avanos MIC-KEY Mode D'emploi page 5

Extension Set Assembly for Jejunal Feeding
1. Open the jejunal port cover (Fig 1-B) located at the top of the MIC-KEY*
Jejunal Feeding Tube.
2. Insert the MIC-KEY* Continuous Feed Extension Set with ENFit® Connectors
by aligning the black line on the SECUR-LOK* connector (Fig 3-A) with the
black line on the MIC-KEY* Jejunal port (Fig 1-B).
3. Lock into place by pushing in and rotating the SECUR-LOK* connector
(Fig 3-A) CLOCKWISE until a slight resistance is felt (approximately
1/4 of a turn).
Caution: DO NOT rotate the connector past the stop point.
4. To remove the extension set, rotate it COUNTER CLOCKWISE until the black
line on the SECUR-LOK* connector (Fig 3-A) aligns with the black line on the
MIC-KEY* Jejunal port (Fig 1-B).
5. Remove the set and cap the jejunal port with the attached port cover.
Caution: Never connect the jejunal port to suction.
Do not measure residuals from the jejunal port.
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 an enteral feeding 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
Caution: Use a 30 to 60 cc enteral feeding 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.
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 2–3 mm above the skin.
Flush the feeding tube
Flush the feeding tube with water using an enteral feeding syringe 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 slip tip 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 an enteral feeding syringe filled with warm water into the
appropriate Extension Set with ENFit® Connections 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 and consider trying a solution of
pancreatic enzymes and sodium bicarbonate (1 crushed Viokase tablet
or 1 teaspoon Viokase powder mixed with 1 nonenteric-coated sodium
bicarbonate tablet, or 1/8 teaspoon baking soda dissolved in 5 ml warm
water) instilled through a catheter tip syringe. Allow to remain in the tube
for 30 minutes. Do not use cranberry juice, cola drinks, meat tenderizer or
chymotrypsin, as they can actually cause clogs or create adverse reactions
in some patients. Diet sodas (non-cola) and carbonated/seltzer water may
prove successful in removing some clogs. 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.
MRI Safety Information
Non-clinical testing has demonstrated the Low-Profile (MIC-KEY*) Enteral
Feeding Tube System is MR Conditional. A patient with this device can be safely
scanned in an MR system meeting the following conditions:
• Static magnetic field of 1.5 Tesla or 3 Tesla;
• Maximum spatial field gradient of 1,960 G/cm (19.6 T/m) or less.
• Maximum MR system reported, whole body averaged specific absorption rate
(SAR) of < 2 W/kg (Normal Operating Mode).
MRI-related heating: Under the scan conditions defined above, the Low-
Profile (MIC-KEY*) Tube System is expected to produce a maximum temperature
rise of less than 1.3 °C after 15 minutes of continuous scanning.
Artifact Information
In non-clinical testing, the image artifact caused by the device extends less than
45 mm from the Low-Profile (MIC-KEY*) Enteral Feeding Tube System when
imaged with a gradient echo pulse sequence and a 3 T MRI system.
Warning: For enteral nutrition and/or medication only.
For more information, please call 1-844-4AVANOS (1-844-428-2667) in the
United States, or visit our web site at www.avanos.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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