Henry has been using his Nutriport brand Skin Level G-Tube by Kangaroo for several months now, so it must be time to describe our experiences so far. To sum it up… so far, so good!
We switched from the Mic Key to the Nutriport earlier this year as the Mic Key kept coming out – both with the balloon popped, and with it still inflated (ouch!). So after lots of internet research, and a meeting with Christine – the g-tube nurse at BC Children’s Hospital, we made the switch.
A Quick Recap of Choices:
MicKey – the first choice in BC for most patients. Seemed good at first, but Henry’s kept falling out.
Nutriport – very similar is shape and design as the MicKey. The balloon has a slightly different shape. Is also replaced every 3 months, at home, by the caregivers
BARD – a more “permanent” button, it is similar in shape but is only replaced once per year, typically in radiology and while the patient is under anesthetic (especially with younger patients).
AMT – according to blogs, it is well liked, but cannot be accessed in Canada as there is no Canadian supplier. Apparently families would need to travel to the US to obtain on.
A Brief Description:
The nutriport is a skin level g-tube, meaning it is a low profile device that sits close to the skin. It comes with both bolus and right angle extension tubes, although we primarily use the bolus one. This button does sit slightly differently above the skin, and this is an unexpected benefit for Henry. While the MicKey “under side” is flat on the side, the nutriport has two “feet” that raise it up ever so slightly above the skin. This seems to result in better air flow around the stoma (the technical term for the hole into Henry’s tummy), and less irritation. But beyond this, it functions pretty similarly to the Mickey.
A Few Photos:
Henry having breakfast :). His pj’s typically cover up the button, so you can just see the tube coming out from underneath.
A closer look at the button itself, with the extension tube attached. We use the bolus extension tube (designed for “meals” versus the right angle tube designed for continuous feeding).
Here’s another photo of just the button, with the flap open but no extension tube attached. Those people familiar with tubes will note that it look very similar to most other skin level g-tubes.
Here’s a photo of the two types of extension tubes. Here’s where the nutriport and the Mickey differ. We find the nutriport tubes to be far superior in terms of longevity and usability. They are longer and wider (a drawback for someone who is volume sensitive), but make them much easier to use for homemade blended meals.
A comparison of just the bolus tubes – which are typically the ones used with homemade foods – really shows how the nutriport’s are better for this purpose. The Mickey’s bolus tube has a permanent angle, presumably to make it easier for self feeding. But most blogs I read found this counterproductive, and personally we hated it. In addition, the Mickey’s bolus tube has no port closures at the end. Meaning that between syringes, even when clamped food would leak out. The nutriport’s bolus tube has the same port closers as their right angle tube does. Plus it is a flexible tube with no permanent angle, making it much more functional for both self feeding and care giver feeding. Overall, so much easier.
Here are two photos of the button itself, first the nutriport and then a side-by-side of the nutriport and Mickey. In the first photo, you can see the two small “feet” that raise it up ever so slightly.
In this one you can see the difference in attaching the extension tubes. The Mickey’s tube are the “click and turn to lock” style. Meaning that once attached the extension cannot be removed until it is turned again. Seems good for ensuring the tube doesn’t come out during feeding, but somehow with Henry’s wiggling, it would come off anyways. And neither Granny (Shawn’s mom) or Grandma (my mom) got the hang of attaching the tube… blame it on their failing eyesight.
The nutriport is just a “push in” style. There is no turning to lock required… just a solid push and it’s attached. This took us a while to get used to, and you have to ensure you have a good grip on both the tube and the button to attach it, but now it’s no problem. This also means that it can come out easier. At first this seemed like a potential problem, but really it’s been a benefit. It certainly doesn’t pull out easily, but in case it gets caught (like in a cupboard door), or pulled (like by a 10 month old younger brother) instead of pulling out the whole button or damaging the skin, the extension tube simply comes off.
Here’s a side by side of the two different buttons with the balloon inflated – Mickey on the left and nutriport on the right. You can see the slightly flatter top of the nutirport’s balloon. We think the “egg” shape of the Mickey might be why it was falling out – literally being pulled through the hole. The flatter top of the nutriport balloon hopefully keeps it in better. Again… so far so good.
- It hasn’t fallen out!
- extension tubes better suited for homemade blended food: wider tubing, ports that close on bolus tube and more flexible.
- extension tubes stand up better to longer use. The Mickey tubes would discolour and begin to permanently crimp after about a week, making it even harder to use a syringe. The nutriport tubes clean easier, don’t discolour and don’t crimp. We used one bolus tube for over 3 months, and with good cleaning it was still as good as ever. I know, not recommended, but we couldn’t get any other bolus tubes at the time, so we had to make it work.
- The “feet” raise the button up slightly, and this has reduced irritation and redness around Henry’s stoma. He doesn’t have much trouble with it anyways, other than a bit of itchiness at times, but now it is even better.
- he used to get some leakage from around the button. Not out of the button itself, but out of the stoma. This was considered common and we typically had to change his shirt daily as it would be discoloured on the inside. Now he has almost no leakage, which we attribute to the different shape of the balloon.
- It is less well-known, at least here is BC, which made getting supplies a bit of a challenge at first. But a huge thank you to Christine from BCCH for helping get the tubes for us.
- the extension tubes are considerably wider, and the right angle tube is a lot longer, than the Mickey. Could be a drawback for a person who is very volume sensitive as it takes up to 30 ml of water to flush.
- another drawback of the wider tubing is that chunks that would have been caught in the Mickey tubing, now get caught in the button itself. We have less clogs overall (which is great!) but end up clearing the button more often than the tubing.
- The buttons tend to leak fluid when open. It isn’t typically a large amount (maybe 1 ml), but the Mickey rarely did that. Our first button leaks a lot… like pooling on the floor a lot. Christine from BCCH recommended changing it earlier than scheduled in case it was just an older button or defective. We haven’t had that problem again since.
- however the valve is more sensitive on the nutriport, so if even a small piece of food is caught in it, it will leak. Typically it is easier to clear and this resolves any leakage. Fine for us, but still not very nice.
Over all, we’re happy with the switch and would recommend it to others. It is especially beneficial to those people wanting to have a homemade blended diet, and we find it makes a HUGE difference in this regard. Plus… it hasn’t fall out!
As always, if you have any questions, please feel free to comment.