What is a mic key button for gastrostomy?
A Mic-Key button is a brand-name, low-profile gastrostomy tube, also known as a "button" G-tube. It is a feeding device that sits flush with the skin of the abdomen and is used to deliver liquid nutrition, fluids, and medication directly into the stomach. The device consists of a small, rounded exterior port, a short shaft, and an internal, water-filled balloon that holds the tube in place against the stomach wall. Unlike a conventional gastrostomy tube (G-tube) that has a long, external tube dangling from the port, the Mic-Key's design is more discreet, secure, and less likely to be accidentally dislodged. When feeding is required, a detachable extension set is connected to the external port. Once the feeding is complete, the extension set is removed, and the button is capped, returning to its low-profile state.
The Anatomy of a Mic-Key Button
Understanding the components of the device is key to proper usage and care. A Mic-Key button includes:
- External Port: The small, skin-level cap on the outside of the abdomen. It has a valve that opens when the extension set is connected, and closes when the set is removed to prevent leakage of stomach contents.
- Balloon Port: A separate port used for inflating and deflating the internal balloon with sterile water to secure the button in place.
- Shaft: The silicone tube that passes through the skin and abdominal wall into the stomach.
- Internal Balloon: The inflatable balloon at the end of the shaft that sits inside the stomach, anchoring the device.
- Extension Set: The removable tubing that connects to the external port for feeding, medication, or venting. It comes in different configurations for bolus or continuous feeding.
Indications for a Mic-Key Button
The Mic-Key button is primarily used for individuals who are unable to take enough nutrition orally for various medical reasons. These can include:
- Swallowing difficulties (dysphagia) resulting from conditions like stroke, neurological disorders, or head and neck cancers.
- Inadequate oral intake to meet nutritional needs, common in chronic illnesses or developmental delays.
- High nutritional requirements that cannot be met through regular eating alone.
- Gastric decompression or venting, which involves releasing air from the stomach to alleviate bloating.
- Aspiration risk, where food or liquid could enter the lungs due to swallowing problems.
Living with a Mic-Key Button: Daily Care and Management
Proper care of the Mic-Key button and the surrounding skin (stoma) is essential to prevent complications such as infection or leakage.
- Daily Stoma Care: Wash the skin around the button with mild soap and water daily. Pat the area dry thoroughly. Do not use hydrogen peroxide or ointments unless directed by a healthcare professional.
- Daily Rotation: Gently rotate the button 360 degrees each day to prevent it from sticking to the skin and help maintain the stoma tract.
- Weekly Balloon Check: Once a week, check the volume of water in the internal balloon. A small, luer-slip syringe is used to withdraw all the water and then replace it with the prescribed amount of sterile or distilled water.
- Extension Set Care: Wash extension sets after each use with warm, soapy water and rinse well. They should be air-dried and stored in a clean place. Most extension sets are disposable and should be replaced every few weeks.
- Flushing: Flush the tube with water before and after each feeding or medication administration to prevent clogging.
- Monitoring: Inspect the stoma site daily for signs of redness, swelling, pain, or leakage, which may indicate a problem.
Mic-Key Button vs. Traditional PEG Tube: A Comparison
| Feature | Mic-Key Button (Low-Profile) | Traditional PEG Tube (Standard) |
|---|---|---|
| Appearance | Sits flush with the skin; very discreet. | Long, external tubing that hangs from the abdomen. |
| Comfort | More comfortable, less likely to snag on clothing. | Long tubing can be cumbersome and at risk of being pulled. |
| Usage | Requires a separate, detachable extension set for feeding. | Feeding sets connect directly to the attached tubing. |
| Replacement | Can often be replaced at home or in an outpatient setting without anesthesia, once the stoma is mature. | Typically requires replacement in a hospital setting, sometimes under general anesthesia. |
| Accidental Dislodgment | Lower risk of accidental pulling or dislodgement. | Higher risk of accidental dislodgement due to the external tubing. |
Nutritional Considerations with a Gastrostomy
Managing nutrition with a gastrostomy tube is a critical part of the patient's care plan. The primary goals are to ensure adequate hydration, calorie intake, and delivery of necessary nutrients.
- Dietitian Support: A registered dietitian is often involved to monitor nutritional adequacy, determine the appropriate formula, and develop a feeding schedule.
- Feeding Methods: Feedings can be administered in two main ways:
- Bolus Feeding: Administering a specific amount of formula over a short period (e.g., 15-20 minutes) using a syringe. This often mimics a regular meal schedule.
- Continuous Feeding: Using a pump to slowly administer formula over a longer duration, such as overnight. This can help with tolerance and is often used for patients who struggle with larger volumes.
- Formula and Water: Only use prescribed formula and water for flushing. Never mix medications with formula. The Mic-Key button provides an anti-reflux valve, which helps prevent stomach contents from leaking out.
- Medication: Most medications must be in liquid form. If tablets are necessary, they must be crushed finely and mixed with water, ensuring they are compatible with tube administration.
Troubleshooting Common Issues
Even with proper care, issues can arise. Here's how to address some common problems:
- Tube Clogging: Ensure proper and frequent flushing. A clogged tube can often be cleared by using a push-pull motion with a syringe and warm water. If this fails, contact a healthcare provider.
- Leakage Around the Stoma: Check the balloon volume, as a deflated balloon can cause leaks. Granulation tissue can also cause leakage and requires treatment from a healthcare provider. Ensure the button is not too tight against the skin.
- Pain or Discomfort: This can be caused by infection, granulation tissue, or a mis-sized button. A healthcare professional should be contacted if pain persists.
- Accidental Dislodgement: A spare tube should always be kept on hand. If the button comes out, immediately insert the spare and contact a healthcare provider, as the stoma tract can close quickly.
Conclusion: Empowering Nutritional Independence
A Mic-Key button for gastrostomy is a significant advancement in enteral nutrition, offering a superior alternative to traditional G-tubes for long-term use. Its discreet and comfortable design improves a patient's quality of life and allows for greater mobility and independence. Proper care, involving routine cleaning, flushing, and monitoring, is vital for preventing complications and ensuring the device's longevity. By providing a reliable method for administering nutrition, fluids, and medication, the Mic-Key button empowers patients to manage their health effectively and maintain a higher quality of life.
For more detailed information on living with a Mic-Key button, consult resources like the Children's Wisconsin teaching sheets.
