Our Kimberly-Clark* MIC-KEY*
Low-Profile Gastrostomy Feeding Tube is a step up from
standard gastrostomy feeding tubes. In designing it, we listened to
many people involved in enteral feeding who requested a tube that
would allow for an active/ more mobile lifestyle. It should, they
told us, be difficult to dislodge-allowing freer
movement-unobtrusive, and easy to conceal under clothing.
Today, MIC-KEY* is the more mobile person's ideal tube-feeding
choice. MIC-KEY* frees children and adults alike to enjoy life to
the fullest while ensuring their nutritional health and
well-being.
• GET TO KNOW
YOUR MIC-KEY*
• INSTRUCTIONS FOR MIC-KEY* FEEDING
• ADMINISTERING MEDICATIONS
• CARING FOR
YOUR MIC-KEY*
• PROBLEM-SOLVING: WHAT TO DO IF …
• REPLACING
THE MIC-KEY* TUBE
• CHILDREN'S SPECIAL CONCERNS
• A MESSAGE
FROM THE MIC-KEY* TEAM AT KIMBERLY-CLARK HEALTH CARE
Get to Know Your MIC-KEY*
How Your MIC-KEY* Works
As you probably know, your MIC-KEY* feeding tube enters your
stomach through the feeding and medication port in your abdominal
wall. The tube allows the intake of nutrients, medication (if
required), and water that your body requires.
Your specialist has prescribed MIC-KEY* feeding for you along with
your feeding schedule, formula, medication (if required), and
amount of water. With MIC-KEY*, you're set to go!
Keep in mind that it's important to use and care for your MIC-KEY*
properly. Follow the instructions your specialist has provided, and
keep this guide handy. That way, you'll always be in control of
your MIC-KEY* experience.
What's Included With Your MIC-KEY*, and Why
The Uniquely Designed MIC-KEY* Low-Profile Feeding
Tube. Ideal for virtually everyone using tube feeding, the
MIC-KEY* tube provides a close, comfortable fit with minimal
leakage risk. So MIC-KEY* provides added peace of mind as you go
about your day.
The External Base. The external base holds the
tube in place on your abdomen while allowing air to circulate to
the skin beneath it. The bottom of the base should rest about 1/8
in (3 mm), the thickness of a dime, above the skin.
The MIC-KEY* Feeding and Medication Port. The
MIC-KEY* port attaches to your extension set to deliver your
nutrients, liquids, and medication (if any) into your stomach. When
you're not receiving a feeding, cap off the MIC-KEY* port with the
attached cover.
An anti-reflux valve located inside and toward the top of the
MIC-KEY* port helps keep stomach contents from leaking out of the
tube. You open (unlock) the valve when you attach the extension set
to the port for feeding or venting (also called decompression or
burping).
Important: Keep the MIC-KEY* feeding port and anti-reflux valve
clean so stuck-on dried formula can't hold the valve open. Be sure
residual formula is not left to pool and dry inside the valve
opening by flushing it thoroughly with water and wiping it clean
with cotton-tipped applicators.
The Silicone Retention Balloon. The balloon on
your MIC-KEY* tube is placed inside your stomach and inflated with
water to hold the tube in place. Check the balloon volume once a
week and replace water as needed.
The Balloon Valve. The balloon holding the tube
in place is inflated and deflated by inserting a luer slip syringe
into the balloon valve. This should be done only when you check the
balloon volume or replace your MIC-KEY*. Always keep the balloon
valve clean to prevent clogging, and never try to feed through
it.
The Syringes. Your MIC-KEY* feeding tube kit
includes:
• A 6 ml luer slip syringe for use when inflating and deflating
the retention balloon
• A 35 ml catheter tip syringe for use when priming and flushing
the extension sets or checking for proper placement of the MIC-KEY*
feeding tube
What MIC-KEY* Accessories Do
The MIC-KEY* Extension Set. This and the bolus
extension set (see below) come with your MIC-KEY kit. Use this
extension set for continuous feeding with a formula pump. To attach
the extension set:
1. Align the black line on the extension set with the black line
on the feeding port.
2. Insert the "nose" of the Secur-Lok* connector into the feeding
port and rotate it one quarter turn clockwise.
3. Open the extension set feeding port and attach the feeding bag
connector to the extension set with a firm push and twist.
Note: The extension set swivels when you move, so you can change
position during feeding.
After every feeding, wash the extension set with warm soapy water
and rinse it thoroughly to prevent dried-formula build-up.
Extension sets are disposable and should be replaced every few
weeks.
