avanos MIC Gebrauchsanweisung Seite 4

11. Release the tube and withdraw the endoscope and forceps in tandem, leaving the tube in
place.
12. Using a male Luer syringe, inflate the balloon.
• Inflate the LV balloon with 3–5 ml of sterile or distilled water.
• Inflate the standard balloon with 7–10 ml of sterile or distilled water.
Caution: Do not exceed 5 ml total balloon volume inside the LV balloon and 20 ml total
balloon volume inside the Standard balloon. Do not use air. Do not inject contrast into the
balloon.
13. Clean the residual fluid or lubricant from the tube and stoma.
14. Gently slide the external retention bolster to approximately 1–2 mm above the skin. Do not
suture the bolster to the skin.
15. Verify tube position and patency using the Verify Tube Position and Patency section above.
Tube Patency Guidelines
Proper tube flushing is the best way to avoid clogging and maintain tube patency. The following
are guidelines to avoid clogging and maintain tube patency.
• Flush the feeding tube with water every 4–6 hours during continuous feeding, anytime the
feeding is interrupted, or at least every 8 hours if the tube is not being used.
• Flush the feeding tube after checking gastric residuals.
• Flush the feeding tube before and after medication administration and between medications.
This will prevent the medication from interacting with formula and potentially causing the
tube to clog.
• Use liquid medication when possible and consult the pharmacist to determine if it is safe to
crush solid medication and to mix with water. If safe, pulverize the solid medication into a
fine powder form and dissolve the powder in warm water before administering through the
feeding tube. Never crush enteric-coated medication or mix medication with formula.
• Avoid using acidic fluids such as cranberry juice and cola beverages to flush feeding tubes
as the acidic quality when combined with formula proteins may actually contribute to tube
clogging.
General Flushing Guidelines
Flush the feeding tube with water using an ENFit® syringe every 4–6 hours during continuous
feeding, anytime the feeding is interrupted, at least every 8 hours if the tube is not being used,
or per clinician's instructions. Flush the feeding tube after checking gastric residuals. Flush the
feeding tube before, after, and in between medication administration. Avoid using acidic irrigants
such as cranberry juice and cola beverages to flush feeding tubes.
• Use a 30 to 60 ml ENFit® syringe. Do not use smaller size syringes as this can increase pressure
on the tube and potentially rupture smaller tubes.
• Use room temperature water for tube flushing. Sterile water may be appropriate where the
quality of municipal water supplies is of concern. The amount of water will depend on the
patient's needs, clinical condition, and type of tube, but the average volume ranges from 10 to
50 ml for adults, and 3 to 10 ml for infants. Hydration status also influences the volume used
for flushing feeding tubes. In many cases, increasing the flushing volume can avoid the need
for supplemental intravenous fluid. However, individuals with renal failure and other fluid
restrictions should receive the minimum flushing volume necessary to maintain patency.
• Do not use excessive force to flush the tube. Excessive force can perforate the tube and can
cause injury to the gastrointestinal tract.
• Document the time and amount of water used in the patient's record. This will enable all
caregivers to monitor the patient's needs more accurately.
Nutrition Administration
1. Open the cap to the Jejunal access port of the MIC* GE Feeding Tube.
2. Use an ENFit® syringe to flush the tube with the prescribed amount of water as described in
the General Flushing Guidelines.
3. Remove the flushing syringe from the Jejunal access port.
4. Securely connect an ENFit® feed set to the Jejunal access port.
Caution: Do not over-tighten the feed set connector or the syringe to the access port.
5. Complete feeding per the clinician's instructions.
Warning: If formula is present in the gastric drainage, stop feeding and notify
the physician or health care provider.
6. Remove the feed set or syringe from the Jejunal access port.
7. Use an ENFit® syringe to flush the tube with the prescribed amount of water as described in
the General Flushing Guidelines.
8. Remove the flushing syringe from the Jejunal access port.
9. Close the cap to the Jejunal access port.
Medication Administration
Use liquid medication when possible and consult the pharmacist to determine if it is safe to crush
solid medication and mix with water. If safe, pulverize the solid medication into a fine powder
form and dissolve the powder in warm water before administering through the feeding tube.
Never crush enteric coated medication or mix medication with formula.
1. Open the cap to the prescribed access port of the MIC* GE tube.
2. Use an ENFit® syringe to flush the tube with the prescribed amount of water as described in
the General Flushing Guidelines.
3. Remove the flushing syringe from the access port.
4. Securely connect an ENFit® syringe containing the medication to the access port.
Caution: Do not over-tighten the syringe to the access port.
5. Deliver the medication by depressing the ENFit® syringe plunger.
6. Remove the syringe from the access port.
7. Use an ENFit® syringe to flush the tube with the prescribed amount of water as described in
the General Flushing Guidelines.
