Giving Your Child Bolus Gastrostomy Feedings through a MIC-KEY™ Tube

1. Wash your hands.
2. Gather these items:
   • 30-60 ml syringe
   • Measuring cup
   • Small cup of water
   • Formula (at room temperature)
     • For gravity method:
       • MIC-KEY™ Bolus extension set
     • For pump method:
       • Feeding set
       • Feeding pump
       • MIC-KEY™ Right Angle extension set
3. Position your child sitting up. For an infant, use an infant seat or a mattress with the head raised. Once the feeding has begun, you may hold or cuddle your child.

A. Gravity method (using a syringe)

• Tell your child what you will be doing.
• Open the cap on the MIC-KEY™ tube and insert the MIC-KEY™ Bolus (straight) extension set.
• Remove the plunger from a 60 ml syringe and put the syringe into the end of the attached extension set and unclamp.
• Hold the syringe set no more than 6 inches above your child’s stomach.
• Pour pre-measured formula into syringe.
• Continue to pour formula into the syringe slowly as it empties.
• Each feeding should flow in over a few minutes. Holding the syringe higher will make it flow faster. Holding it lower will make it flow more slowly.
• When the feeding is finished, pour warm water into the syringe to flush the tubing and clear it of formula. Use 5 ml of water for an infant and 10-30 ml for an older child.
• If needed, replace the plunger into the syringe and push gently to push the remaining water into the stomach.
• Clamp the extension set and then remove the syringe and the the MIC-KEY™ bolus extension set. Put the cap into the MIC-KEY™ tube port.
• Wash the syringe and MIC-KEY™ bolus extension set with warm water and mild soap and rinse well. Let air dry and then store in a clean area until the next feeding.

B. Feeding set method (using a pump)

• Tell your child what you will be doing.
• Remove the cap from the end of the feeding set.
• Fill the feeding set with the prescribed amount of formula. Do not touch the inside of the set.
• Let formula run completely through the tubing to get rid of all air. Then clamp the tubing shut with the roller clamp.
• Place the tubing into the pump and set the pump at the proper rate.
• Open the cap on the MIC-KEY™ tube and insert the MIC-KEY™ right angle extension set.
• Connect the feeding set to the end of the extension set and then unclamp the extension set.
• Open the roller clamp on the feeding set.
• Turn on the pump and watch to see that it starts to work.
• When the feeding is finished, clamp the extension set and disconnect the feeding set. Attache the syringe, then unclamp the extension set and flush with water, using 5 ml of water for an infant and 10-30 ml for an older child.
• Clamp the extension set and then disconnect from the MIC-KEY™ tube. Put the cap into the MIC-KEY™ tube port.  
• Wash the feeding set and MIC-KEY™ extension set with warm water and mild soap and rinse well. Let air dry and then store in a clean area until the next feeding.  

• Wash your hands before mixing formula. Use clean bowls, measuring cups, and spoons. If you are using cans of formula, wash the top of the can before you open it.
• Always store formula in a clean container.
• When making formula from powder, make only enough for 24 hours and refrigerate. Throw away any leftover formula 24 hours after mixing it.
• Ready-to-feed formulas can be used up to 48 hours once opened. Refrigerate after opening.
• Do not use formula after the expiration date found on the side of the bottle or can.
• If the g-tube feeding is in addition to feeding by mouth, let your child to eat before giving the g-tube feeding.
• Brush your child’s teeth, gums, and tongue at least two times each day.
• Offer your infant a pacifier to suck on during feedings. This will help him/her get used to sucking while feeding. If your child is older than 1 year, talk to your child’s doctor or nurse for guidance on oral stimulations during bolus feedings.
• Hold and cuddle your infant/toddler during feedings when possible.
• Stabilize the extension set to the belly surface with tape to avoid pulling and tension at the g-tube site.
• Leaving the extension set in for a long time may affect the one-way valve in the MIC-KEY™ g-tube and cause leaking of stomach juices out of the tube.
• Replace the MIC-KEY™ extension set once per week or per your home care supply company recommendations.
• Replace feeding sets as instructed by your home care company. You may want to write the date you change it on the calendar.
• Your doctor or nurse will arrange for a home care company to deliver the supplies you need.
• Call your home care company to make sure they have your child’s prescriptions with refills, when you are getting low on supplies, and if you are having trouble using the feeding pump.

• Your child has severe coughing, blueness around the lips, or trouble breathing. Stop the feedings and call an ambulance if his or her breathing or color does not get better right away.
• Your child throws up with each feeding
• Your child complains of heartburn or appears uncomfortable with feedings
• Your child has diarrhea or cramping
• You have any questions or concerns

Please call the GI office 617-355-6058 if you have questions or concerns. Our GI nurses can help you with all types of PEG tube questions:

• 8 a.m. to 4:30 p.m. weekdays: A nurse in the GI clinic will be available to help you.
• Weekdays after 4:30 p.m., weekends, holidays: Use the same number to reach a GI doctor on-call for urgent questions or emergencies.

If your child is followed by General Surgery:

• 8:30 a.m. to 5 p.m. weekdays: Call the General Surgery outpatient nurses at 617-355-7716 or 617-355-7704.
• Weekdays after 5 p.m., weekdays, holidays: Call the Boston Children’s page operator at 617-355-6369 and ask for the General Surgery Senior Resident on-call.