4
Tube Placement
1. Advance the MIC* gastrostomy feeding tube until the balloon is in the
stomach.
2. Using a male Luer 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
and 15 ml total balloon volume in the Standard balloon. Do not use air. Do
not inject contrast into the balloon.
3. Tie the purse string sutures around the tube.
4. Gently pull the tube up and away from the abdomen until the balloon
contacts the inner stomach wall.
5. Use the purse string sutures to attach the stomach to the peritoneum. Take
care to avoid puncture of the balloon.
6. Clean the residual fluid or lubricant from the tube and stoma.
7. Gently slide the external retention bolster to approximately 2-3 mm above
the skin. Do not suture the bolster to the skin.
Tube Placement
1. Advance the distal end of the tube over the guidewire, through the stoma
tract and into the stomach.
2. Verify that the tube is in the stomach, remove the guidewire or peel-away
sheath if utilized and inflate the balloon.
3. Using a male Luer 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
and 15 ml total balloon volume in the Standard balloon. Do not use air. Do
not inject contrast into the balloon.
4. Gently pull the tube up and away from the abdomen until the balloon
contacts the inner stomach wall.
5. Clean the residual fluid or lubricant from the tube and stoma.
6. Gently slide the external retention bolster to approximately 2-3 mm above
the skin. Do not suture the bolster to the skin.
Verify Tube Position and Patency
1. Attach an ENFit® syringe with 10 ml water to an access port
(Fig. 1-B, 1-C,
& 2-B)
of the gastrostomy feeding tube. 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 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.
3. Begin feeding only after confirmation of proper patency, placement and
according to physician instructions.
Tube Removal
1. Ensure 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 a male Luer 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.
Caution:
Never attempt to change the tube unless trained by the
physician or other health care provider.
Warning: After use, this product may be a potential biohazard.
Handle and dispose of in accordance with accepted medical
practice and applicable local, state, and federal laws and
regulations.
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
to the instructions in the Tube Preparation section above.
3. Gently insert the Gastrostomy through the stoma into the stomach.
4. Using a male Luer 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
and 15 ml 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 external retention bolster to approximately 1-2 mm above
the skin.
8. Verify proper tube position according to the instructions in the Verify Tube
Position section above.
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 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
and after each 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.
• Ensure the second access port (if applicable) is closed with the tethered cap
prior to flushing.
• 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 an access port of the gastrostomy 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® feed set or an ENFit® syringe to the 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.
6. Remove the feed set or 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.
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 an access port of the gastrostomy 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.
