G-tube and mic-key care
If stomach fluid is leaking out around the mic-key
- Check the volume of water in the balloon, using the mic-key syringe. Gradual leaks from the balloon can sometimes be dealt with by just checking and refilling it periodically. The amount of water the balloon requires can vary across mic-keys and across kids.
- If the water is leaking from the balloon more rapidly or the mic-key is old, it may be time to replace it. Some kids need their mic-keys to be replaced every month or so. Other kids can go as long as 6+ months between replacements.
- Granulation tissue on the skin around the mic-key can cause leaking from the stomach and prevent healing. Granulomas can be treated with a steroid cream like Kenalog (triamcinolone), or more aggressively by burning them with silver nitrate sticks. Care should be taken to touch the silver nitrate only to the granuloma, and not to surrounding tissue. It will spread easily from the dampness of the granuloma.
- Stabilizing the button can be critical. (Otherwise, it may twist around, widening the stoma, like a stick twisting in sand to make a bigger hole.) You may need to wait through a long period of leaking while the tissue grows back in around the stabilized button. The products below can help to fill in the gaps in the hole, but might also interfere with the tissue growing back in to create a better seal.
- To create a tighter seal and prevent/absorb leaks, you can try putting different products under the mic-key, such as:
- Aquacel or sorbsan: These wound dressing products can be wrapped around the mic-key stem and nestled in where the mic-key is inserted into the skin. They prevent leaking and promote healing.
- Mepilex transfer: This is a special product that wicks moisture away from the skin. It comes in sheets that can be cut into squares with a split to fit around the mic-key. It should be covered with an absorbent product like one below. (Any of the products below can also be used by itself.)
- gauze or a dressing such as Allevyn (I use the 2" square non-adhesive -available at National Rehab 800-451-6510).
- IV sponges
- panty-liners folded in half. They are wonderfully absorbent. We just cut a slit in the middle of the pad after folding it, fit it around the g-tube, and then tape around the edges with Hypafix, which doesn't seem to bother the skin. It's the only thing that we have found to prevent skin break-down.
- If the skin around the mic-key gets irritated from leakage, it can be treated with a diaper rash ointment like Balmex, or a skin protectant like Ilex. Many parents like Calmoseptine.
- The mic-key may be more prone to leaking with stomach sleepers too since the mic-key will be pushed into the stomach, leaving more space internally between the balloon and stomach wall, for the stomach contents to escape.
- If you're having chronic leaks, consider having your child re-sized to ensure the g-tube stem isn't too long.
- Leaking g-tubes can lead to bag leaks. All the wetness seems to wear away at the wafer adhesive. You can make the adhesive on the wafer water proof and decrease leaks by framing the outside perimeter of the wafer with Tegaderm or a similar water proof dressing.
Replacing the mic-key
You can use water as lubrication when you replace the mic-key. Some doctors recommend a lubricant such a surgilube (available at the pharmacy). It may bleed a bit for the first few days due to the trauma to the track.
Alternatives to the mic-key
Mini one balloon button: a friend uses it and it looks great! It's a product similar to and compatible with the Mic-key g-tube button. However, it's fully flexible and flatter to the skin than even the low profile Mic-key, so I anticipate it will be easier on the skin. The balloon is more apple shaped, which is supposed to improve leaking.
Nutriport -- some parents really like this system because it sits more flat against the skin than the mic-key and has an easily-detaching extension, but others dislike this function, saying it leads to too many messes with active kids.