Commentary by Janet Ramundo

Although this case study focuses on the pediatric patient, the principles of tube management apply equally to the adult population. Regardless of the age of the patient, the underlying condition, or the type of tube, certain principles of management must be considered.

Successful tube management should provide effective drainage to promote activity and comfort and minimize the risk of infection. Tube stabilization is essential to prevent "in and out," as well as lateral migration of the tube. The migration associated with poor stabilization commonly results in leakage, tract erosion, and inadvertent tube dislodgement. Complications may include infection and development of hypergranulation tissue, as well as the pain associated with reinsertion of a dislodged tube. The implications of not securing indwelling urinary catheters, as seen in a recent "Challenges in Practice" 1 case study, should also be considered. Last year's pediatric issue of JWOCN published 2 articles that addressed the challenges of gastrostomy tubes and provided additional methods of stabilization using PercuStay (Derma Sciences, Inc, Princeton, NJ) and use of a pacifier and tape. 2,3 Another device is Flexi-Trac (ConvaTec, Princeton, NJ).

The authors have given several options for tube stabilization. The choice, of course, will be dictated by the type of tube, setting, product availability, and patient. Effective tube management, which we are well equipped to manage, is a common challenge for the WOC nurse. It is hoped that the strategies outlined in this article will heighten your awareness of the need for continual education of patients, family, and staff, as well as increase your options for management.

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