What is a MIC Gastric-Enteric feeding tube?
A MIC Gastric-Enteric feeding tube is a type of feeding tube that provides fluids, nutrition, and medications directly into the small intestine (jejunum) through the jejunal feeding port. There is a second port that gives access to the stomach for venting and a third port for balloon inflation. The balloon keeps the MIC Gastric-Enteric tube in place and a disk sits on the outside of the stomach to prevent it from moving into the stomach. This tube is placed by an interventional radiologist using image guidance.
The MIC Gastric-Enteric tube is placed through an opening in your child's abdomen called a stoma. The tunnel from the outside through the stoma is called the tract.
Feeds are given by attaching an adaptor to the "Jejunal" port. The "Gastric" port is used for venting the stomach. The port marked "BAL" is the balloon port and is used for inflating the balloon with water.
The port labelled "Gastric" is used to access the stomach. This port is usually used for venting, although it is possible to give medications and feeds through it if instructed to do so by your health-care team.
The port labelled "Jejunal" is used to access the small intestine. This port is usually used for feeding, medications, and fluids.
A MIC Gastric-Enteric feeding tube is not used for primary tube insertion. This means that your child will have a different type of feeding tube first and may then transition to a MIC Gastric-Enteric feeding tube after a few months.
How is a MIC Gastric-Enteric tube different from other types of tubes?
A MIC Gastric-Enteric tube is a type of combination G/GJ tube. It is typically selected for children who weigh less than 10kg and who require a combination G/GJ tube. This type of tube accesses the jejunum but is different than surgically inserted J tubes. While both tubes are inserted into the small intestine, the MIC Gastric-Enteric feeding tube enters through your child's stomach, passes through into the first part of the small intestine and ends in the jejunum. Surgical J tubes are inserted directly into the jejunum by a surgeon in an operating room.
The MIC Gastric-Enteric feeding tube is also different than a low-profile GJ tube. Both types of feeding tubes provide fluids, nutrition, and medication directly into the small intestine, however the combination G/GJ tube has a gastric port through which gas can be vented from the stomach, while the low-profile GJ tube does not.
The G tube team provides support related to G tubes, GJ tubes, combination G/GJ tubes, and surgical J tubes after insertion.
Giving feeds, liquids, and medication through the MIC Gastric-Enteric feeding tube
Your child's tube feeds will be the same as with previous GJ or combination G/GJ tube exchanges.
A purple Kangaroo extension needs to be attached to the jejunal port to give feeds and medications. It is often helpful to attach a purple extension to the gastric port when venting the stomach. Both extensions can be connected at the same time to allow you to vent the stomach during feeds.
The extension should be replaced as needed (i.e., broken, rigid, stained).
Using the extension, flush the jejunal port with at least 5 to 10 mL of water before and after each feed and medication dose, and every four hours during continuous feeds. This helps to prevent the tube from becoming blocked. Some children may also require flushing into the stomach, using the gastric port. Only do this if your health-care team has told you to.
Caring for your child's MIC Gastric-Enteric feeding tube
The MIC Gastric-Enteric feeding tube is a size 16 FR at the stoma and then becomes an 8 FR where the tube enters the small intestine. The balloon on the MIC Gastric-Enteric feeding tube helps to keep the tube from accidentally being pulled out.
| Tube diamter | Balloon volume minimum | Balloon volume maximum |
|---|---|---|
| 16 FR at the stoma 8 FR at small intestine | 3 mL | 5 mL |
Here are some things to remember when caring for your child's MIC Gastric-Enteric feeding tube:
- Do not feed your child through the balloon port
- Do not fill the balloon with saline solution or air
The disk on top of the stomach can be moved up and down to ensure a good fit. The disk should sit snug to your child’s stomach but not too tight. The disk should not sit too loose either as this will allow the tube to move into the stomach. Families can adjust the disk up and down as needed for best fit and comfort. Above the disk you can see numbers on the tube to keep track of where the disk should sit for reference.
Checking the volume of water in the balloon
The interventional radiologist who inserts the tube may fill the balloon with less than the recommended balloon volume. If this is the case, you will need guidance from your health-care team before you increase the balloon volume. It is important to check the amount of water in the balloon at least once a week. Use a 5 mL slip-tip syringe to do this.
- Insert a 5 mL slip-tip syringe into the tube's balloon port (marked "BAL").
- Remove all the water from the balloon. Throw the removed water away - do not reuse it. It is normal for the removed water to be discoloured. You may re-use the syringe as long as you wash it well with hot water and soap.
- Re-inflate the balloon with the amount of new sterile or distilled water you usually use to inflate the balloon.
