Halyard MIC GASTROSTOMY FEEDING TUBE Instrucciones De Uso página 4

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.
Note: For gastrostomy tube placement , the best angle of insertion is a true
right angle to the surface of the skin. The needle should be directed toward the
pylorus if conversion to PEGJ tube is anticipated.
4. Use endoscopic visualization to verify correct needle placement.
Additionally, to aid in verification, a water filled syringe may be attached to
the needle hub and air aspirated from the gastric lumen.
5. Advance a J tip guidewire, up to .038", through the needle and into stomach.
Confirm position.
6. Remove the introducer needle, keeping the J tip 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
Note: A peel-away sheath may be used to facilitate advancement of the tube
through the stoma tract.
1. Select the appropriate gastrostomy feeding tube and prepare according to
the instructions in the Tube Preparation section above.
2. Advance the distal end of the tube over the guidewire, through the stoma
tract and into the stomach.
3. Verify that the tube is in the stomach, remove the endoscope, remove the
guidewire or peel-away sheath if utilized and inflate the balloon.
4. Using the Luer slip syringe, inflate the balloon.
• Inflate the LV balloon with 3–5 ml of sterile or distilled
water.
• Inflate the Standard balloon with 7–10 ml of sterile or
distilled water.
Caution: Do not exceed 7 ml total balloon volume inside the LV balloon.
Do not use air. Do not inject contrast into the balloon.
Caution: Do not exceed 15 ml total balloon volume in the Standard
balloon. Do not use air. Do not inject contrast into the balloon.
5. Gently pull the tube up and away from the abdomen until the balloon
contacts the inner stomach wall.
6. Clean the residual fluid or lubricant from the tube and stoma.
7. Gently slide the SECUR-LOK* ring to approximately
1-2 mm (approximately 1/8 inch) above the skin.
Verify Tube Position and Patency
1. Attach a catheter tip syringe with 10 ml of water to the feeding port.
Aspirate gastric contents. When air or gastric contents are observed, flush
the tube.
2. Check for moisture around the stoma. If there are signs of gastric leakage,
check the tube position and SECUR-LOK* ring placement. Add fluid as
needed in 1–2 ml increments. Do not exceed balloon capacity as indicated
previously.
3. Begin feeding only after confirmation of proper patency, placement and
according to physician instructions.
Tube Removal
1. First, make sure that this type of tube can be replaced at the bedside.
2. Assemble all equipment and supplies, cleanse hands using aseptic
technique and apply clean, powder-free gloves.
3. Rotate the tube 360 degrees to ensure the tube moves freely and easily.
4. Firmly insert the catheter tip syringe into the balloon port and withdraw all
the fluid from the balloon.
5. Apply counter pressure to the abdomen and remove the tube with gentle,
but firm traction.
Note: If resistance is encountered, lubricate the tube and stoma with
water soluble lubricant. Simultaneously push and rotate the tube. Gently
manipulate the tube free. If the tube will not come out, refill the balloon with
the prescribed amount of water and notify the physician. Never use excessive
force to remove a tube.
Warning: Never attempt to change the tube unless trained by
the physician or other health care provider.
Replacement Procedure
1. Cleanse the skin around the stoma site and allow the area to air dry.
2. Select the appropriate size Gastrostomy feeding tube and prepare according
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to the instructions in the Tube Preparation section above.
3. Lubricate the distal end of the tube with water soluble lubricant and gently
insert the Gastrostomy through the stoma into the stomach.
4. Using the Luer slip syringe, inflate the balloon.
• Inflate the LV balloon with 3–5 ml of sterile or distilled water.
• Inflate the Standard balloon with 7–10 ml of sterile or distilled water.
Caution: Do not exceed 7 ml total balloon volume inside the LV balloon.
Do not use air. Do not inject contrast into the balloon.
Caution: Do not exceed 15 ml total balloon volume in the Standard
balloon. Do not use air. Do not inject contrast into the balloon.
5. Gently pull the tube up and away from the abdomen until the balloon
contacts the inner stomach wall.
6. Clean the residual fluid or lubricant from the tube and stoma.
7. Gently slide the SECUR-LOK* ring to approximately 1-2 mm (approximately
1/8 inch) above the skin.
8. Verify proper tube position according to the instructions in the Verify Tube
Position section above.
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 gastric and balloon ports
Use a cotton tip applicator or soft cloth to remove all residual formula and
medication.
Rotate the tube
Rotate the tube 360 degrees plus a quarter turn daily.
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 a catheter tip or slip tip 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 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