The MIC-KEY* Bolus Extension Set. If you receive
several feedings during the day, use this extension set to feed
with a catheter tip syringe or feeding bag. Bolus feeding normally
takes 20-40 min.
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INSTRUCTIONS FOR MIC-KEY* FEEDING
TUBE SAFETY TIPS
• ALWAYS WASH YOUR HANDS WITH WARM SOAPY WATER BEFORE TOUCHING
YOUR MIC-KEY* FEEDING TUBE.
• AVOID PUNCTURING OR TEARING ANY PART OF THE TUBE.
Preparation Procedures
Check for Proper Tube Placement. Before feeding,
check the MIC-KEY* feeding tube to be sure it is not clogged or
displaced outside the stomach:
• Connect the extension set to the tube and attach a Monoject
catheter tip syringe containing 10 ml of water to the extension set
feeding port.
• Pull back on the plunger. When you see stomach contents in the
tube, flush the tube with water.
• Stomach contents are normally yellow or clear unless there is
food in the stomach. If you feel resistance as you inject the
water, pull back stomach contents again, then try to re-inject the
water.
• Check for leaking around the stoma.
Another method:
• Draw 5-10 ml of air into a syringe.
• Place a stethoscope on your waist. Inject the air into the
extension set feeding port and listen for your stomach to
"growl."
• If you don't hear it, try again. If you still don't hear it, DO
NOT FEED. Contact the specialist and report the problem.
Measure Residual
Stomach Contents. "Residual" is the amount of gastric
fluid and formula left in the stomach four hours after
feeding.
Your stomach may not always empty completely, and the amount of
residual varies. It may also depend on your activity or body
position. Check for residual if:
• The formula backs up in the extension tubing, or
• You feel nauseated.
Generally, replace the residual back into your stomach, since it
contains important electrolytes and nutrients.
Check the residual again in 30 minutes and resume feeding if the
amount is less than you obtained at the first check.
As Directed, Decompress or Vent the Stomach. Your
specialist may instruct you to decompress (release air or food from
the stomach) before or after feedings. To decompress your
stomach:
• Attach the extension set or bolus extension set to the MIC-KEY*
feeding tube.
• Drain into a collecting cup or bag.
Feeding Steps
Continuous
Feeding. Your specialist will recommend the type of
formula best for you.
1. Clean the tops of formula cans and shake well.
If you use powdered formula, prepare it fresh every day. Be sure
to use the prescribed amount. Label each formula batch with the
date and time you prepared it.
2. Wash your hands with soap and water and dry them
thoroughly.
3. Fill the feeding administration bag with formula.
4. Connect the feeding administration bag tubing to the MIC-KEY*
extension set feeding port.
5. Purge air from the tubing by allowing formula to run through
it. When formula reaches the extension set SECUR-LOK* Connector,
clamp the tubing.
6. Remove the feeding port cover and insert the extension set into
the feeding port by matching the black lines on both. Lock the
extension set into place by turning the connector CLOCKWISE until
you feel a slight resistance (about a three-quarter turn). DO NOT
turn the connector past the stop point.
7. Connect the feeding administration bag tubing to the pump. Set
the pump rate according to the manufacturer's instructions. Unclamp
the tubing and begin feeding.
8. When the feeding is nearly finished, add the prescribed amount
of water to the feeding bag.
9. After administering the formula and water, disconnect the
feeding administration bag tubing from the extension set. Flush the
extension set with 10-20 ml of warm water or until the tubing is
clear.
10. Disconnect the extension set from the MIC-KEY* feeding tube by
rotating it COUNTER-CLOCKWISE until the black line on the feeding
port lines up with the black line on the extension set. Gently
detach the extension set and cap the MIC-KEY* feeding tube securely
with the attached feeding port cover.
11. Wash the extension set and feeding bag in warm soapy water
immediately after each use. Rinse thoroughly and air dry.
Bolus
Feeding
To bolus feed with a syringe,
1. Attach a water-filled catheter tip syringe to the MIC-KEY*
bolus extension set. Prime the extension set by filling it with
water.
2. Attach the bolus extension set to the tube's feeding port by
matching the black lines on both. Insert the bolus extension set
locking adapter into the feeding port and rotate it CLOCKWISE until
you feel a slight resistance (about a three-quarter turn). DO NOT
turn the connector past the stop point.
3. Clamp the extension set.
4. Disconnect the syringe and remove the syringe plunger. Reattach
the syringe.
5. Slowly pour the formula into the syringe and unclamp the
tubing. Keep the syringe filled to prevent air from entering the
stomach. Adjust the flow rate by raising or lowering the syringe.
