MIC Bolus Gastrostomy Feeding Tube is utilized for patients who are on a bolus feeding regimen. It has medical-grade silicone construction for visibility and drapability, and an inflatable silicone internal retention balloon. Features a Secur-Lok external retention ring, which is designed to allow air to circulate the stoma site and reduce tube pressure 360 degrees from the sides of the stoma wall.

Features

• Dual exit ports.
• Radiopaque stripe.
• Available in 7 French sizes.
• FDA approved and CE marked.
• Secur-Lok external retention ring.
• Medical-grade silicone construction.
• Inflatable silicone internal retention balloon.
• Recessed distal tip at recommended fill volume.
• Offers graduated centimeter markings for tube position verification.

Indications for Use

The AVANOS MIC Gastrostomy / Bolus Feeding Tube is indicated for use in patients who require long-term feeding, are unable to tolerate oral feeding, are at low risk for aspiration, require gastric decompression, and/or medication delivery directly into the stomach.

Contraindications

Contraindications for placement of a gastrostomy feeding tube include, but are not limited to, ascites, colonic interposition, portal hypertension, peritonitis, and morbid obesity.

Complications

The following complications may be associated with any low-profile gastrostomy feeding tube:

• Infection
• Skin Breakdown
• Pressure Necrosis
• Intraperitoneal Leakage
• Hypergranulation Tissue
• Stomach or Duodenal Ulcers

Note: Verify package integrity. Do not use if the package is damaged or the sterile barrier compromised.

Placement

The AVANOS MIC Gastrostomy / Bolus feeding tubes may be placed surgically, percutaneously under fluoroscopic or endoscopic guidance, or as a replacement to an existing device using an established stoma tract.

• Caution: A gastropexy must be performed to affix the stomach to the anterior abdominal wall, the feeding tube insertion site identified, and the stoma tract dilated before initial tube insertion to ensure patient safety and comfort.
• Caution: Do not use the retention balloon of the feeding tube as a gastropexy device. The balloon may burst and fail to attach to the stomach to the anterior abdominal wall.
• Warning: The insertion site for infants and children should be high on the greater curvature to prevent occlusion of the pylorus when the balloon is inflated.

Tube Preparation

• Select the appropriate gastrostomy feeding tube, remove it from the package, and inspect for damage.
• Using a Luer slip syringe, inflate the balloon with sterile or distilled water through the balloon port.
  • Inflate the balloon with 3-5 ml of sterile or distilled water for low-volume tubes identified by LV following the REF code number.
  • Inflate the balloon with 7-10 mL sterile or distilled water for Standard tubes.
• Remove the syringe and verify balloon integrity by gently squeezing the balloon to check for leaks. Visually inspect the balloon to verify symmetry. Symmetry may be achieved by gently rolling the balloon between the fingers. Reinsert the syringe and remove all the water from the balloon.
• Lubricate the tip of the tube with a water-soluble lubricant. Do not use mineral oil. Do not use petroleum jelly.

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, or 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 medication.

Rotate the tube: Rotate the tube 360 degrees plus a quarter turn daily.

Verify placement of the external bolster: Verify that the external bolster rests 2–3 mm above the skin.

Flush the feeding tube: Flush the feeding tube with water using a catheter tip or slip tip syringe 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. Avoid using acidic irrigants such as cranberry juice and cola beverages to flush feeding tubes.

Balloon Maintenance

Check the water volume in the balloon once a week.

• Insert a Luer slip syringe into the balloon inflation port 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 that 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.
• Note: 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.

Balloon Longevity

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.

MRI Safety Information

The MIC Gastrostomy Feeding Tubes are MR Safe.

Warning

Do not reuse, reprocess, or resterilize this medical device. Reuse, reprocessing, or resterilization may

•  For enteral nutrition and/or enteral medication only.
• Adversely affect the known biocompatibility characteristics of the device
• Compromising the structural integrity of the device
• Lead to the device not performing as intended, or
• Create a risk of contamination and cause the transmission of infectious diseases, resulting in patient injury, illness, or death

Model No:	Diameter (Fr)	Silicone Internal Retention Balloon Volume (ml)	Tube Tip Type
0110-12LV	12	3-5	Tapered Distal Tip
0110-14LV	14	3-5	Recessed Distal Tip
0110-16LV	16	3-5	Recessed Distal Tip
0110-18	18	7-10	Recessed Distal Tip
0110-20	20	7-10	Recessed Distal Tip
0110-22	22	7-10	Recessed Distal Tip
0110-24	24	7-10	Recessed Distal Tip