Gastrostomy tubes (G tubes) are feeding devices that provide liquid nutrition, medication and other fluids directly into the stomach. G tubes are placed through a surgical opening in your child's stomach called a stoma. The tunnel from the outside of the body to the stomach is called the tract.
Balloon G tubes have an inflatable balloon on the end that sits inside the stomach to keep the tube in place. A low-profile balloon G tube is a type of feeding tube that sits close to the skin. These tubes are sometimes referred to as a “button” because of their appearance and how they sit on the skin. Low-profile balloon G tubes need a special extension tubing to connect to the tube to feed your child. There are several different brands of low- profile G tubes available. A Mic-Key G tube is a specific brand of low-profile balloon G tube.
This page is about the primary insertion of a Mic-Key low-profile balloon G tube placed by an interventional radiologist using image guidance, where images produced by X-rays and ultrasounds are used to guide the placement of the tube in your child’s belly (abdomen). Use this information if your child’s very first G tube is/was a Mic-Key button. This page does not apply to non-balloon style G tubes, GJ tubes, combination G/GJ tubes, or the primary insertion of G tubes by a general surgeon. It also does not apply to Mic-Key G tubes that replace a Corflo PEG tube. For information on other types of feeding tubes, please see AboutKidsHealth Tube feeding learning hub.
General post primary insertion care
Your child will be admitted to the hospital for a few days after the insertion of the low-profile G tube. Your child’s progress will be monitored during this time. You can expect the following:
- Your child may have a nasogastric (NG) tube in place for a minimum of 24 hours after the primary insertion of the Mic-Key G tube. Once your child tolerates feeds through the new Mic-Key G tube, the NG tube can be removed.
- Your child cannot have anything to eat or drink by mouth until they tolerate feeds through the new tube.
- Your child will have an intravenous (IV) line to provide essential electrolytes and fluid. The IV will stay in place until your child tolerates fluids/feeds through their new Mic-Key G tube.
Using the new Mic-Key G tube for fluids/feeds:
- The new Mic-Key G tube will not be used for fluids or feeds for a minimum of four hours after primary insertion. After four hours, a health-care provider will listen to your child’s abdomen for bowel sounds.
- If bowel sounds are heard four hours after the tube insertion, a very small volume of an electrolyte solution will be given through the new tube.
- After the small volume of electrolyte solution, it will gradually be replaced by formula and feeds will be increased to the goal volume. Feed progression through the new tube will be guided by a dietitian.
Once your child tolerates the goal volume of feeds through the new Mic-Key G tube, you will be told when they can begin drinking and/or drinking by mouth. Offer only small volumes to start and do not overfeed.
Retention suture buttons
After insertion, there will be up to four retention suture buttons around the Mic-Key G tube. These sutures keep the stomach attached to the abdominal wall while it heals. The retention suture buttons will remain in place for two weeks.
In the unlikely event all retention sutures fall off within the first two weeks of tube insertion, DO NOT use the Mic-Key tube until the placement of the Mic-Key button is verified.
For children that had their tube inserted at SickKids, their Mic-Key G tube check will be done at SickKids. Contact the G Tube Resource Nurse during business hours or go to the Emergency Department after hours to get help with coordinating this tube check.
For children who are not SickKids patients, contact your child’s G tube specialist for guidance on managing tube issues.
If only some of the retention sutures fall off within the first two weeks of the Mic-Key placement, you can continue to use it. All the remaining retention sutures will be cut two weeks after the Mic-Key button insertion.
Caring for your child’s primary insertion Mic-Key G tube
After the primary insertion of a Mic-Key G tube, your child’s stoma is left open to the air. A dressing is not needed.
Follow these instructions for the care of your child’s G tube:
- Wash the stoma and skin around the retention suture buttons daily with soap and water, starting 24 hours after the tube is inserted. A cotton swab can be used to clean around the retention suture buttons.
- You may bathe or shower your child 24 hours after the primary insertion of the Mic-Key button. Your child may go swimming two weeks after the tube is inserted.
- After primary insertion, the feeding extension tubing will remain connected to the Mic-Key button and taped to the abdomen for the first few days to limit tube movement and minimize pain. After the first few days, the extension can be removed from the tube when it is not in use. To learn how to connect and remove the extension set from the Mic-Key button, please see the article “Feeding extension set for a low-profile balloon tube”.
The balloon
The balloon at the end of the tube sits inside the stomach to keep it in place. The balloon is inflated with sterile or distilled water through the port labelled “BAL”. You can also use tap water that has been boiled and cooled down. Do not use air or normal saline in the balloon. The balloon of a Mic-Key 14FR G tube can hold 5-10 mL of sterile water.
To review how to check and change the volume of water in the balloon, please see the article “Checking the balloon on a feeding tube”.
How to change the Mic-Key G tube
To review how to change the balloon tube and how to check the placement of the tube, please see the article “How to change a balloon G tube and check tube placement”.
How often should you change the Mic-Key G tube?
The tubes are recommended to be changed every six to eight months to prevent leaks in the balloon, which could allow the tube to fall out of the stoma. It may be time to change the tube when:
- the balloon is broken
- the one-way feeding port is broken
- the balloon port is broken
- the tube is blocked
- the tube has been dislodged
When changing the tube, it is important to remember the risks involved.
Infection
When you replace the tube, the stoma and the tract can become irritated, and bacteria can be introduced. This increases the risk of infection. Wash the stoma with soap and water before inserting the new tube to reduce the risk of infection. Always wash your hands before handling the tube and continue to clean the site with soap and water daily. Keep the site open to air.
Increased hypergranulation tissue
Removing an old tube and inserting a new one can irritate the skin and cause hypergranulation tissue. This is a common occurrence. Your child’s G tube specialist can help you manage hypergranulation tissue.
Perforation
There is a possibility that, when inserting a new tube, the tube is not inserted along the existing tract. It could create a new tract and space inside the body. This is extremely rare. If your child has instant intolerance (vomiting) or severe pain after their first feeding with a new tube, stop using the tube and go to the emergency department for assistance. A G tube check may need to be scheduled in the interventional radiology department. Perforation can lead to a condition called peritonitis.
What to do if the Mic-Key G tube is accidently pulled out?
If the Mic-Key tube is pulled out within eight weeks after insertion:
- Insert a 14FR (or smaller) foley catheter into the tract.
- Do not inflate the balloon or use the foley catheter for feeds, fluids or medication until a tube check is completed.
- If your child is a SickKids patient, contact the G Tube Resource Nurse during business hours or go to the Emergency Department after hours to have the tube replaced and placement checked.
- If your child is a not a patient of SickKids, contact their G tube specialist or seek medical attention at your closest emergency room.
If the tube is pulled out after eight weeks from primary insertion, see "What to do if your child's feeding tube is pulled out".
Managing stoma issues
For more information about treating stoma issues, see G and GJ tubes > Stoma and skin care on AboutKidsHealth’s Tube feeding learning hub. If you are unable to manage the stoma issue(s) at home, contact your child’s G tube team.
At SickKids
If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.
G Tube Resource Nurse contact info:
Phone 416-813-7177
On weekends/afterhours, you may need to come to the Emergency Department for an alternate method of feed/fluids/medication administration.