The feeding should finish in 20-40 minutes.
6. When the syringe is nearly empty, add the prescribed amount of
water to the syringe.
7. After administering the formula and water, clamp the tube and
fill the syringe with 10-20 ml of warm water. Reinsert the syringe
plunger and unclamp the tube. Flush the bolus extension set until
the tubing is clear. Proceed to Step 12.
8. To bolus feed with a ("gravity drip") bag, fill the bag with
the desired amount of formula and evacuate the air from the bag's
tubing. Attach the bolus extension set to the feeding
administration bag tubing, prime it and clamp the tubing. Attach
the bolus extension set to the tube's feeding port and open the
clamp. Adjust the flow by opening or closing the clamp on the bag's
tubing.
9. When the feeding is nearly finished, administer the prescribed
amount of water by adding it to the feeding administration
bag.
10. After administering the formula and water, disconnect the
bolus extension set from the feeding administration bag
tubing.
11. Flush the bolus extension set tubing with 10-20 ml of warm
water or until the tubing is clear.
12. Disconnect the bolus extension set and wash it in warm soapy
water until the tubing is clear.
After-Feeding Care
Stoma. Develop a habit of inspecting the skin
around the tube (the stoma) after feeding. Make sure the skin is
clean and dry, and observe the stoma for a few minutes to check for
gastric leakage.
Gently clean the skin around the stoma. Rotate the MIC-KEY*
feeding tube and clean again with cotton-tip applicators or a soft
cloth, using soap and warm water. If you think soap is irritating
the skin, try cleansing with water alone, or try another
soap.
If you use a dressing, change it when it becomes wet or soiled.
Never allow a wet dressing to remain in contact with the skin.
Note: The MIC-KEY* feeding tube does not require a dressing.
Port. Clean the MIC-KEY* tube's feeding port
after feeding. Use a cotton-tip applicator or soft cloth to remove
oil or food. If you receive a continuous feeding, flush the tube
and the extension set tubing at least three times daily.
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ADMINISTERING MEDICATIONS
First, Check … The Correct Form of
Medication for MIC-KEY* Use:
• Medication should be in liquid form when possible. If the liquid
is thick, thin it with water so it doesn't clog the tube.
• If your medication is only available in a pill or capsule, ask
your specialist or pharmacist if it's one you can crush and mix
with water. (Not all pills and tablets can be taken this way.) If
you can do this, crush the medication finely, and make sure it is
well dispersed in the water.
• Do not mix medication with formula unless your specialist tells
you to do this.
To Administer …
You'll generally use a bag and extension set, attaching the
extension set's medication port to the bag instead of to its
feeding port.
For small amounts of medication, you may be able to eliminate the
need for extension tubing by using a syringe:
• Dilute the medication with water in a luer slip syringe.
• Inject directly into the MIC-KEY* feeding port.
• When you're finished, flush the port with at least 10 ml of
water.
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CARING FOR YOUR MIC-KEY*
TUBE SAFETY TIPS
• ALWAYS WASH YOUR HANDS WITH WARM SOAPY WATER BEFORE TOUCHING
YOUR MIC-KEY* FEEDING TUBE.
• AVOID PUNCTURING OR TEARING ANY PART OF THE TUBE.
Daily
Clean the MIC-KEY* feeding tube. The following
supplies will make your work easier:
• Soap and water
• Cotton-tip applicators
• Tissues
• Luer slip syringe
Tube care is easy. Just:
• Keep the tube and the skin around the tube (stoma) clean and
dry.
• Rotate the MIC-KEY* feeding tube in a full circle when you
perform daily tube care.
• This will prevent the tube or balloon from sticking to your
skin.
Clean the extension set and feeding bag as
directed for Continuous Feeding or Bolus
Feeding.
If you receive a continuous feeding, flush the MIC-KEY* feeding
tube and the extension set tubing at least three times daily.
At Least Once a Week:
Check Balloon Volume. The balloon holds your
feeding tube in place. To check the volume of water in the
balloon:
• Attach the luer slip syringe to the balloon port and withdraw
all the water, while leaving the feeding tube in place. If there is
less fluid than the prescribed amount, replace it.
Replace Balloon Water as Needed. Distilled or
sterile water is a good choice for the replacement fluid once the
stoma site has healed. Fill the balloon with the amount of water
your specialist has prescribed.
• Never fill the balloon with air. Air will rapidly migrate out of
the balloon and the MIC-KEY* feeding tube will not stay in
place.