8. Remove the flushing syringe from the access port.
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9. Close the cap to the access port.
Gastric Decompression
Gastric decompression may be performed via either gravity drainage or low intermittent suction.
Caution: Never connect the Jejunal access port to suction. Do not measure residuals from the
Jejunal access port.
1. Open the cap to the Gastric access port of the MIC* GE Feeding Tube.
2. For gravity drainage, place the opened Gastric access port of the MIC* GE Feeding Tube directly
over the opening of an appropriate container.
Note: Ensure the open access port is positioned below the stoma.
3. For low intermittent suction, connect an ENFit® syringe to the Gastric access port.
4. Apply low intermittent suction by slowly retracting the plunger of the syringe in short
intervals.
Warning: Do not use continuous or high pressure suction. High pressure could
collapse the tube or injure the stomach tissue and cause bleeding.
5. Disconnect the decompression syringe from the Gastric access port.
6. Use an ENFit® syringe to flush the tube with the prescribed amount of water as described In
the General Flushing Guidelines.
7. Remove the flushing syringe from the Gastric access port.
8. Close the cap to the Gastric access port.
Balloon Maintenance
Precise balloon life cannot be predicted. Silicone balloons generally last 1–8 months, but the life
span of the balloon varies according to several factors. These factors may include medications,
volume of water used to inflate the balloon, gastric pH, and tube care.
Check the water volume in the balloon once a week.
• Insert a male Luer syringe into the Balloon Inflation Port (BAL.) and withdraw the fluid
while holding the tube in place. Compare the amount of water in the syringe to the amount
recommended or the amount initially prescribed and documented in the patient record. If
the amount is less than recommended or prescribed, refill the balloon with the water initially
removed, then draw up and add the amount needed to bring the balloon volume up to the
recommended and prescribed amount of water. Be aware as you deflate the balloon there may
be some gastric contents that can leak from around the tube. Document the fluid volume, the
amount of volume to be replaced (if any), the date and time.
• Wait 10–20 minutes and repeat the procedure. The balloon is leaking if it has lost fluid, and
the tube should be replaced. A deflated or ruptured balloon could cause the tube to dislodge
or be displaced. If the balloon is ruptured, it will need to be replaced. Secure the tube into
position using tape, then follow facility protocol and/or call the physician for instructions.
Caution: Refill the balloon using sterile or distilled water, not air or saline. Saline can
crystallize and clog the balloon valve or lumen, and air may seep out and cause the balloon to
collapse. Be sure to use the recommended amount of water as over-inflation can obstruct the
lumen or decrease balloon life and under-inflation will not secure the tube properly.
Daily Care & Maintenance Check List
• Assess the patient for any signs of pain, pressure or discomfort.
• Assess the stoma site for any signs of infection, such as redness, irritation, edema, swelling,
tenderness, warmth, rashes, purulent, or gastrointestinal drainage. Assess the patient for any
signs of pressure necrosis, skin breakdown, or hypergranulation tissue.
• Use warm water and mild soap.
• Use a circular motion moving from the tube outwards.
• Rinse thoroughly and dry well.
• Assess the tube for any abnormalities such as damage, clogging, or abnormal discoloration.
• Use warm water and mild soap being careful not to pull or manipulate the tube excessively.
• Rinse thoroughly and dry well.
• Clean the Jejunal, Gastric, and Balloon Inflation Ports. Use a cotton tip applicator or soft cloth
to remove all residual formula and medication.
• Verify that the external bolster rests 1–2 mm above the skin.
• Flush the feeding tube as described in the General Flushing Guidelines section above.
Caution: Do not rotate the external retention bolster. Rotating the bolster may cause the
tube to kink and possibly lose position.
Tube Occlusion
Tube occlusion is generally caused by:
• Poor flushing techniques
• Failure to flush after measurement of gastric residuals
• Inappropriate administration of medication
• Pill fragments
• Thick formulas, such as concentrated or enriched formulas that are generally thicker
• Formula contamination that leads to coagulation
• Reflux of gastric or intestinal contents up the tube
To Unclog a Tube
1. Make sure that the feeding tube is not kinked or clamped off.
2. If the clog is visible above the skin surface, gently massage or milk the tube between fingers
to break up the clog.
3. Connect a 30 to 60 ml ENFit® syringe filled with warm water into the appropriate access port
of the tube and gently pull back on then depress the plunger to dislodge the clog. Do not use
smaller size syringes as this can increase pressure on the tube and potentially rupture smaller
tubes.
4. If the clog remains, repeat step #3. Gentle suction alternating with syringe pressure will
relieve most obstructions.
5. If this fails, consult with the physician. Do not use cranberry juice, cola drinks, meat tenderizer