Halyard MIC Gebrauchsanweisung Seite 3

Warning: Allow adequate distance between the insertion site and gastropexy
placement to prevent interference of the T-Fastener and inflated balloon.
2. Localize the puncture sites with 1% lidocaine and administer local anesthesia to the skin and
peritoneum.
3. Place the first T-Fastener and confirm Intragastric position. Repeat the procedure until all
three T-Fasteners are inserted at the corners of the triangle.
4. Secure the stomach to the anterior abdominal wall and complete the procedure.
Create the Stoma Tract
1. Create the stoma tract with the stomach still insufflated and in apposition to the abdominal
wall. Identify the puncture site at the center of the gastropexy pattern. With endoscopic
guidance confirm that the site overlies the distal body of the stomach below the costal
margin and above the transverse colon.
Caution: Avoid the epigastric artery that courses at the junction of the medial two-
thirds and lateral one-third of the rectus muscle.
Warning: Take care not to advance the puncture needle too deeply in order to
avoid puncturing the posterior gastric wall, pancreas, left kidney, aorta or spleen.
2. Anesthetize the puncture site with local injection of 1% lidocaine down to the peritoneal
surface.
3. Insert a .038" compatible introducer needle at the center of the gastropexy pattern into the
gastric lumen directed toward the pylorus.
Note: The best angle of insertion is a 45 degree angle to the surface of the skin.
4. Use endoscopic visualization to verify correct needle placement.
5. Advance a guidewire, up to .038", through the needle into the stomach. Using endoscopic
visualization, grasp the guidewire with atraumatic forceps.
6. Remove the introducer needle, leaving the guidewire in place and dispose of according to
facility protocol.
Dilation
1. Use a #11 scalpel blade to create a small skin incision that extends alongside the guidewire,
downward through the subcutaneous tissue and fascia of the abdominal musculature. After
the incision is made, dispose of according to facility protocol.
2. Advance a dilator over the guidewire and dilate the stoma tract to the desired size.
3. Remove the dilator over the guidewire, leaving the guidewire in place.
Tube Placement
1. Advance the distal end of the tube over the guidewire, through the stoma tract and into the
stomach.
2. Using endoscopic guidance, grasp the suture loop (Fig 1-F) or the tip of the tube with
atraumatic forceps.
3. Advance the HALYARD* MIC* Gastric-Jejunal Feeding Tube through the pylorus and upper
duodenum. Continue to advance the tube using the forceps until the tip is positioned 10–15
cm beyond the Ligament of Treitz and the balloon is in the stomach.
4. Release the tube and withdraw the endoscope and forceps in tandem, leaving the tube in
place.
5. Using a Luer slip syringe, inflate the balloon with 7–10 ml of sterile or distilled water.
Caution: Do not exceed 20 ml total balloon volume. Do not use air. Do not inject
contrast into the balloon.
6. Remove the guidewire.
7. Gently pull the tube up and away from the abdomen until the balloon contacts the inner
stomach wall and a slight tension is felt. The balloon should now abut the stomach wall.
8. Gently slide the SECUR-LOK* external retention ring down the tube toward the abdomen
until it rests 2–3 mm above the skin. Do not suture the ring to the skin.
Verify Tube Position
1. Verify proper tube placement radiographically to avoid potential complication (e.g. bowel
irritation or perforation) and ensure that the tube is not looped within the stomach or small
bowel.
Note: The jejunal portion of the tube contains tungsten which is radiopaque and can be used
to radiographically confirm position. Do not inject contrast into the balloon.
2. Flush the gastric and jejunal lumens to verify patency.
3. Check for moisture around the stoma. If there are signs of gastric leakage, check the tube
position and the external bolster placement. Add fluid as needed in 1–2 ml increments.
Caution: Do not exceed 20 ml total balloon volume.
4. Check to make sure that the external bolster is not placed too tightly against the skin and rest
2–3mm above the abdomen.
5. Document the date, the type, the size, and lot number of the tube, the fill volume of the
balloon, skin condition and patient tolerance to the procedure. Start feeding and medication
administration per physician orders and after confirmation of proper tube placement and
patency.
Endoscopic Placement Through An Existing Gastrostomy Tract
1. Select the appropriate MIC* Gastric-Jejunal Feeding Tube and prepare according to the
directions in the Tube Preparation section listed above.
2. Following established protocol, perform routine Esophagogastroduodenoscopy (EGD).
Once the procedure is complete and no abnormalities are identified that could pose a
contraindication to placement of the tube, place the patient in the supine position and
insufflate the stomach with air.