It is normal to remove 0.5 mL less water from the balloon than you originally put in. This is because some of the water has evaporated.
If there is no water after attempting to withdraw, re-inflate the balloon with 5 mL of water. After three to four hours, attempt to withdraw this water.
- If you get all the water back, the balloon may have been empty before. You can then re-inflate the balloon with the amount of water you normally put in. Check the balloon volume every two to three days to make sure there are no further problems.
- If you do not get any water back when you withdraw after three to four hours, the balloon is likely damaged, and the tube will need to be replaced.
If you are concerned that the balloon is broken, there is a risk that the tube may be accidentally pulled out. Secure the tube in place by taping the disk to your child’s stomach until you can contact your G tube specialist (at SickKids, this is a G Tube Nurse) to arrange an appointment for a tube change in a radiology department. Meanwhile the tube is still in place so you can continue to use it while waiting for the appointment.
The MIC Gastric-Enteric feeding tube is recommended to be changed every 4-6 months. This will be done in the radiology department.
Skin care
Keep the stoma and surrounding skin as dry and clean as possible. Dressings and tape are not needed with this tube.
Despite your best effort to keep your child's skin around the stoma healthy, some common skin problems may occur, including:
When to seek medical attention
Contact the G tube specialist for non-urgent issues by phone or email if you notice any of the following signs and symptoms:
- There is hypergranulation tissue, which is pink to bright red, bloody, raw, moist, and/or painful.
- There is ongoing leakage of stomach contents.
- Your child's stoma site appears infected. Signs of infection include redness, edema (swelling) and odorous discharge. If your child is unwell, please contact your family doctor or take them to the emergency department.
- The tube appears to be damaged or broken but is still able to be used.
If the MIC Gastric-Enteric feeding tube has moved out of the small intestine and into the stomach, your child may experience:
- increased vomiting
- vomiting formula
- gagging and retching
- abdominal discomfort or pain
- bloated stomach
- diarrhea
- leaking of formula from the gastric port or stoma
The position of the tip of the combination G/GJ tube will need to be confirmed by an interventional radiologist using image guidance. During office hours (at SickKids, Monday to Friday 8:30-4:00 PM) page the G tube specialist. After hours and on weekends bring the child to the emergency department. Do not use the tube for feeding until the tube position is confirmed.
Intussusception
Intussusception may occur around the tube. Intussusception is when one part of the small intestine slides into the next part. This can happen at the tip of the combination G/GJ tube. Large combination G/GJ tubes and/or normal movements of the bowels may cause intussusception.
A child with intussusception will experience:
- discomfort and feeding intolerance (vomiting when fed)
- vomiting bile (green fluid)
- diarrhea or blood in the stool
If you think that your child’s tube has intussuscepted, page your G tube specialist during business hours. After hours, on weekends or on holidays, take your child to the emergency department.
If there are urgent issues with the tube that you cannot manage after hours or on weekends, go to the emergency department. During regular business hours page your G tube specialist. If the page is not returned or you are clinically concerned about the child, go to the emergency department. These issues may include:
- The tube appears to be damaged, broken or dislodged.
- Your child experiences abdominal pain, abdominal distension (swelling), discomfort, vomiting and/or other signs of feeding intolerance.
- Your child has signs of respiratory distress (i.e., higher breathing rate or difficulty breathing).
- You are concerned the tube has moved into the stomach or your child has intussusception.
What to do if your child's tube is accidentally pulled out
If your child’s MIC Gastric-Enteric feeding tube is partially pulled out but remains in the stoma, tape the tube to your child’s stomach to prevent it from completely dislodging. Do not try to push the tube back in.
If the tube has been pulled out <5cm and the child is tolerating feeds, you can continue to use the tube and monitor closely for symptoms. call the g tube specialist during regular business hours to arrange a tube exchange. if the tube has been pulled out>5cm or your child has any issues with tolerating feeds, do not continue to use the tube. Call the G tube specialist during regular business hours or come to the emergency department after hours, on weekends or on holidays.
If your child’s MIC Gastric-Enteric feeding tube is accidentally completely pulled out of the stoma, please follow the instructions in the linked article below for: Inserting the Foley catheter after a GJ tube has been accidently pulled out.
Do not use the Foley for medications, feeds, or fluids. Do not inflate the balloon.
At SickKids
G Tube Resource Nurse Contact info:
- Phone: 416-813-7177
- Email: g.tubenurse@sickkids.ca
On weekend/afterhours, your child may need to come to the Emergency Department for an alternate method of feed/fluids/medications administration.