Gastrojejunostomy Tube Care and Maintenance

Initial Placement and Fixation

The external fixation plate should be positioned with very low traction, without tension, allowing at least 5 mm of free movement along the tube shaft, to prevent local ischemia and tissue necrosis 1, 4, 5, 6
Maintain approximately 0.5-1 cm of free distance between the skin and external bolster to reduce the risk of buried bumper syndrome (BBS) and other complications 1, 2, 3
Use a Y-compress or sterile dressing placed under the external disc plate to cushion movements and prevent moisture accumulation 1, 2

Push the tube inward at least 2-3 cm (ideally 5-10 cm) and then pull it back carefully until you feel resistance from the internal fixation device, without rotating the tube, to prevent malposition or obstruction 1, 2, 3, 5
Return the tube to its initial position with 0.5-1 cm free distance between skin and external bolster after weekly mobilization 1, 2, 3
Cleanse the site twice weekly with fresh tap water and soap using a clean cloth, and gently dry the skin after cleaning 1, 2

Excessive compression between internal and external bolsters is the most important risk factor for BBS, making it crucial to maintain at least 0.5-1 cm of free space 1, 2, 3
Monitor for warning signs of BBS, including difficulty mobilizing the tube, leakage around the insertion site, frequent feeding pump alarms, abdominal pain, and chronic site infections 1, 2, 3, 4

Consider additional fixation devices for patients at high risk of tube dislodgement, and ensure the incision at the puncture site is sufficiently large to prevent pressure-related skin lesions 1, 4, 5
The tube should move freely without causing ischemia to surrounding tissue, and breathable dressings or Y-compresses that don't shed fibers should be used 2, 3, 5, 6