Kimberly-Clark MIC‑KEY Bedienungsanleitung Seite 4

• Inflate the balloon with 7-10 ml of sterile or distilled
water for adult sized tubes (REF numbers ending in -45).
CAUTIoN: Do NoT ExCEED 10 ML ToTAL BALLooN
voLUME. Do NoT UsE AIR. Do NoT INJECT CoNTRAsT
INTo ThE BALLooN.
8. Remove the guidewire through the introducer cannula
while holding the cannula in position. Remove the
introducer cannula.
verify Tube Position
1. Verify proper tube placement radiographically to avoid
potential complication (e.g. bowel irritation or perforation)
and ensure 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 lumen to verify patency.
3. Check for moisture around the stoma. If there are
signs of gastric leakage, check the tube position and
external bolster placement. Add fluid as need in 1-2 ml
increments.
CAUTIoN: Do NoT ExCEED ToTAL BALLooN voLUME
INDICATED ABovE.
4. Check to assure that the external bolster is not placed
too tightly against the skin and rests 2-3 mm 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.
Radiologic Placement Through An Estab‑
lished gastrostomy Tract
1. Under fluoroscopic guidance, insert a floppy-tipped
guidewire, up to .038", through the indwelling gastrostomy
tube.
2. Remove the gastrostomy tube over the guidewire.
3. Direct the guidewire through the stoma and coil in the
stomach.
4. Advance a .038" guidewire compatible flexible catheter
over the guidewire until the catheter tip is at the pylorus.
5. Negotiate the pylorus and advance the guidewire into the
duodenum. If the catheter is difficult to advance through
the pylorus, reduce the length of the catheter coiled in the
stomach. A rotational motion on the flexible catheter may
allow easier passage over the guidewire.
6. Advance the guidewire and catheter to a point 10-15 cm
beyond the Ligament of Treitz.
7. Remove the catheter and leave the guidewire in place.
8. Measure the stoma length with the Kimberly-Clark*
Stoma Measuring Device.
Tube Placement
1. Select the appropriate size MIC-KEY* Transgastric-
Jejunal feeding tube and prepare according to the
directions in the Tube Preparation section above.
2. Advance the distal end of the tube over the guidewire and
into the stomach.
3. Rotate the Kimberly-Clark* MIC-KEY* Transgastric-
Jejunal feeding tube while advancing to facilitate passage
of the tube through the pylorus and into the jejunum.
4. Advance the tube until the tip of the tube is 10-15 cm
beyond the Ligament of Treitz and the balloon is in the
stomach.
5. Using a Luer slip syringe, inflate the balloon.
• Inflate the balloon with 3-5 ml of sterile or distilled water
for pediatric sized tubes (REF numbers ending in -15, -22
or -30)
CAUTIoN: Do NoT ExCEED 5 ML ToTAL BALLooN
voLUME. Do NoT UsE AIR. Do NoT INJECT CoNTRAsT
INTo ThE BALLooN.
• Inflate the balloon with 7-10 ml of sterile or distilled
water for adult sized tubes (REF numbers ending in -45).
CAUTIoN: Do NoT ExCEED 10 ML ToTAL BALLooN
voLUME. Do NoT UsE AIR. Do NoT INJECT CoNTRAsT
INTo ThE BALLooN.
6. Remove the guidewire through the introducer cannula
while holding the cannula in position.
7. Remove the introducer cannula.
8. Verify proper tube placement according to Verify Tube
Position section above.
4
suggested Endoscopic Placement Procedure
1. 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.
2. Transilluminate through the anterior abdominal wall to
select a gastrostomy site that is free of major vessels,
viscera and scar tissue. The site is usually one third the
distance from the umbilicus to the left costal margin at the
midclavicular line.
3. Depress the intended insertion site with a finger. The
endoscopist should clearly see the resulting depression
on the anterior surface of the gastric wall.
