Optimising wound care in a child with an infected gastrostomy exit site

The percutaneous endoscopic gastrostomy (PEG) tube has become a widely used feeding tube for long-term delivery of fluids, liquid feed and medicines. PEG tube insertion can be considered a minimally invasive technique, associated with rapid recovery and early discharge from hospital but is not without risk (Vervloessem et al 2009; Naiditch et al 2010). A lack of nationally agreed, evidence-based clinical practice guidelines makes PEG exit site care a matter of local clinical practice and clinical judgement. In paediatric practice, children experience care shared across several healthcare settings, meeting clinical teams with varying levels of knowledge and experience of PEG care. This can lead to conflicting advice, which can have a negative effect on patient safety and experience. The case history in this article demonstrates how PEG tube insertion is never a minor procedure for a child and family (Vervloessem et al 2009; Khattak et al 1998). It highlights areas of potential conflict in clinical management of PEG exit sites, and it shows how application of wound care principles, along with a range of modern products can have a positive outcome.