Do you replace MIC-KEY buttons??

[skoolrn, BSN, MSN, RN]

Hi fellow nurses!

I have a darling special needs child that routinely gets her MIC-Key button out at home. She recently succeeded in getting it out here at school even though she is a 1:1 with staff. My district does not have a policy or procedure for school nurses to reinsert the MIC-KEY, so when she got it out Mom had to come and put it back in. Mom had a hard time re-inserting because it was out for 30 mins. Mom says it has to go right back in or it becomes impossible and then its a trip to the ED or GI doc. So my question is this: Do any of you replace GT's? Do you have a written policy or just a MD order??? Mom wants me to replace if it gets pulled out again but I won't without sometype of policy. And yes, she is wearing a belly band type wrap and a neoprene sensory vest and she has 1:1 supervision so you would think she would never be able to pull it out but.....SHE DOES! Any feedback will be appreciated!

[Jolie, BSN]

Yes. We do this in our district with a doctor's standing order, parental consent and proper advance training of the nurses.

Our support staff is wonderful about contacting us immediately and setting up everything so we can come in quickly (if we are in another building) and get it done in time to avoid a trip to the hospital.

It's all arranged in advance when we have our parent meetings in the weeks before school starts, and then we do some "dry runs" during our yearly inservice training with building staff, which occurs in early August.

[lrenfro]

I am a school RN in Arkansas and the Arkansas State Board of Nursing School Nurse Roles & Responsibilities specifically states "procedures that the LPN is not qualified to perform" and listed is gastrostomy tube reinsertion.

There is also a table that lists procedures and who can perform the procedure the ONLY procedure that is marked X (cannot perform) under the RN category is Gastrostomy Tube Reinsertion............It makes no sense to me and I see that others are performing this procedure in the school setting......Has everyone checked their Board of Nursing Guidelines? Anyone else in Arkansas?