3. Manipulate the endoscope until the indwelling gastrostomy tube is in the visual field.
4. Insert a floppy-tip guidewire into the indwelling gastrostomy tube and remove the tube.
Tube Placement
1. Advance the HALYARD* MIC* Gastric-Jejunal Feeding Tube over the guidewire and into the
stomach.
2. Refer to step 2 in the Tube Placement section above and complete the procedure according to
the steps listed.
3. Verify proper placement according to the directions in the Verify Tube Position section listed
above.
Jejunal Feeding
1. Open the feeding port cover (Fig 1-B) located at the top of the Gastric-Jejunal Feeding Tube.
2. Using a catheter tip syringe flush the Jejunal port with 30 ml of sterile or distilled water.
3. Remove the syringe and insert the feed set into the Jejunal port. Use a firm 1/4 twist to
secure the connection.
4. Open the feed clamp if present.
5. Flush the Jejunal and Gastric ports every 4–6 hours with at least 30 ml of water. Do not use
force.
6. If formula is present in the gastric drainage, stop feeding and notify the physician or health
care provider.
Caution: Never connect the Jejunal port to suction. Do not measure residuals from the
Jejunal port.
Gastric Decompression
1. Open the gastric port and connect it to gravity drainage or low, intermittent suction to allow
stomach contents or gas to escape.
2. Flush the gastric port every 4–6 hours with at least 30 ml of water.
Caution: Do not use continuous or high intermittent suction. High pressure could
collapse the tube or injure the stomach tissue and cause bleeding.
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 Use a cotton tip applicator or soft cloth to
ports 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 Verify that the external bolster rests 2–3mm
bolster 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.
Balloon Maintenance
Check the water volume in the balloon once a week.
• Insert a Luer slip syringe into the balloon inflation port and withdraw the fluid while holding
the tube in place. Compare the amount of water in the syringe to the amount recommended
or the amount initially prescribed and documented in the patient record. If the amount is less
than recommended or prescribed, refill the balloon with the water initially removed, then
draw up and add the amount needed to bring the balloon volume up to the recommended
and prescribed amount of water. Be aware as you deflate the balloon there may be some
gastric contents that can leak from around the tube. Document the fluid volume, the amount
of volume to be replaced (if any), the date and time.
• Wait 10–20 minutes and repeat the procedure. The balloon is leaking if it has lost fluid, and
the tube should be replaced. A deflated or ruptured balloon could cause the tube to dislodge
or be displaced. If the balloon is ruptured, it will need to be replaced. Secure the tube into
position using tape, then follow facility protocol and/or call the physician for instructions.
Note: Refill the balloon using sterile or distilled water, not air or saline. Saline can crystallize
and clog the balloon valve or lumen, and air may seep out and cause the balloon to collapse.
Be sure to use the recommended amount of water as over-inflation can obstruct the lumen or
decrease balloon life and under-inflation will not secure the tube properly.
Tube Occlusion
Tube occlusion is generally caused by:
• Poor flushing techniques
• Failure to flush after measurement of gastric residuals
• Inappropriate administration of medication
• Pill fragments
• Viscous medications
• Thick formulas, such as concentrated or enriched formulas that are generally thicker and
more likely to obstruct tubes
• Formula contamination that leads to coagulation
• Reflux of gastric or intestinal contents up the tube
To Unclog A Tube
1. Make sure that the feeding tube is not kinked or clamped off.
2. If the clog is visible above the skin surface, gently massage or milk the tube between fingers
to break up the clog.
3. Next, place a catheter tip syringe filled with warm water into the appropriate adaptor or
lumen of the tube and gently pull back on then depress the plunger to dislodge the clog.
4. If the clog remains, repeat step #3. Gentle suction alternating with syringe pressure will
relieve most obstructions.
5. If this fails, consult with the physician. Do not use cranberry juice, cola drinks, meat
tenderizer or chymotrypsin, as they can actually cause clogs or create adverse reactions
in some patients. If the clog is stubborn and cannot be removed, the tube will have to be
replaced.
Balloon Longevity
Precise balloon life cannot be predicted. Silicone balloons generally last 1–8 months, but the life
span of the balloon varies according to several factors. These factors may include medications,
volume of water used to inflate the balloon, gastric pH and tube care.
Warning: For enteral nutrition and/or medication only.
For more information, please call 1-844-425-9273 in the United States,
or visit our web site at www.halyardhealth.com.
Educational Booklets: "A guide to Proper Care" and a Stoma Site and Enteral Feeding Tube
Troubleshooting Guide is available upon request. Please contact your local representative or
contact Customer Care.
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