Low Profile Buttons and Hypotonia

[RiverNurse]

Hi all,

I am fairly new to pediatrics. I'm a wound care nurse and have been working in pediatrics for a year now. I work primarily with the infant population that have had issues with gastric mucosa visible around low profile buttons (MIC Key buttons - that is what we use in our facility) along with large amounts of drainage. All of the infants with drainage/leakage issues have all had poor muscle tone and three of them have had their MIC Key buttons replaced with MiniONE buttons. I have found the design of the MiniONEs have helped to clear up much of the drainage and hypergranulation tissue problems. However, I have two patients where this solution hasn't worked. In both of these patients, their buttons have become dislodged previously and then each began experiencing excessive drainage.

I have also tried removing the buttons on each patient for a day to see if the stoma would begin to contract. Initially it did, until the button was replaced.

I would like to see if there is some way to at least slow down the drainage so that these children do not experience any nutritional/electrolyte disturbances as well as protecting the skin from breakdown.

Thoughts?

Thanks,

RiverNurse

[JustBeachyNurse, LPN]

Do you mean leaking of gastric contents or serous drainage from GT stoma with granulation tissue?

A parental support group has a lot of good tips (Oley Foundation).

Look here: http://www.oley.org/tubetalks.html

[Esme12, ASN, BSN, RN]

threads merged and moved for best response

[meanmaryjean, DNP, RN]

You removed someone's Mic-key for a day? How did they get their nutrition? And did you have an order for that? We replace our immediately if not sooner in case of accidental dislodgement. I cannot imagine being able to get it back in after being out for 24 hours.

[NicuGal, MSN, RN]

When we get the skin just starting to

look funky we make a ring if duoderm and place it around the stoma with the MicKey in place. It helps stabilize the skin and keeps any leakage from irritating it. I'd never take one out and leave it out.

[RiverNurse]

You removed someone's Mic-key for a day? How did they get their nutrition? And did you have an order for that? We replace our immediately if not sooner in case of accidental dislodgement. I cannot imagine being able to get it back in after being out for 24 hours.

Yes. I did remove the pt's MIC-Key button for one day. The pt does not have prune belly syndrome, but her abdominal muscles are hypotonic. In addition, she has a history of button displacement which further complicated the issue. At our facility, if the pediatric team also agrees, the order is placed and the button removed for the specified period of time so that the musculature can contract with the hope that leakage can be resolved. However, in this instance (and this is why I posted my question), the pt's issue has not been resolved by this method. The pt continues to leak formula from her site.

As to the question regarding nutrition, this pt had leaked a significant enough amount of formula to cause her electrolytes to be off. As a result, I recommended (and the team agreed) to have an NJ tube placed, and the button removed. There was still some drainage, but not nearly as much. I returned 24 hours later and reinserted the button with no difficulty. At first, there was no drainage and I had hoped the issue was fixed. Now, though, the drainage has started again. The other potential option is a MIC Key GJ - but the patient is still likely to leak non-formula gastric contents from the site. While likely not as much, I would still be concerned about electrolyte imbalances.

Rivernurse