Kimberly-Clark MIC-KEY Gebrauchsanweisung Seite 6

4. Lock into place by pushing in and rotating the connector CLOCKWISE until a slight resistance is
felt (approximately 1/4 of a turn). DO NOT rotate the connector past the stop point.
5. To remove the Extension Set, rotate it COUNTER CLOCKWISE until the black line on the
Extension Set aligns with the black line on the MIC-KEY*. Remove the set and cap the port
with the attached port cover.
Verify Tube Position and Patency
1. With either Extension Set connected, attach the catheter-tip syringe containing 10 ml of
water to the feed port.
2. Aspirate gastric contents. The presence of gastric contents in the syringe confirms the correct
tube position within the stomach.
3. Flush with 10 ml of water. Check for leakage around the stoma. If there is a leak, reconfirm
proper balloon inflation. Also verify the French size, stoma length and placement. Proper
placement may be confirmed radiographically. The MIC-KEY* has a Radiopaque stripe on the
tube. Do not use contrast inside the balloon.
4. Begin feeding only after confirmation of proper patency, placement and according to
physician instructions.
Tube Removal
1. First, make sure that this type of tube can be replaced at the bedside.
2. Assemble all equipment and supplies, cleanse hands using aseptic technique and apply clean,
powder free gloves.
3. Rotate the tube 360 degrees to ensure the tube moves freely and easily.
4. Firmly insert the Luer slip syringe into the balloon port and withdraw all the fluid from the
balloon.
5. Apply counter pressure to the abdomen and remove the tube with gentle, but firm traction.
Note: If resistance is encountered, lubricate the tube and stoma with water soluble lubricant.
Simultaneously push and rotate the tube. Gently manipulate the tube free. If the tube will not
come out, refill the balloon with the prescribed amount of water and notify the physician. Never
use excessive force to remove a tube.
Warning: Never attempt to change the tube unless trained by the physician or
other health care provider.
Replacement Procedure
1. Cleanse the skin around the stoma site and allow the area to air dry.
2. Measure the stoma length with the Kimberly-Clark* Stoma Measuring Device.
3. Select the appropriate size MIC-KEY* Gastrostomy feeding tube and prepare according to the
directions in the Tube Preparation section above.
4. Lubricate the distal end of the tube with water soluble lubricant and gently insert the
MIC-KEY* through the stoma into the stomach.
5. Ensure the external bolster is flush with the skin.
6. Using the 6 ml Luer slip syringe, inflate the balloon.
• Inflate the 12 FR balloon with 3 ml of sterile or distilled water.
• Inflate 14 FR and larger tube balloons with 5 ml of sterile or distilled water.
Caution: Do not exceed 5 ml total balloon volume inside the 12 FR balloon. Do not use air.
Do not inject contrast into the balloon.
Caution: Do not exceed 10 ml total balloon volume in 14 FR or larger tube balloons. Do not
use air. Do not inject contrast into the balloon.
7. Clean the residual fluid or lubricant from the tube and stoma.
8. Verify proper tube position according to the direction in the Verify Tube Position section above.
Feeding Administration
1. Remove the feed port plug (Fig 3A).
2. If feeding with a syringe, connect the catheter tip syringe to the bolus extension feed port
(Fig 4A). Push firmly and twist 1/4 turn to secure the connection.
3. If using a feeding bag, purge the air from the bag and tubing. Connect the tubing to the
SECUR-LOK* Extension Set (Fig 3B). Push firmly and twist 1/4 turn to secure the connection.
4. Adjust the formula flow rate and administer the feeding.
5. Upon completion, flush the Extension Set and MIC-KEY* with 20 ml of water until the tubing
is clear.
6. Disconnect the SECUR-LOK* or the Bolus Extension Set and replace the MIC-KEY* feed port
plug (Fig 2B).
7. Wash the Extension Set and the catheter tip syringe or feeding bag with warm soapy water,
rinse and dry thoroughly.
8. If feeding continuously with a pump, flush the MIC-KEY* with 10 ml to 20 ml of water every
six hours.
