Feeding Tube Service | Home Care Instructions for Changing the MIC-KEY™ Skin Level Gastrostomy Tube (g-tube)

• sterile water or distilled water
• MIC-KEY™ g-tube
• 2 to 6 cc/ml slip tip syringe
• water soluble lubricant (such as K-Y Jelly®). Do not use oil or petroleum jelly (such as Vaseline®).

Note: Plan to change the MIC-KEY™ g-tube just before a feeding. This will help limit the amount of stomach contents that leak onto your child’s belly during the change.

1. Wash your hands. Remove the new MIC-KEY™ g-tube from the package (Figure 2).
2. Check the new MIC-KEY™ g-tube balloon for any leaks. To check for leaks, attach the syringe to the balloon port of the new g-tube and fill the balloon with 3 to 5 cc/ml of sterile water or distilled water. Use a 5 to 10 cc/ml syringe. Remove the syringe and look at the balloon. Check and see if any water leaks from the g-tube.
3. Gently pull back on the syringe plunger to remove the water from the balloon of the new MIC-KEY™ g-tube. Keep the syringe attached and set to the side.
4. Attach an empty 5 to 10 cc/ml syringe to the balloon port of the MIC-KEY™ g-tube that is in your child’s stomach. Pull back the plunger until all water is removed from the balloon. If you cannot withdraw any water, check that the port opening is clean and not clogged with formula, and that you have a tight connection between the syringe and MIC-KEY™ g-tube balloon port. Then try again to withdraw water.
5. Gently remove the old MIC-KEY™ tube from your child’s stomach. You might feel a little resistance (tug) when you do this. This is normal. 
   • If the g-tube feels stuck, stop trying to remove the tube and call your doctor or nurse right away for instructions. Do not use the tube. Your child may need to be seen to have the g-tube checked and changed.
6. If the g-tube is removed easily, then grease the tip of the new MIC-KEY™ g-tube with the water-soluble lubricant.
7. Gently put the new MIC-KEY™ g-tube into the stoma until the base is flat against the skin.
8. Hold the g-tube with the syringe still attached. Fill the g-tube’s balloon using the prescribed amount of sterile or distilled water (usually 3 to 5 cc).
9. Gently pull up on the MIC-KEY™ g-tube to position balloon against the stomach wall. Remove the syringe. Wipe away any extra lubricant.
10. After the new MIC-KEY™ g-tube is in place, attach the extension set. Attach a 10 to 30 cc/ml syringe to the extension set, and pull back on the syringe to draw out any stomach secretions (juices). This will help you know the MIC-KEY™ g-tube is in the right place in the stomach. 
    • If you are not able to withdraw any secretions, DO NOT USE the g-tube and call your child’s doctor or nurse.  It is possible that the g-tube is not in the the right place.

• Always keep an extra MIC-KEY™ g-tube kit on hand. Your child’s doctor or nurse will give you a prescription for a new kit. Give the prescription to your home care supply company.
• MIC-KEY™ g-tubes usually last three to six months. Change or resize:
  • if fluid is leaking from the middle of the tube
  • if water is missing from the balloon after two weekly balloon checks
  • if the base of the tube is too tight to the skin
• It is helpful to keep a spare syringe, roll of tape, and lubricant with you in case the tube needs to be replaced when you are not home.

• you have any questions or concerns about your child’s g-tube
• you do not get stomach juices (secretions) back up the extension tubing after the g-tube change.
• the tube is clogged.
• the skin around the g-tube is red, swollen, warm, sore, or bleeding
• the stoma has a strange smell
• there is pus or drainage around the g-tube
• your child has a fever of 101 degrees F, along with any of the problems above
• your child throws up more than three times in 24 hours
• the g-tube falls out and you cannot easily replace it
• there is any redness or soreness around the skin that does not get better with routine skin care and dressing changes.

Please call the GI office at 617-355-6058 if you have questions or concerns. Our GI nurses can help you with all types of questions:

• 8 a.m. to 4:30 p.m. weekdays: A nurse in the GI clinic will be available to help you.
• Weekdays after 4:30 p.m., weekends, holidays: Use the same number to reach a GI doctor on-call for urgent questions or emergencies.

If your child is followed by General Surgery:

• 8:30 a.m. to 5 p.m. weekdays: Call the General Surgery outpatient nurses at 617-355-7716 or 617-355-7704.
• Weekdays after 5 p.m., weekdays, holidays: Call the Boston Children’s page operator at 617-355-6369 and ask for the general surgery senior resident on-call.