G-tube vs Mic-Key

My PALS has had the g-tube, what we call the dangler since 9-2016. It seems like it gets clogged more often in the last few months and the tube is somewhat misshapen from us rotating the tube between our fingers trying to relieve the clog.

How long should a g-tube last?

I called yesterday to inquire about having it replaced. They said our options were to replace with another g-tube would require sedation or we could replace with a mic-key in the office with no sedation.

Previously my PALS didn't want a mic-key. He didn't like the idea of a balloon inside his stomach. He thought it would take up space. I told him that his stomach would stretch a little to accommodate the balloon.

Has anyone had a g-tube and had it replaced with a mic-key? Are you happy with your choice?

What's the pros and cons of the mic-key compared to the g-tube?

How painful is the procedure going from g-tube to mic-key?

I have only our expierence for knowledge on this subject but I am confused by their statement that your PALS would need sedation for another g-tube but not for a mic-key?! My PALS came home from rehab with a mic-key and about a year later it was switched to a gtube dangler with no sedation, a two minute procedure sitting in his wheelchair . Both had balloons less than an inch in diameter. I have been changing them at home as it is such a simple procedure once the track is well established and it sure beats going to the hospital at night when it's completely blocked.

The mic-key didn't work well for my PALS as he goes through stages of stomach bloating and it would get too tight causing discomfort. To my knowledge you can't adjust the length on the mic-key as we can on the gtube. I also prefer the dangler for the ease of use vs having to attach the extension every time you use it. Kate

That sounds wrong to me too! If his current G tube has a "bumper" or flange in the stomach to keep it from sliding out, it is possible to pull it out, but it is painful and risks bleeding and/or trauma to the track it is in. Replacing it with any type of tube would ideally be done as an endoscopic procedure with anesthesia, especially if he is on an anticoagulant to prevent blood clots. The anesthesia would be for the discomfort of the large endoscopic tube down the throat, not the new G tube. It would use the same track as the old one so no new puncture needed and no pain after.

If his current tube has a balloon to hold it in his stomach, it can easily be replaced in the office by deflating the balloon. It will slide out painlessly and the new one slid in. If there is any question of which type he has now, one with a bumper will have two ports on the end, a large one for feeding and usually a small one for meds. A balloon type will have three ports, feeding, meds, and one to inflate/deflate the balloon.

A Mic-Key or other button type of tube has the advantage of no tube dangling, but requires a small adapter to connect the Mic-Key to a syringe or tube for feedings. In the past, all button types were balloon tubes, but a bumper/flange type is now available.
MiniONE® G-Tubes Family | Applied Medical Technology
and
Low-Profile - Bard PV

A balloon requires replacement about every six months because the balloon gradually deteriorates from stomach acids. Replacement can be done in the office or at home by a caregiver. A balloon can be easily pulled out accidentally as it reaches the six months or more point. A hard tug can pull it out if it has begun to deteriorate and deflate. Because the tube has to be replaced within twelve hours or less or the track will collapse and close, reasonably fast access to the office, ER, or a spare at home and someone trained to insert it and check to be certain it is in the stomach is necessary. Usually, a failing balloon can be detected simply with a gentle, short tug on the feeding tube. It will slide out a little or a lot! Just slide it back in and re-inflate the balloon with air. That won't hold it long, so tape it down and call for an appointment to replace it.

A bumper tube will last a long time, but my GI doctor says to replace it every eighteen months. I don't want to deal with the whole endoscopy thing that often even though I am on a ventilator and don't have to worry about being anesthetized. If you don't mind being scolded by your doctor, you can wait longer. My last tube lasted seven years before cracking and leaking. Even then it wouldn't have been an emergency if I had access to some duct tape. But I happened to be in the hospital when it sprung a leak so they replaced it the next day. I got definite instructions to have it replaced in eighteen months. I smiled and nodded ... but I won't.

Hi sooner - did they not explain to him how small the balloon is?
I would think the dangler he has now how has a balloon holding it in?

Most people find the Mic key or other button like the bard wonderful but it doesn't matter which as it is preference. It does sound like it's time to replace the current dangler tho

He has a bumper inside not a balloon holding the dangler.

