Kimberly-Clark MIC‑KEY Bedienungsanleitung Seite 5

Endoscopic Placement Through An Existing
gastrostomy Tract
1. 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.
2. Manipulate the endoscope until the indwelling
gastrostomy tube is in the visual field.
3. Insert a floppy-tip guidewire through the indwelling
gastrostomy tube and remove the tube.
4. Measure the stoma length with the Kimberly-Clark*
Stoma Measuring Device.
Tube Placement
1. Select the appropriate sized MIC-KEY* Transgastric-
Jejunal feeding tube and prepare according to the
directions in the Tube Preparation section above.
2. Hold the introducer cannula and jejunal hub while
advancing the Kimberly-Clark* MIC-KEY* Transgastric-
Jejunal feeding tube over the guidewire and into the
stomach.
3. Refer to step 2 in the Tube Placement section above and
complete the procedure according to the steps listed.
4. Verify proper placement according to the directions in the
Verify Tube Position section listed above.
Extension set Assembly For Jejunal Feeding
1. Open the feeding port cover (Fig 1C) located at the top of
the MIC-KEY* Transgastric-Jejunal feeding tube.
2. Insert the MIC-KEY* extension set (Fig 2) into the port
labeled "Jejunal" by aligning the lock and key connector.
Align the black orientation marking on the set with the
corresponding black orientation line on the jejunal feeding
port.
3. Lock the set into the jejunal feeding port by pushing
in and rotating the connector clockwise until a slight
resistance is felt (approximately 1/4 turn) Do not rotate
the connector past the stop point.
4. Remove the extension set by rotating the connector
counter clockwise until the black line on the set aligns
with the black line on the jejunal feeding port.
5. Remove the set and cap the gastric and jejunal ports with
the attached port cover.
CAUTIoN: NEvER CoNNECT ThE JEJUNAL PoRT To
sUCTIoN. Do NoT MEAsURE REsIDUALs FRoM ThE
JEJUNAL PoRT.
Extension set Assembly For gastric
Decompression
1. Open the feeding port cover located at the top of the MIC-
KEY* Transgastric-Jejunal feeding tube.
2. Insert the MIC-KEY* Bolus Extension set (Fig 3) into
the port labeled "Gastric" by aligning the lock and key
connector. Align the black orientation marking on the
set with the corresponding black orientation line on the
gastric port.
3. Lock the set into the gastric decompression port by
pushing in and rotating the connector clockwise until a
slight resistance is felt (approximately 1/4 turn).
NoTE: Do not rotate the connector past the stop point.
4. Remove the extension set by rotating the connector
counter-clockwise until the black line on the set aligns
with the black line on the gastric port.
5. Remove the set and cap the gastric and jejunal ports with
the attached port cover.
CAUTIoN: Do NoT UsE CoNTINUoUs oR hIgh
INTERMITTENT sUCTIoNs. 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 ml 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 Checklist
Assess the patient
Assess the patient for any signs of pain, pressure or
discomfort, 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.
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.
Kit Contents:
* 1 Low-Profile Transgastric-Jejunal Feeding Tube
* 1 Introducer Cannula
* 1 - 6 ml Luer Slip Syringe
* 1 - 35 ml Catheter Tip Syringe
* 1 MIC-KEY* Extension Set with SECUR-LOK* Right Angle Connector
and 2 Port "Y" and Clamp 12
* 1 MIC-KEY* Bolus Extension Set with Cath Tip, SECUR-LOK* Straight
Connector and Clamp 12
* 4 Gauze Pads
For enteral nutrition and /or medication only.
For more information, please call 1-800-KCHELPS in the United States,
or visit our web site at www.kchealthcare.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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