Wednesday, January 22, 2014

Everything About the MIC* Jejunostomy Tube You Cannot Find (Review)

Ok, well if you are as frustrated as I am about the fact you cannot find an impartial review of the MIC* Jejunostomy tube you will understand the fundamental need for someone to say anything that weighs out the pros and cons for the consumer, especially the chronically ill who care for their own welfare and, of course, any care takers that might me at risk for pulling their hair out.

 (Image property of Kimberly Clark, http://www.mic-key.com/products/kc_mic_jejunostomy_feeding_tube.aspx)

First off, on the website it describes that there is an inner cuff, along with sutcher wings to keep the tube from falling out and reducing leaks. It also describes the preference of the Witzel-Tunnel procedure as a must for this type of tube.

The Witzel-Tunnel typically has poor outcomes and mortality rate is rather high compared to just a direct J (small bowel) feeding tube would be. Much to my surprise and delight, when asking cautiously if we could perhaps modify the technique (my surgeon is extremely qualified in the area), she merely gave a typical surgeon response : "I don't Witzel."

Very well then. Liking the sound of this already.

I DO NOT RECOMMEND TUBES WITH BALLOONS IN THE SMALL BOWEL UNLESS YOUR SURGEON KNOWS WHAT THEY ARE DOING. I do not recommend a simple GI place this tube. Nicking is too easily done and this type of tube is unique only to Kimberly-Clark. There isn't a tube like this elsewhere on the market in the United States as of 1/22/2014.

So, how is the tube working for me?

Well, for starters, this tube has and internal diameter of only 9FR, or 3mm. Yep, is clogs easily. If you are using a thick formula like TwoCal, Ensure Plus, Peptamen (Jr.) 1.5, etc you will need to dilute it. If you take medication that is thick like Trileptal (oxcarbazepine) in the liquid form and put them in this tube, you will need to use a larger barrel syringe (>10cc) and dilute slightly)

This tube also has a detatchable tip



Pops on and off easily, and this is a must to cap it off. Please don't lose this. You will not be able to replace this easily without a replacement kit (I will describe further down) and...let's be honest, they aren't common nor are they cheap. If you have insurance with a lot of holes (AARP, Blue Cross HMO, Medicare parts A and D without other supplements, HealthLink PPO &c) you will be paying out more than you care to.

This actually has a tip that will fit caps from saline flushes. Do I recommend you do this?

NO!



This is the tip. Again, look how little it is. Thick solutions of anything will not fit. If you have had a G/J tube and are switching to this, you need to be told that this tube is even more prone to clogs than at least the MIC-KEY button G/J (which I have had, cannot comment on the AMT button). You will need to change EVERYTHING.

There is a cap that screws on this tip. Now, do I have it? Nope. Nope not at all. Lost it quickly. So I t=use this when disconnecting the barbed adapter from the bag



To this instead



That is a Lopez enteral valve. I did a review on it almost two years ago, just follow the tag and you will find what you need. This keeps everything in when disconnected for cleaning the tube, flushes, changing bags, during hygiene practices, and...

...whenever...



Only have oral tip or luer tip (slip tip, not luer lock) syringes? Use this. I only have BAXA syringes for medication and this works nicely. I have also used it for pressure relief for G tube feeding if Farrel valve bags are on back order.

As for the surgery itself: we did not use the Witzel technique. Simply, it was place further up than the last one and threaded deeper. The sutcher wings were used only to ground the tube in a way that, as long as it is secured, cannot fall out and it never leaks



No need to wince. Cannot even feel it and I have "visceral hyperalgesia" (exaggerated gut pain, a catchall diagnonsense). That tape is called Hypafix and it's one of the only ones I am not allergic to. It's soft and stretches. I used ti use Medipore H, but after so many breakouts I cannot use it anymore. I get two rolls a month, which is nice as I go though it quickly (gastrostomy sight is spitting some nasty things, so dressing changes are frequent.

(picture may offend, feel free to scroll)



This is the first weekend I was home, so just about a week. They had to do an open procedure as we cannot do any more less invasive techniques due to other problems. The G tube (in the stomach; gastr-) is the one higher up and the J (small bowel; jejunum) in this post is further down.

There is a repair kit for this tube, and it is for all external parts since traditionally this is a more invasive, long term tube (as in, those who will never have a button there, which in my personal experience I no longer recommend for J tubes)

Kimberly-Clark / Ballard Medical's MIC  JEJUNOSTOMY (J-Tube) FEEDING TUBE REPAIR KIT EACH(property of Phoenix Med2U http://www.phoenixmed2u.com/index.php?crn=3&rn=1493&action=show_detail, manufactured by Kimberly Clark)

Looks like fun, right?

Let's see how this pans out...

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