I didn't realize you could get a dangler with a balloon.

The home health nurse is coming out Sunday. I spoke with her today and she didn't see fond of the mic-key. She said she found it hard to attach the tube.

Part of the problem we were having was that my PALS antidepressant was time release and it would get stuck in both the syringe and the tube. Also, after me helping him all day today, l have found that he is having trouble pushing the syringe in to the tube far enough.

My PALS had a Boston Scientific EndoVive Low Profile Button. I'm not sure this model has a balloon - I think it has a bumper and some anti-reflux valve.

The first time he had the regular dangling PEG, which he hated and had a negative psychological impact on him - he could not even bear seeing the tube sticking out of his stomach. I had to fight with the gastroenterologist to place the button six weeks later - he did not want to do it because he felt that it would make it impossible for my PALS to do the feedings himself, but my PALS wanted the low-profile button.

We never had any issues with the button: no clogging, no granulation, no nothing. The only issue later on was that my PALS stomach became bigger and we were considering replacing the button with the next size up. But other than that, I feel the button would have lasted a long time.

My PALS was happy with his button. He did need to go under mild sedation to replace the PEG with a button. Also one thing he loved about the button is that in the early stages of the disease when he could still go to the beach, he would just cover the button with a bandaid and no one in the world could tell he had a PEG. Again, aesthetics were important to him.

Please forgive me for high jacking Sooner ....... Diane, why do you prefer one with a bumper when you have to have to have endoscopy and anesthesia each time? My PALS is on a vent also. Kate

Chris had a BARD which does not have a balloon.

Hopeful Rose will stumble across this thread too as she is the tube-chic

KateEmerson said:

Please forgive me for high jacking Sooner ....... Diane, why do you prefer one with a bumper when you have to have to have endoscopy and anesthesia each time? My PALS is on a vent also. Kate

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I have never had any problems with anesthesia and that makes the whole procedure painless. My first tube was a long red rubber, bumper tube that lasted for years. Then, for several years I had the balloon type. The frequent appointments were a nuisance. We kept a spare at home and when a tube fell out because it was overdue for a change, John tried replacing it but it would not go in. So we ended being told to go to the ER. Nurses tried, then the doctor, but I ended up going to endoscopy. When I woke up, the doctor said he was able to use my existing stoma but a needed to tunnel a new track. (Only painful for few hours.) I wasn't happy when I learned it was a bumper tube and would require endoscopy replacement. He didn't explain why he put in a bumper tube, but I suspect it was because I had been gaining weight since going on the ventilator and a track through fatty tissue collapses quickly when the tube comes out.

We found out that it was nice not having to have the balloon tube changed so frequently or worry about it getting pulled out so easily. The doctor didn't tell me when I should have the bumper tube replaced. I had read that there was no need to replace them unless they were hopelessly clogged, so I went on happily for seven years before the tubing began to split and leak.

The replacement tube is the same but has a clamp on it. This is the first of all the tubes over 13 years to have a clamp and I hate the clamp! It makes a big lump under my shirt which is something I never had to deal with before. But John finds it convenient, so I guess I won't demand to have the (actually unnecessary) clamp cut off. And I may be reasonably compliant and have to tube replaced in a couple of years, but not every eighteen months.

Thanks Diane for the good information. I think we will continue with the dangler with the bumper inside for now. I think our issues may have been more about Cliff's hands failing. We also changed his antidepressant from ER to two a day so now it is crushable instead of little beads that don't dissolve and get stuck in the syringe and tube. Maybe we can go on for a while without having to change it at all.

My PALS, Frank, initially had the dangling g-tube (balloon type) which was changed to the Mic-Key button after about one year. We much prefer the Mic-Key because we had several episodes of the tube clogging with the g-tube and it was impossible to get it completely clean.

It is very easy to attach the extension tube to the Mic-Key and if it gets clogged, it is easy to clear with hot water. The appearance was much more acceptable to Frank than the dangling G-tube.

Sharon

One other answer to your question-- the process of changing from the G-tube to the Mic-Key was done in the doctor's office with no anesthesia and Frank said it wasn't painful. It only took a few minutes.