Procedure: Percutaneous Mic Key button gastrostomy tube placement
Indication: Head and neck cancer
Date: 01/01/2021
Operators: John Doe, MD (Attending)/Jane Doe, MD (Fellow)
Medications: 1 mg IV glucagon, Ancef, 4 mg IV Zofran, Versed and IV fentanyl, Glucagon [ 2mg ]
Contrast: [20] mL nonionic
Fluoroscopy time: [5 ] minutes
Catheter: 20 French MIC Key Button gastrostomy tube
Complications: None immediate.
Technique:
The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. The specific risk of damage to adjacent structures was detailed and accepted. Written informed consent was obtained. A time out/call to order was performed prior to procedure initiation.
The patient was assessed for conscious sedation and found to be an adequate candidate. A dedicated nurse monitored heart rate, blood pressure, and oxygen saturation throughout the procedure.
The anterior abdominal wall was prepped and draped in sterile fashion. Ultrasound was used to mark the liver edge. Fluoroscopy was utilized to localize the transverse colon. IV glucagon was administered. Through a fluoroscopically placed a 5 French catheter, the stomach was insufflated with air.
2 T-fasteners were placed appropriately placed in the anterior abdominal wall. Gastrostomy was made this was dilated a 20 French. An 18-gauge Chiba needle was used to access the stomach between the T-fasteners. Air was aspirated contrast injected and a wire passed into the gastric lumen. The dilator was passed over the wire. The 18 French by 4 CM Mic key button was inserted through a peel-away sheath and inflated with dilute contrast to verify adequate location within the gastric lumen. Contrast was injected
The balloon was inflated with 5 mL of saline. Contrast was injected through the MIC key button to verify adequate location within the stomach . The T-fasteners locks were set.
Sterile dressings were applied to the anterior abdominal wall. The G-tube was connected to external passive drainage system.
The catheter was placed to gravity drainage and orders written for NPO for 24 hours.
The procedure was well tolerated, and the patient discharged from the angio suite in satisfactory condition.
Findings:
The tube enters the gastric body to the left of midline. Contrast injection confirms appropriate intragastric location.
Impression:
Uneventful percutaneous image guided placement of an 18F MIC Key Button gastrostomy tube as described.
Frequently Asked Questions
A Mic Key button gastrostomy tube is a type of feeding tube placed directly into the stomach through the abdomen. It's used for long-term nutritional support in patients who cannot eat by mouth. The 'button' design is low-profile, making it more comfortable and less obtrusive than traditional tubes.
Placement involves a minimally invasive procedure called percutaneous endoscopic gastrostomy. Under sedation and using imaging guidance, a small incision is made in the abdomen. A tube is then inserted into the stomach, secured with T-fasteners, and connected to an external drainage system. The procedure generally takes about 30-60 minutes.
Risks include infection, bleeding, injury to adjacent organs, and tube dislodgement. However, these complications are rare. Patients are monitored closely during the procedure to minimize risks, and informed consent is obtained beforehand.
Why might someone need a gastrostomy tube?
Gastrostomy tubes are often used for patients with conditions that impair swallowing or digestion, such as head and neck cancer, neurological disorders, or severe gastrointestinal issues. They provide a reliable method for nutritional intake when oral feeding is not possible.
What care is needed after receiving a gastrostomy tube?
Post-procedure care includes keeping the site clean and dry, monitoring for signs of infection, and ensuring the tube remains patent. Patients are usually advised to remain NPO (nothing by mouth) for 24 hours after placement to allow healing. Instructions on tube feeding and maintenance are provided by healthcare professionals.
Can a gastrostomy tube be removed?
Yes, gastrostomy tubes can be removed when they are no longer needed. This is typically done by a healthcare professional. The procedure is simple and usually involves deflating the balloon that holds the tube in place and gently pulling it out.
What is the role of fluoroscopy in gastrostomy tube placement?
Fluoroscopy is an imaging technique used during the procedure to guide the placement of the gastrostomy tube. It helps ensure the tube is correctly positioned within the stomach by providing real-time X-ray images, reducing the risk of complications.
Medications typically include sedatives like Versed and fentanyl for comfort, Zofran to prevent nausea, and antibiotics such as Ancef to prevent infection. Glucagon may also be used to relax the stomach and aid in tube placement.
What is the significance of T-fasteners in gastrostomy tube placement?
T-fasteners are small devices used to secure the stomach to the abdominal wall during the procedure. They help maintain the tube's position and ensure proper healing by preventing movement and reducing the risk of dislodgement.