please tell me what this is...

TPfan24 · Apr 17, 2008

Hi, you must be talking about a PEG ( percutaneous endoscopic gastrostomy) tube otherwise known as a Mickey which is a tube inserted into the stomach. The upper end of the stomach ( fundus ) is wrapped around the esophagus as to avoid vomiting. It's used for GERD, hiatal hernia or in the case of these children to avoid aspiration of stomach contents. The tube is changed every few months or sooner if indicated. The important thing is to keep the skin clean around the tube and verify the patency.

I have cared for children with CP and have had many great times with them. Hope this helps and good luck as you start your very rewarding nursing career!

FlyingScot, RN · Apr 17, 2008

Right on about the Mickey button but the surgery you are talking about isn't the same thing. The surgery is called a Nissen fundoplication and is used to treat severe reflux. Kids who have had this procedure are said to have had a "Nissen". A g-tube is usually, but not always, inserted at the same time. The Mickey buttons are sooo much nicer than the old-fashion foley tubes we used to use.

santhony44, MSN, RN, NP · Apr 17, 2008

It's called a Nissen. Don't call it a "Nissan." I once did that- a slip of the tongue- and had a doctor walk away muttering about "little trucks."

prmenrs, RN · Apr 17, 2008

It's a Mic-Key button, and it makes life much easier! http://www.bmed.com/products/eftmain.htm

TPfan24 · Apr 18, 2008

I did mean to write about the fundoplication in my post. Thought about it but did not write it.

TiredMD · Apr 18, 2008

i just started at a new LTC facility that takes children..... (we have 4 CP kids that im already in love with) but one had a G-tube but it wasnt long like normal it was right against the skin..... the nurse i was orientating with said sometimes you have to release teh gas off her stomach because of a surgery she has to where she cant throw up.... they like i think folder her esophagus into ridges...... can anyone tell me what this surgery is and about it... ive only been a nurse 7 mths and never heard of it or seen it

As others have pointed out here, you are talking about the Nissen fundoplication. The gastric fundus is folded up and wrapped 360 degrees around the lower esophagus. The rationale behind this surgery is that reflux results from an ineffective lower esophageal sphincter (the thickened muscle in the distal esophagus that closes it off to prevent stomach contents from refluxing back up the esophagus). There are actually many other types of fundoplication ("plication" = to fold), but the Nissen is by far the most commonly used.

CP kids, for a variety of reasons, frequently have nasty reflux, which causes a lot of complications. The Nissen is a pretty standard treatment for these little ones. Many surgeons also insist on placing a gastrostomy tube (g-tube) at the same time they do the Nissen. The thinking is that (1) in the immediate period after the procedure, their bodies aren't used to the new sphincter, and so may not be able to swallow well, and (2) that same tightness may predispose to air trapping and gastric bloating, which hurts. In all honesty, for the bad CP kids, they're probably not safe to eat by mouth anyway, so they're getting some kind of feeding tube eventually anyway, so why not.

The procedure can also be performed on adults for severe GERD. Historically it had a pretty high morbidity rate because it was done open. Now with more and more surgeons doing it laparoscopically, it is much safer and easier to tolerate.

RNAnnjeh, MSN, CNS · Apr 25, 2008

....and the person who was providing your orientation was correct. Sometimes you do need to "vent" the g-tube to expell excess gasses. The Mic-Key comes with 2 attachment tubes...one for feeding/meds and one for venting.