4. Prep and drape the skin at the selected insertion site.
gastropexy Placement
CAUTIoN: IT Is RECoMMENDED To PERFoRM A ThREE
PoINT gAsTRoPExY IN A TRIANgLE CoNFIgURATIoN To
ENsURE ATTAChMENT oF ThE gAsTRIC wALL To ThE
ANTERIoR ABDoMINAL wALL.
1. Place a skin mark at the tube insertion site. Define
the gastropexy pattern by placing three skin marks
equidistant from the tube insertion site and in a triangle
configuration.
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.
4. Measure the stoma length with the Kimberly-Clark*
Stoma Measuring Device.
Measuring the stoma Length
CAUTIoN: sELECTIoN oF ThE CoRRECT sIzE MIC‑KEY* Is
CRITICAL FoR ThE sAFETY AND CoMFoRT oF ThE PATIENT.
MEAsURE ThE LENgTh oF ThE PATIENT's sToMA wITh
ThE sToMA MEAsURINg DEvICE. ThE shAFT LENgTh
oF ThE MIC‑KEY* sELECTED shoULD BE ThE sAME As
ThE LENgTh oF ThE sToMA. AN INAPPRoPRIATELY
sIzED MIC‑KEY* CAN CAUsE NECRosIs, BURIED BUMPER
sYNDRoME AND/oR hYPERgRANULATIoN TIssUE.
1. Moisten the tip of the Stoma Measuring Device with
water soluble lubricant. Do not us mineral oil. Do not use
petroleum jelly.
2. Advance the Stoma Measuring Device over the
guidewire, through the stoma and into the stomach. DO
NOT USE FORCE.
3. Fill the Luer slip syringe with 5ml of water and attach to
the balloon port. Depress the syringe plunger and inflate
the balloon.
4. Gently pull the device toward the abdomen until the
balloon rests against the inside of the stomach wall.
5. Slide the plastic disc down to the abdomen and record
the measurement above the disc.
6. Add 4-5 mm to the recorded measurement to ensure the
proper stoma length and fit in any position. Record the
measurement.
7. Using a Luer slip syringe, remove the water in the balloon.
8. Remove the stoma measuring device.
9. Document the date, lot number and measured centimeter
shaft length.
Tube Placement
1. Select the appropriate sized MIC-KEY* Transgastric-
Jejunal feeding tube and prepare according to the
directions in the Tube Preparation section listed above.
2. Advance the distal end of the tube over the guidewire
until the proximal end of the guidewire exits the
introducer cannula.
NoTE: Direct visualization and manipulation of the
introducer and guidewire may be required to pass the
guidewire through the end of the introducer.
3. Hold the introducer hub and jejunal port while advancing
the tube over the guidewire and into the stomach.
4. Using endoscopic guidance, grasp the suture loop or the
tip of the tube with atraumatic forceps.
5. Advance the Kimberly-Clark* MIC-KEY* Transgastric-
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.
6. Release the tube and withdraw the endoscope and
forceps in tandem, leaving the tube in place.
7. Ensure that the external bolster is flush with the skin.
8. Using a Luer slip syringe, inflate the balloon.
• Inflate the balloon with 3-5 ml of sterile or distilled water
for pediatric sized tubes (REF numbers ending in -15, -22
or -30).
CAUTIoN: Do NoT ExCEED 5 ML ToTAL BALLooN
voLUME. Do NoT UsE AIR. Do NoT INJECT CoNTRAsT
INTo ThE BALLooN.
• Inflate the balloon with 7-10 ml of sterile or distilled
water for adult sized tubes (REF numbers ending in -45).
CAUTIoN: Do NoT ExCEED ThE 10 ML ToTAL BALLooN
voLUME. Do NoT UsE AIR. Do NoT INJECT CoNTRAsT
INTo ThE BALLooN.
9. Remove the guidewire through the introducer cannula
while holding the cannula in place.
10. Remove the cannula.
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 ToTAL BALLooN voLUME
INDICATED ABovE.
4. Check to assure 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.