Mic-key Buttons

JustBeachyNurse, LPN · Apr 3, 2015

What do you want to know? First replacement is generally done by the MD (surgeon or GI) if a new placement is dislodge the tract is not yet healed you have less than a minute to rinse & replace or use a foley to maintain the tract and call the MD/go to ED.

Buttons are replaced every 1-3 months depending on MD order. Some agencies only allow RN or parent to inflate the balloon.

Site care is mild soap and water. You can use a cotton swab (some use saline if skin is sensitive) to get under button.

GT buttons need to be gently rotated a few times a day (a quarter turn).

JT and GJT buttons must NEVER be rotated as you can dislodge the weighted tube in the jejunum. Careful not to rotate too much or granulation tissue can develop. Covering the site with split gauze is necessary in the initial phase to contain any serous drainage. Some patients only use a dressing when ointments are used, some use a dressing always, some nearly never. The barrier cream or ointment at the site is based on physician order. Some use mupirocin, some petroleum jelly, some bacitracin, some zinc oxide. Triamcinalone ointment is often very effective to treat granulation especially if caught early before cauterization is needed.

never leave the extension tubing attached when not in use. Especially when repositioning or transferring the client! This is high risk for the extension to get caught and dislodge the GB with an intact balloon

The two main manufacturers (Kendall makes MIC-KEY, AMT (American medical technologies) makes the AMT mini-one) have training and resources if you choose the healthcare professional website. Both have nurse educators that can answer questions during business hours and help troubleshoot

Flush post medication or feed volume depends on patient/physician. I have 8 yr olds with 85 mL flushes, 17yo with 30mL flushes. Volume is 3 to 120mL. JT always requires larger volume due to tube length generally at least 8mL.

Nibbles1 · Apr 3, 2015

This^^^^ also you might have to vent the child periodically so that gas doesn't build up on their tummy.

Elle23 · Apr 3, 2015

It isn't a new stoma. Just switched to a Mic-key from a different type of button.

There are no orders to replace the Mic-key periodically. Do I need to see about that?

What supplies do I need to have on hand to replace it? Distilled water and water soluble lube? Anything else?

I assume placement needs to be checked each shift (aspiration/ ausculation)?

How often does the balloon volume need to be checked? (I believe it started out with 5 ml).

JustBeachyNurse, LPN · Apr 3, 2015

Balloon is usually once a week. Never overfill it will stress the balloon and risk leakage. The balloon port is marked with the max volume amount (most MIC-KEY are 5mL, AMT varies 2.5 to 7.5). When you check the balloon you must secure the GB just like if you were changing trach ties to reduce the chance for accidental dislodgement

The replacement GB are kits complete with extension. Some brands/"styles" include lube & a water filled syringe (like some Foley kits). Others you need surgilube and clean bottled water. It's a luer lock or slip tip syringe and is generally included in the kit. If not a new tract client should have been sent home with a back up/replacement kit. Otherwise yes you need orders for nursing to replace per physician recommended schedule q1 month, q2 months, q3 months etc plus an order to the supply company to send the replacement kit per the schedule. There should always be at least one of not two spares available (one home, one in go bag.

Checking placement usually I "vent". Attach the bolus extension with a 30-60 mL syringe without plunger. The air comes out with possibly residual feed. (Vent out gas & check for residual at the same time). If a child had increased mucus that is swallowed it can clog the tube when venting. You may need to gently aspirate to pull out the mucus. I have one kiddo with tons of has plus copious mucus. We actually have to strain the residual before replacing. It may be 50mL residual and 20-30 mL mucus! (For this kiddo mucus is a huge discomfort combine with gas and wow!!)

Auscultation is useless and ineffective. You can actually cause gastric distention and bloating by instilling air via the GB, especially if the client had a fundiplication and can't easily burp or vomit.

Venting, you may need to check pH, and checking residuals is used to confirm placement

Even a healed tract is at risk for granulation development especially if the button is often manipulated, played with, slept on

Elle23 · Apr 3, 2015

Great info. Thanks!

caliotter3 · Apr 3, 2015

You can get the doctor to add an order to the 485 regarding changing of the device every 3 to 6 months (usually 6 months, unless function deteriorates sooner) or for malfunction, by nurse/PCG. Another 485 entry would be to include venting to prevent/relieve gastric distention. Site care can be specified. Many admitting supervisors write the initial 485 to include the most common cleansing agents/methods, so that one can use what is available/indicated at the time. As time goes on, the general care can be modified as needed.

brillohead, ADN, RN · Apr 4, 2015

Petroleum products are actually contraindicated for use with Mic-Key buttons as it can break down the silicone in the product (just like using Vaseline with a condom can lead to pregnancy!).

You may need to check the ointments that are used -- I had one case where they had a lot of ointments that had petroleum jelly / mineral oil (also known as Paraffinum Liquidum) in them, and both the mother and the clinical supervisor weren't aware that they were all contraindicated for use with the Mic-Key. Read those ingredient labels!

KelRN215, BSN, RN · Apr 4, 2015

MIC-Keys are pretty easy to maintain. Weekly balloon checks, change the button q 3-4 months. Sometimes kids come home with instructions to not check the balloon until after first GI follow-up and then orders to check it weekly follow after that appointment.

Elle23 · Apr 7, 2015

Thanks for all the replies!

I guess it was a little frustrating because the patient has zero orders regarding the mic-key, so I wanted to be certain I was doing what needed to be done.

Also, re: ausculation, I could have sworn I read in the manual to do ausculation, because I didn't think it was necessary either, unlike for a g-tube. Maybe I just dreamed that!

JustBeachyNurse, LPN · Apr 7, 2015

Even a g tube it's inaccurate to confirm placement especially in pediatrics and is not recommended. Venting or Aspiration of gastric contents is oodles better, but checking pH of aspirate is gold standard.

In pedi the whoosh is easy to hear resonance & mistake for accurate placement and has little evidence base for use in practice whether child or adult. The risk outweighs benefit in younger children

Elle23 · Apr 7, 2015

That's intersesting.

In NICU, we always checked placement by ausculation and aspiration.