avanos MIC Mode D'emploi page 4

5. Advance the MIC* GJ Feeding Tube slowly into the cannula. If the tube
does not slide freely, it may be coiled. Withdraw the tube and repeat the
procedure.
6. Hold the cannula stationary and advance the MIC* GJ Feeding Tube until the
gastric balloon enters the stomach. Palpate the tube through the duodenum.
When satisfied with the placement, check the position. The tip should lie
10–15 cm past the Ligament of Treitz (Fig. 6).
7. Stabilize the distal tube by holding it with the fingers through the jejunal
wall to withdraw the cannula from the stomach.
8. Using a male Luer syringe, inflate the balloon with 7–10 ml of sterile or
distilled water.
Caution. Do not exceed 20 ml total balloon. Do not use air. Do not inject
contrast into the balloon.
9. Tie the purse string sutures around the tube.
10. Gently pull the tube up and away from the abdomen until the balloon
contacts the inner stomach wall (Fig. 7).
11. Use the purse string sutures to attach the stomach to the peritoneum. Use
one or two extra sutures, if necessary, to ensure a leak-proof seal. Take care to
avoid puncture of the balloon.
12. Clean the residual fluid or lubricant from the tube and stoma.
13. Gently slide the external retention bolster to approximately 2–3 mm above
the skin.
14. Tie a suture around the "waist" of the bolster. Suture the ring to the skin.
This step is optional. Sutures may prevent inadvertent tube removal or
displacement as the tract matures. However, sutures may also increase the
risk of infection or the development of a fistula.
Verify Tube Position and Patency
1. Verify proper tube placement radiologically to avoid potential complication
(e.g. bowel irritation or perforation) and ensure the tube is not looped within
the stomach or small bowel.
Caution: 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 both the jejunal and gastric lumens with water to verify patency.
3. Check for moisture around the stoma. If there are signs of gastric leakage,
check the tube position and placement of the external retention bolster.
Add sterile or distilled water as needed in 1–2 ml increments. Do not exceed
balloon capacity as indicated previously.
4. Check to ensure that the external retention bolster is not placed too tightly
against the skin and rests 2–3 mm above the abdomen.
5. Begin feeding only after confirmation of proper patency, placement and
according to physician instructions.
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, 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 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 fluids 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
Flush the feeding tube with water using an ENFit® syringe every 4–6 hours
during continuous feeding, anytime the feeding is interrupted, at least every
8 hours if the tube is not being used, or per clinician's instructions. Flush the
feeding tube after checking gastric residuals. Flush the feeding tube before, after,
and in between medication administration. Avoid using acidic irrigants such as
cranberry juice and cola beverages to flush feeding tubes.
• Use a 30 to 60 ml ENFit® syringe. Do not use smaller size syringes as this can
increase pressure on the tube and potentially rupture smaller tubes.
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• Use room temperature 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 ml for adults, and
3 to 10 ml 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.
Nutrition Administration
1. Open the cap to the Jejunal access port of the MIC* GJ Feeding Tube.
2. Use an ENFit® syringe to flush the tube with the prescribed amount of water
as described in the General Flushing Guidelines.
3. Remove the flushing syringe from the Jejunal access port.
4. Securely connect an ENFit® feed set to the Jejunal access port.
Caution: Do not over-tighten the feed set connector or the syringe to the
access port.
5. Complete feeding per the clinician's instructions.
Warning: If formula is present in the gastric drainage, stop
feeding and notify the physician or health care provider.
6. Remove the feed set or syringe from the Jejunal access port.
7. Use an ENFit® syringe to flush the tube with the prescribed amount of water
as described in the General Flushing Guidelines.
8. Remove the flushing syringe from the Jejunal access port.
9. Close the cap to the Jejunal access 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 warm
water before administering through the feeding tube. Never crush enteric coated
medication or mix medication with formula.
1. Open the cap to the prescribed access port of the MIC* GJ tube.
2. Use an ENFit® syringe to flush the tube with the prescribed amount of water
as described in the General Flushing Guidelines.
3. Remove the flushing syringe from the access port.
4. Securely connect an ENFit® syringe containing the medication to the access
port.
Caution: Do not over-tighten the syringe to the access port.
5. Deliver the medication by depressing the ENFit® syringe plunger.
6. Remove the syringe from the access port.
7. Use an ENFit® syringe to flush the tube with the prescribed amount of water
as described in the General Flushing Guidelines.
8. Remove the flushing syringe from the access port.
9. Close the cap to the access port.
Gastric Decompression
Gastric decompression may be performed via either gravity drainage or low
intermittent suction.
Caution: Never connect the Jejunal access port to suction. Do not measure
residuals from the Jejunal access port.
1. Open the cap to the Gastric access port of the MIC* GJ Feeding Tube.
2. For gravity drainage, place the opened Gastric access port of the MIC* GJ
Feeding Tube directly over the opening of an appropriate container.
Note: Ensure the open access port is positioned below the stoma.
3. For low intermittent suction, connect an ENFit® syringe to the Gastric access
port.
4. Apply low intermittent suction by slowly retracting the plunger of the
syringe in short intervals.
Warning: Do not use continuous or high pressure suction. High
pressure could collapse the tube or injure the stomach tissue and
cause bleeding.
5. Disconnect the decompression syringe from the Gastric access port.
6. Use an ENFit® syringe to flush the tube with the prescribed amount of water
as described In the General Flushing Guidelines.
7. Remove the flushing syringe from the Gastric access port.
8. Close the cap to the Gastric access port.