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PROBLEM-SOLVING: WHAT TO DO IF …
Stomach Contents Leak Out Around the
Tube
First, check
your stomach residual. Your stomach may be too full or contain
gas. If the stomach contains too much residual more than a few
times, you may be getting too much formula at one time. If you are
using an intermittent (bolus) feeding, consider switching to
continuous. If using a continuous feeding, try decreasing the flow
rate. Make sure the balloon inside the stomach is filled by gently
pulling on the tube and checking for resistance. You can
also:
Test the balloon by attaching a luer slip syringe to the inflation
valve. Withdraw the fluid from the balloon and note the volume in
the syringe. If the amount is less than prescribed, refill the
balloon with the prescribed amount of water, wait 10-20 minutes,
and repeat the procedure. If the prescribed volume of water is
still not in the balloon, try increasing the volume by 2 ml at a
time until the leak stops. The maximum fill volume is 10 ml (5 ml
for 12 French sizes). Do not exceed this amount.
CAUTION: USE CARE WHILE FILLING OR REMOVING WATER FROM THE
BALLOON.THE MIC-KEY* FEEDING TUBE MAY BE EASILY PULLED OUT.
The Feeding Tube Becomes Disconnected
Stop the pump. Estimate the amount of formula lost. Thoroughly
wipe the tube connections with soap and water or alcohol. (They
must be free of oil and formula build-up.) Clean inside the
extension set feeding port with a cotton-tip applicator and
alcohol. Irrigate the tube with warm water. Dry the connections and
firmly reconnect the tubes with a quarter turn. Resume the feeding,
replacing the estimated volume lost during the disconnection.
The Balloon Leaks or Ruptures
Always keep a replacement MIC-KEY* feeding tube or standard
gastrostomy tube at home. Silicone balloons generally last several
months, but the life span of the balloon varies due to several
factors, including medication administration, volume of water used
to fill the balloon, gastric pH, and extent of tube care.
You Want to Prevent Tube Blockage
Flush the tube with10-20 ml warm water. (If your specialist has
given you different instructions for this procedure, follow them
instead of what appears here.)
Flush:
• Before and after each feeding
• Before and after giving medications
• Every 3 to 4 hours during continuous feedings
• After checking for stomach content residuals
Do not mix medication with formula.
The Balloon Will Not Deflate
If you cannot extract water from the balloon with the syringe,
make sure the recess in the balloon valve is clean: The recess
sometimes traps spills of formula or other material. Be sure the
valve is not closed by food. Then:
• Clean inside the recess, then firmly seat the syringe into the
valve, push, and twist one quarter turn.
• Try pulling back on the plunger again.
• If the balloon still will not deflate, use the end of a large
paper clip to depress the valve and release the water. BE SURE YOU
HAVE A REPLACEMENT TUBE TO INSERT INTO THE STOMA.
Stoma and/or Skin Problems Occur
Stoma. IMMEDIATELY CALL YOUR SPECIALIST IF:
• The stoma is bleeding more than a small amount, or
• You notice blood mixed with stomach contents.
ALSO CALL YOUR SPECIALIST IF:
• The stoma is persistently red and sore, and/or if the red area
is larger than 2.5 cm in diameter.
Redness or soreness around the skin and stoma may be the result of
gastric
leakage. Clean and dry the area frequently. Be sure to rotate
the MIC-KEY* feeding tube in a full circle during daily tube
care.
• The stoma emits an odor.
• The skin surrounding the stoma is swollen.
• There is pus around the stoma.
• You have a fever.
Skin: Granulation Tissue. Granulation tissue is
the result of the body's effort to repair the surgical incision.
The tissue area may enlarge and require treatment. If it bleeds or
a large amount of tissue builds up, contact your specialist.
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REPLACING THE MIC-KEY* TUBE
When? Check With Your
Specialist
He or she will decide when to replace the MIC-KEY* feeding tube.
You may change the tube yourself if the specialist trains you to do
so.
Steps to Follow
To replace a MIC-KEY* feeding tube:
1. Remove the new MIC-KEY*feeding tube from the package. Fill the
balloon with 5 ml sterile or distilled water.
2. Remove the syringe and observe the balloon. It should be
symmetrical. Check for leaks. Remove the water from the
balloon.
3. Attach the luer slip syringe to the balloon valve of the
MIC-KEY* feeding tube. Pull back on the plunger until all the water
is out of the balloon.
4. Gently remove the MIC-KEY* feeding tube from the your stomach.
It may help to use a little water-soluble lubricant as you are
removing it.
5. Lubricate the tip of the replacement MIC-KEY* feeding tube with
a water-soluble agent. DO NOT USE OIL OR PETROLEUM JELLY.
