia, and wound infection 1, 2, 4, 5, 6, 7, 3
- Proper spacing prevents the most common complication: wound infection (occurring in approximately 15% of cases) and reduces risk of buried bumper syndrome, where the internal bumper migrates through the gastric wall (occurs in 0.3%-2.4% of patients) 7, 3, 6
Proper Care and Maintenance
- Using a Y-compress or cut drain sponge placed OVER (not under) the external bumper can cushion movements and avoid applying excessive tension, and the tube should be pushed approximately 2-3 cm ventrally and carefully pulled back to the resistance of the internal fixation flange during dressing changes to prevent adhesions 7, 3, 8
- Daily inspection during the first 7-10 days is critical to ensure the external bumper maintains at least 5 mm of free movement 7, 3