Mic-key Buttons

Specialties Private Duty

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My patient has a new Mic-key button. I had patients in the hospital before with them, but always on a short term basis.

I read through the manual that came with it, and it was honestly a little skimpy regarding care and maintenance of the Mic-key button.

Can any of you more experienced PDN nurses share your knowledge with me regarding long term use, care, and maintenance of the Mic-key button? Any tips I need to know?

Specializes in Complex pedi to LTC/SA & now a manager.

GrnTea linked in another thread why it's considered poor practice and doesn't meet EBP. Instilling air can cause distention, especially if a child has a fundoplication, I've seen the result of instilling air first hand in a child with a GB & fundo it was thought, in this case, to have been one of the causes of a painful intestinal pseudo obstruction that resulted in an inpatient stay and regression in progress towards goals.

The gold standard EBP is aspirate/vent and check pH. In a hospital X-ray placement verification is also very valid. Venting/aspirating and checking for gastric contents/residual is also acceptable.

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I have never seen any PH strips in any of the hundreds of homes i have been in where a kid or adult pt has a GT,or NGT for that matter.

Of course,you can buy your own.

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Specializes in Complex pedi to LTC/SA & now a manager.

I have 4 patients with specific orders to check gastric pH. pH strips are provided by DME for 3 and parent provides for the first (she has a $$ on DME and found a great deal on Amazon) Everyone else is check for gastric contents/residual via venting GT/GB/NGT or aspirating

Just because you've never seen pH strips in your hundreds of clients' homes does not negate it as the best method and preferred standard to confirm placement of a GT/GB/NGT.

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I was gonna start a thread about a different Mic-Key issue, but I'll jump in with my related issue.

I have two 7 yr old boys as patients, each with the same Mic-Key GTs. The little boy with severe DD and CP and GT feedings only has had his GT for as long as he's been around, and his stoma is always moist, you can see some 'proud flesh' that has been cauterized and is now just a little nub, but he needs a gauze dressing due to constant though scant drainage. Once it a while the stoma is irritated/inflamed looking out to a few mm surrounding intact skin, then we use Bacitracin for a few days which clears it. He is bathed or showered daily and his mom is very conscientious.

The other little guy (GT for a mitochondrial disorder, but is developmentally + for age) has a perfectly 'dry' GT stoma, no need for a dressing. His mother sews cute little flannel pads but he never wears them. His stoma is dry w/no drainage at all.

Does it just differ between kids or . . .? We're supposed to use half and half H2O2/saline to clean the boy with the weepy stoma, and the other little guy takes a nightly bath and no other cleansing direction. I'm suspicious the H2O2 is harsh, and wonder if it's preventing the stoma from fully healing? Then again, everybody's body responds differently to chronic wounds.

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I looked up the H2O2 cleansing agent routine one time and found a blurb that stated H2O2 can be an irritant and is no longer recommended. I thought about it and came to the conclusion that one needs to make the solution dilute enough to prevent any irritation. That is why I prefer the order that gives options.

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My little guy who is developmentally about six weeks old got hold of his button and yanked it out, balloon intact last week. Just to see if I knew how to put it back in, I'm thinking (I did).

When I put an empty syringe on it to deflate the balloon, it was a mL short (it has been in since the first week of Feb). I filled it with 5mL of sterile saline after washing it and reinserting it. I'm wondering if his stoma, which has had all sorts of issues like excessive granulation tissue, is 'too big' to be adequately 'sealed' by the 18F size and 5mL balloon? Years ago I had an LOL (little old lady) with a chronic foley that needed a 12F with a 30mL balloon or she'd leak leak leak.

Thanks Caliotter about the H2O2. I've been using like 2 drops to 20ml of sterile saline on Q tip swabs, rather than the 50/50 mixture per 'orders'. As if his poor mother needs more stuff to worry about, I'll do some more looking around and bring this up with her later (right now we think he has pseudomonas tracheitis AGAIN :( and I'm not going to bother her about anything else)

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Specializes in Complex pedi to LTC/SA & now a manager.

Usually it's sterile or clean water not sterile saline to fill a balloon. Check the manufacturer.

Excessive granulation can be treated with silver nitrate or triamcinolone both require a physicians order. You need to contact the MD regarding the stoma condition.

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Specializes in Pediatrics, High-Risk L&D, Antepartum, L.

I as a parent of 2 child with buttons I kind of giggle at how difficult care of a button is when nursing is involved. I'm an RN (working on my PNP) so I come at this as mom but also an RN.

We don't have care in the home and never have. I've always done everything including dropping NG tubes without any assistance on a toddler.

We use tap water in the balloon, we have gone 6-12 months worth a button (though recently we have been changing more often because they just aren't last like they used to), we just bathe the kids like normal kids and I would never let peroxide near my kid.

Oh and always did pH when we had an NG. We never check placement with a button.

It's just kind of funny how simple it is when nursing isn't involved (at least not officially involved).

I've been doing feeding tubes for 10 years at home...on a much simpler level. It always cracks me up to see posts like this as a mom and RN.

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Specializes in Complex pedi to LTC/SA & now a manager.

Every single pedi patient I have is wash with mild soap and warm water not a single H2O2 or diluted H2O2. I will say there have been A LOT of QA/QC issues with mic-key and AMT mini buttons in the past year or so necessitating more frequent replacement. Rapid deflation of a balloon in the patient where the nurse used NaCl instead of water.

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Usually it's sterile or clean water not sterile saline to fill a balloon. Check the manufacturer.

Excessive granulation can be treated with silver nitrate or triamcinolone both require a physicians order. You need to contact the MD regarding the stoma condition.

I'm sure you are right about what to put in the balloon. Duh. His stoma, as far as I can tell, has been like this as long as he's had nursing care in the home, but I'll talk to his mom about it and get some history of the situation.

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