Decompression
1. Decompression may be done with either the Bolus or SECUR-LOK* Extension Set.
2. Attach the Bolus (Fig 4) or the SECUR-LOK* (Fig 3) Extension Set to the MIC-KEY* (Fig 2).
3. If using the SECUR-LOK* Extension Set, remove the feed port plug. Drain the stomach
contents into a container.
4. After decompression, flush the Extension Set and the MIC-KEY* with 20 ml of warm water.
5. Remove the Extension Set and replace the attached MIC-KEY* plug.
6
Medication Administration
Use liquid medication when possible and consult the pharmacist to determine if it is safe to crush
solid medication and mix with water. If safe, pulverize the solid medication into a fine powder
form and dissolve the powder in water before administering through the feeding tube. Never
crush enteric coated medication or mix medication with formula.
Using a catheter tip syringe flush the tube with the prescribed amount of water.
Tube Patency Guidelines
Proper tube flushing is the best way to avoid clogging and maintain tube patency. The following
are guidelines to avoid clogging and maintain tube patency.
• Flush the feeding tube with water every 4-6 hours during continuous feeding, anytime the
feeding is interrupted, before and after every intermittent feeding, or at least every 8 hours if
the tube is not being used.
• Flush the feeding tube before and after medication administration and between medications.
This will prevent the medication from interacting with formula and potentially causing the
tube to clog.
• Use liquid medication when possible and consult the pharmacist to determine if it is safe to
crush solid medication and to mix with water. If safe, pulverize the solid medication into a
fine powder form and dissolve the powder in warm water before administering through the
feeding tube. Never crush enteric-coated medication or mix medication with formula.
• Avoid using acidic irrigants such as cranberry juice and cola beverages to flush feeding tubes
as the acidic quality when combined with formula proteins may actually contribute to tube
clogging.
General Flushing Guidelines
• Use a 30 to 60 cc catheter tip syringe. Do not use smaller size syringes as this can increase
pressure on the tube and potentially rupture smaller tubes.
• Use room temperature tap water for tube flushing. Sterile water may be appropriate where
the quality of municipal water supplies is of concern. The amount of water will depend on the
patient's needs, clinical condition, and type of tube, but the average volume ranges from 10 to
50 mls for adults, and 3 to 10 mls for infants. Hydration status also influences the volume used
for flushing feeding tubes. In many cases, increasing the flushing volume can avoid the need
for supplemental intravenous fluid. However, individuals with renal failure and other fluid
restrictions should receive the minimum flushing volume necessary to maintain patency.
• Do not use excessive force to flush the tube. Excessive force can perforate the tube and can
cause injury to the gastrointestinal tract.
• Document the time and amount of water used in the patient's record. This will enable all
caregivers to monitor the patient's needs more accurately.
Daily Care & Maintenance Check List
Assess the patient
Assess the patient for any signs of pain, pressure or discomfort.
Assess the stoma site Assess the patient for any signs of infection, such as redness,
irritation, edema, swelling, tenderness, warmth, rashes,
purulent or gastrointestinal drainage.
Assess the patient for any signs of pressure necrosis, skin
breakdown or hypergranulation tissue.
Clean the stoma site Use warm water and mild soap.
Use a circular motion moving from the tube outwards.
Clean sutures, external bolsters and any stabilizing devices using
a cotton-tipped applicator.
Rinse thoroughly and dry well.
Assess the tube Assess the tube for any abnormalities such as damage, clogging
or abnormal discoloration.
Clean the feeding tube Use warm water and mild soap being careful not to pull or
manipulate the tube excessively.
Rinse thoroughly, dry well.
Clean the jejunal, gastric
and balloon ports Use a cotton tip applicator or soft cloth to remove all residual
formula and medication.
Do not rotate the
external bolster This will cause the tube to kink and possibly lose position.
Verify placement of the
external bolster Verify that the external bolster rests 2-3mm above the skin.
Flush the feeding tube Flush the feeding tube with water every 4-6 hours during
continuous feeding, anytime the feeding is interrupted, or at
least every 8 hours if the tube is not being used.
Flush the feeding tube after checking gastric residuals.
Flush the feeding tube before and after medication
administration.
Avoid using acidic irrigants such as cranberry juice and cola
beverages to flush feeding tubes.