6. Gently guide the new tube into the stoma. Insert the tube all
the way until it is flat against the skin.
7. Hold the tube in place and fill the balloon with 5 ml (3-5 ml
for 12 French sizes) distilled or sterile water. Do not use air.
NEVER FILL THE BALLOON WITH MORE THAN 10 ML (5 ML FOR 12 FRENCH
SIZES) OF FLUID.
8. Position the balloon against the stomach wall by pulling the
MIC-KEY* feeding tube up and away very gently until it stops.
9. Wipe away fluid or lubricant from the tube and stoma.
10. Check the tube for correct placement. Insert an extension set
into the feeding port, then:
• Listen for air, and
• Aspirate residual stomach contents.
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CHILDREN'S SPECIAL CONCERNS
Be Aware of These
Differences
Children are special, and they have special needs. If you are
caring for a child with a gastrostomy, the following points may
help.
Children Have Small Stomachs. Infants develop the
capacity to hold larger feedings in their stomachs as they grow.
Feedings usually begin with frequent small amounts of formula.
Bolus feedings take 20-40 minutes. A gravity flow system or a pump
regulates a slow steady flow and leaves you free to do other
things. Be patient, and gradually increase the amount of formula
given during the feeding.
If your child's stomach is full, formula may leak around the
stoma. The child may also act colicky and vomit, or burp up
formula. Ask your specialist if decompression or venting is
appropriate for this child.
Children Are Growing. Keep in mind that children
with gastrostomies have the same basic growth and developmental
needs as other children.
Children Need to Get Enough Water. Gastrostomy
patients are no different from the rest of us: If the weather is
warm or your child has a fever, additional water may prevent
dehydration. Ask your specialist for guidelines.
Children Need to Experience Food. Even though
your child receives nourishment through a tube, being at the table
during meals is important: It gives your child the chance to
experience food. Encourage your child to touch and taste, just like
everyone else, even if it makes a mess around the high chair.
All Babies Need Oral Stimulation. The mouth is a
very sensitive part of your baby's body. Even if your child cannot
suck and swallow well enough to eat, the sucking reflex is there.
Sucking seems to comfort babies. Experiment with a pacifier. Use it
to stimulate your child's lips, gums, and tongue during feedings.
As the baby grows, talk with your specialist about other
opportunities for your child to chew or suck.
Children Need to Move About. It's important for
babies to roll over on their stomachs: That's how they learn to
push up and crawl. The MIC-KEY* feeding tube's low-profile design
may make rolling over easier for your child.
Know What to Do If …
Your Child Vomits. If your child vomits during
feeding, these actions may help:
• Have your child sit up during feeding. NOTE: Some children have
gastroesophageal reflux, causing food to flow backward up the
esophagus. Correct feeding position is VERY IMPORTANT for these
children. Place them in an upright position or at least a 30-degree
angle before feeding.
• Be sure the formula is mixed correctly and warm.
• Don't use formula that's been hanging longer than 4 hours.
• Slow the rate of feeding or even take a short break, starting
again when your child feels better (flush the tube with warm water
before resuming feeding).
IF VOMITING (OR NAUSEA) PERSISTS, OR YOUR CHILD VOMITS AFTER
FEEDING, CALL THE SPECIALIST.
Your Child Develops Difficulty Breathing During or
Immediately After a Feeding. STOP THE FEEDING AT ONCE,
DRAIN (DECOMPRESS) THE STOMACH, AND CALL THE SPECIALIST. If the
child feels nauseated, wait one to two hours and then resume the
feeding at a slower rate.
Your Child's Feeding Tube Clogs. Children's
smaller tubes clog more easily but require less water to flush out.
Infants usually receive a 10 to 15 ml flush.
Your Child Develops Diarrhea. Causes of diarrhea
include:
• Rapid formula administration-try giving the formula at a slower
rate.
• Spoiled formula-It's best to mix new formula for each feeding.
If you do save leftover formula, always refrigerate it, and never
keep it longer than 24 hours.
• Changes in formula, medications, or feeding routines-these and
other changes can cause constipation as well as diarrhea. Introduce
changes gradually if possible.
IF DIARRHEA LASTS LONGER THAN 3 DAYS, CALL THE SPECIALIST.
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A MESSAGE FROM THE MIC-KEY* TEAM AT
KIMBERLY-CLARK HEALTH CARE
We created this guide to your MIC-KEY*
experience so you can easily find and use the information you need,
when you need it. If you have additional questions or concerns
about your MIC-KEY* Gastrostomy Feeding Tube, call us! We'll be
glad to help. The toll-free number is:
1-800-528-5591
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