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For more information please visit www.KCDigestiveHealth.com The Kimberly-Clark* MIC*, MIC-KEY* Introducer kit The new Kimberly-Clark MIC*, MIC-KEY* Introducer Kit is making gastrostomy an option for more paediatric patients who need nutritional support delivered directly to the stomach. Dr Gunnar Göthberg, a paediatric surgeon at the Queen Silvia Children’s Hospital, Sahlgrenska University Hospital in Gothenburg, says the Introducer Kit which facilitates the initial placement of the MIC* and MIC-KEY* balloon-retained enteral feeding tubes, means that he can now perform a gastrostomy on patients with significant oesophagus strictures. Previously, this procedure had not been possible because of the difficulties in performing percutaneous endoscopic gastrostomy (PEG) even with an ultra slim scope, because of the narrowing of the oesophagus. Dr Göthberg says that the main advantage of the new Introducer Kit is that placement of the MIC-KEY* tubes can now be completed in one procedure rather than two as was previously the case. Furthermore, the placement can be completed at the same time as another medical or surgical procedure which benefits both the patient and the operating room team. To date Dr Göthberg has performed 20 procedures with the Introducer Kit on a total of 14 girls and six boys. Eleven of the patients were less than three years old, seven were under 12 months old and the youngest patient was a four month-old baby weighing 4kg. His patients had a variety of conditions that necessitated gastrostomies including neurological problems, cardiac conditions with disturbed swallowing reflex, pre-mature born babies that require tube feeding for another three to four years, lip malformations preventing the child from swallowing, metabolic problems, heart transplant patients and cancer patients prior to treatment. “In general, oncology patients have the procedure a week prior to their chemo at the same time as they have their IV lines placed,” explained Dr Göthberg . “With a traditional PEG placement I only needed a nurse to assist and with the Introducer Kit I need an extra assistant to hold the endoscope to give me the visualisation I need throughout the procedure. But the patient is only in the operating room once which is much better for them and means less operating room time is required as we don’t need to allow for a second procedure. The whole process takes around 20 minutes.” Dr Göthberg, who performs up to 40 gastrostomies a year, has been using the MIC-KEY* low profile feeding tubes since they were first introduced in Sweden in 1993. He favours the Introducer kit above the laparoscopic techniques for placement because they take much longer to set up. The features contained within the Introducer Kit include: ■ A Pre-loaded Saf-T-Pexy* gastrointestinal suture anchor system which incorporates resorbable sutures and external suture locks to secure the stomach to the anterior abdominal wall. The Saf-T-Pexy* system eliminates the need for traditional suture removal, minimizes the risk of infection, and enhances stoma tract formation. Unlike traditional sutures, which require an additional office visit for removal, the Saf-T-Pexy* system simply resorbs and sloughs with the internal components passing through the GI tract, leaving the balloon-retained tube in place until replacement is required. However in children the sutures stays to long if not cut within 4 weeks. Regularly the patients see a nurse after 3-4 weeks for removal of these sutures. ■ A telescoping serial dilator system with an integrated peel-away sheath provides all-in-one, continuous dilation and easy tube placement. The Kimberly-Clark all-in-one dilator and peel-away sheath does not require removal or multiple exchanges prior to complete dilation and is available in various sizes to better accommodate specific patient needs. ■ An over-the-wire stoma measuring device enables a more accurate stoma tract measurement, improving the tube fit for enhanced patient comfort and safety. ■ Safety devices facilitate efficiency, enhance the ease of use and protect the health care worker from inadvertent needle sticks. In using the Introducer Kit to date, Dr Göthberg has adapted his techniques to achieve the best possible results. He recommends: ■ If using forceps to clamp on sutures to hold gastropexy before closing the bumper, wrap suture with plastic to ensure you don’t damage the suture ■ Measure 2mm under the bumper with the forceps to ensure the gastropexy is not too tight on the skin ■ Ensure a deep incision is made before dilation ■ Leave the button open for four hours after placement to let the air and liquid evaporate. Feeding can start after six hours. NEW KIMBERLY-CLARK MIC*, MIC-KEY* INTRODUCER KIT OPENS UP GASTROSTOMY FOR MORE PAEDIATRIC PATIENTS - An interview with Dr Gunnar Göthberg, paediatric surgeon at the Queen Silvia Children’s Hospital, Sahlgrenska University Hospital in Gothenburg. Advertisement C M J CM MJ CJ CMJ N Introducer Kit ad – EJPS.eps 1 10/08/09 09:02 Introducer Kit ad – EJPS.eps 1 10/08/09 09:02
