Halyard MIC Instructions For Use Manual Download

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1. Place a skin mark at the tube insertion site. Define the gastropexy pattern

by placing three skin marks equidistant from the tube insertion site and in a

triangle configuration.

Warning: Allow adequate distance between the insertion

site and gastropexy placement to prevent interference of the

T-Fastener and inflated balloon.

2. Localize the puncture sites with 1% lidocaine and administer local

anesthesia to the skin and peritoneum.

3. Place the first T-Fastener and confirm Intragastric position. Repeat the

procedure until all three T-Fasteners are inserted at the corners of the

triangle.

4. Secure the stomach to the anterior abdominal wall and complete the

procedure.

Create the Stoma Tract

1. Create the stoma tract with the stomach still insufflated and in apposition

to the abdominal wall. Identify the puncture site at the center of the

gastropexy pattern. With endoscopic guidance confirm that the site overlies

the distal body of the stomach below the costal margin and above the

transverse colon.

Caution:

Avoid the epigastric artery that courses at the junction of the

medial two-thirds and lateral one-third of the rectus muscle.

Warning: Take care not to advance the puncture needle too

deeply in order to avoid puncturing the posterior gastric wall,

pancreas, left kidney, aorta or spleen.

2. Anesthetize the puncture site with local injection of 1% lidocaine down to

the peritoneal surface.

3. Insert a .038” compatible introducer needle at the center of the gastropexy

pattern into the gastric lumen.

Note:

For gastrostomy tube placement , the best angle of insertion is a true

right angle to the surface of the skin. The needle should be directed toward the

pylorus if conversion to PEGJ tube is anticipated

4. Use endoscopic visualization to verify correct needle placement.

Additionally, to aid in verification, a water filled syringe may be attached to

the needle hub and air aspirated from the gastric lumen.

5. Advance a J tip guidewire, up to .038”, through the needle and into stomach.

Confirm position.

6. Remove the introducer needle, keeping the J tip guidewire in place and

dispose of according to facility protocol.

Dilation

1. Use a #11 scalpel blade to create a small skin incision that extends alongside

the guidewire, downward through the subcutaneous tissue and fascia of the

abdominal musculature. After the incision is made, dispose of according to

facility protocol.

2. Advance a dilator over the guidewire and dilate the stoma tract to the

desired size.

3. Remove the dilator over the guidewire, leaving the guidewire in place.

Tube Placement

Note:

A peel-away sheath may be used to facilitate advancement of the tube

through the stoma tract.

1. Select the appropriate gastrostomy feeding tube and prepare according to

the instructions in the Tube Preparation section above.

2. Advance the distal end of the tube over the guidewire, through the stoma

tract and into the stomach.

3. Verify that the tube is in the stomach, remove the endoscope, remove the

guidewire or peel-away sheath if utilized and inflate the balloon.

4. Using the Luer slip 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 7 ml total balloon volume inside the LV balloon.

Do not use air. Do not inject contrast into the balloon.

Caution:

Do not exceed 15 ml total balloon volume in the Standard

balloon. Do not use air. Do not inject contrast into the balloon.

5. Gently pull the tube up and away from the abdomen until the balloon

contacts the inner stomach wall.

6. Clean the residual fluid or lubricant from the tube and stoma.
7. Gently slide the SECUR-LOK* ring to approximately

1-2 mm (approximately 1/8 inch) above the skin.

Verify Tube Position and Patency

1. Attach a catheter tip syringe with 10 ml of water to the feeding port.

Aspirate gastric contents. When air or gastric contents are observed, flush

the tube.

2. Check for moisture around the stoma. If there are signs of gastric leakage,

check the tube position and SECUR-LOK* ring placement. Add fluid as

needed in 1–2 ml increments. Do not exceed balloon capacity as indicated

previously.

3. Begin feeding only after confirmation of proper patency, placement and

according to physician instructions.

Tube Removal

1. First, make sure that this type of tube can be replaced at the bedside.
2. Assemble all equipment and supplies, cleanse hands using aseptic

technique and apply clean, powder-free gloves.

3. Rotate the tube 360 degrees to ensure the tube moves freely and easily.
4. Firmly insert the catheter tip syringe into the balloon port and withdraw all

the fluid from the balloon.

5. Apply counter pressure to the abdomen and remove the tube with gentle,

but firm traction.

Note:

If resistance is encountered, lubricate the tube and stoma with

water soluble lubricant. Simultaneously push and rotate the tube. Gently

manipulate the tube free. If the tube will not come out, refill the balloon with

the prescribed amount of water and notify the physician. Never use excessive

force to remove a tube.

Warning: Never attempt to change the tube unless trained by

the physician or other health care provider.

Replacement Procedure

1. Cleanse the skin around the stoma site and allow the area to air dry.
2. Select the appropriate size Gastrostomy feeding tube and prepare according

to the instructions in the Tube Preparation section above.

3. Lubricate the distal end of the tube with water soluble lubricant and gently

insert the Gastrostomy through the stoma into the stomach.

4.  Using the Luer slip 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 7 ml total balloon volume inside the LV balloon.

Do not use air. Do not inject contrast into the balloon.

Caution:

Do not exceed 15 ml total balloon volume in the Standard

balloon. Do not use air. Do not inject contrast into the balloon.

5. Gently pull the tube up and away from the abdomen until the balloon

contacts the inner stomach wall.

6. Clean the residual fluid or lubricant from the tube and stoma.
7. Gently slide the SECUR-LOK* ring to approximately 1-2 mm (approximately

1/8 inch) above the skin.

8. Verify proper tube position according to the instructions in the Verify Tube

Position section above.

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 water before

administering through the feeding tube. Never crush enteric coated medication

or mix medication with formula.
Using a catheter tip syringe flush the tube with the prescribed amount of water.

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, before and after every

intermittent feeding, or at least every 8 hours if the tube is not being used.

• 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 irrigants 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

• Use a 30 to 60 cc catheter tip syringe. Do not use smaller size syringes as this

can increase pressure on the tube and potentially rupture smaller tubes.

• Use room temperature tap 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 mls for adults,

and 3 to 10 mls 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.

Daily Care & Maintenance Check List

Assess the patient

Assess the patient for any signs of pain, pressure or discomfort.

Assess the stoma site

Assess the patient 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.

Clean the stoma site

  Use warm water and mild soap.
  Use a circular motion moving from the tube outwards.
  Clean sutures, external bolsters and any stabilizing devices using a cotton-

tipped applicator.

Rinse thoroughly and dry well.

Assess the tube

Assess the tube for any abnormalities such as damage, clogging or abnormal

discoloration.

Clean the feeding tube

Use warm water and mild soap being careful not to pull or manipulate the

tube excessively.

Rinse thoroughly, dry well.

Clean the gastric and

balloon ports

Use a cotton tip applicator or soft cloth to remove all residual formula and