A review of AMT (non-balloon) Capsule button with photos

This past February, my doctor switched me from a balloon button to a non balloon.  I requested it mainly because I had always had issues with my peg tube doing the hunger dance.  By this, I’m referring the button moving of its own accord when my stomach was empty.  And, obviously, with an all liquid diet, and bolus feeding, my stomach was frequently empty.  If you, too, have a “possessed” button, you know what I’m talking about.

The movement, especially in the mornings, was strong.  The button would pull so tight against my abdomen, that it could barely be turned, and then, POP!  it would push back up the other direction, all the while twirling around.

Entertaining?  Possibly.  Comfortable?  No.

Adding to the mix was my propensity to develop overgranulation tissue.  The #1 cause (for most of us) for the perpetuation of the granulation cycle is friction.  And, with all of the movement going on throughout every day and night, there was always a degree of friction within my stoma.

When I searched for answers (my doctor had never heard of such a thing!)  The only explanation, and “fix” mentioned on the various forums and blogs, was that it was the balloon causing it, and to switch to a non-balloon feeding tube.  In simple terminology, the stomach tries to eat the balloon.  Whether or not this is really why it happens, I do not know.

Balloon bolster feeding tubes do not have a long lifespan.  Six months is average, but they can (and do) certainly fail sooner than that.

My secondary reason for wanting to try the non-balloon type of button is because of medical insurance coverage.  In the United States, those who are covered  by (original) Medicare Part B have their peg tubes covered as a “prosthetic device”.  And, all supplies needed to maintain  prosthetic devices must be  provided by a durable medical equipment company (DME).

Because I do not use any commercial formula I do not have a DME, and therefore no resource for replacement g-buttons.  So, in order for me to have my insurance pick up 80% of my out of pocket cost, it was necessary to have the change done by my doctor, which of course in turn had to be done at a medical facility.

The main advantage to balloon type feeding tubes is that they can be changed out at home by the patient or their caregiver (regardless of whether it is a dangler or button type balloon feeding tube).  But, I was unable to obtain any sort of balloon button and change it by myself, using  my 20% Medicare co-pay because I had no DME to provide it to me, because I don’t use formula.  Yes, this is frustrating, and yes, I am completely 100% correct on information about this coverage.  Believe me, I’ve tried and tried.

So, even though I was physically able to change my balloon button at home, it was costing me hundreds of dollars out of pocket on a regular basis if I wanted to do it myself.  Otherwise.  it entailed the whole long drive to the hospital,  plus, I had to have someone with me, I couldn’t drive myself due to hospital policies, etc etc.  AND it still cost me a good bit out of pocket, because now I had to pay 20% of the medical facility costs, and the doctor.

So, did the idea of a longer lasting g tube seem appealing?  Why, yes, as a matter of fact it did!

I had read that the non balloon g tubes (button or dangler) had to be changed under anesthesia, or have to endure a painful pullout procedure.  Neither of these options were good ones.

Then, I read about the “Capsule” version of the non balloon button made by AMT.  I already knew that I liked the AMT Mini One much better than the widely known Mic-Key button by Halyard.   The balloon version of the AMT Mini One is so much lighter and less bulky  than the Mic-Key, and the anti-reflux valve lasted much longer for me too.

*The MiniONE® Capsule Non-Balloon Button combines the advantages of a low-profile device with the longer life of a non-balloon device.

    Ideal for patients who don’t tolerate balloon buttons
    Significantly longer life than a balloon button
    Capsule design dramatically reduces pain during insertion
    Button shaft is as narrow as that of a balloon button
    Capsule is self-lubricating for easy insertion
    Internal bolster is smaller than a balloon button (less likely to block pylorus)
    Internal dome provides more larger openings for more efficient feeding and venting
    Removal tool distends bolster to a smaller profile

(*Taken from the Applied Medical Technology website)

 

 

Supposedly, removal is not painful because of the special tool.  I have not had it changed yet.

This capsule feeding tube comes in both the button and dangler version.

The button type does not have a huge selection in lengths.  My doctor and I ultimately decided to go with a longer length than I’d used with a balloon type device.  Even though it sits quite a ways (relatively speaking) from the surface of my skin, I have had zero instances of any stomach acid leakage.  The diameter of my tube (20fr) stayed the same.  Most likely, it’s because the diameter is a nice snug fit,  that I  have no leakage issues.

Camera angle from the side

It was challenging to hold the camera at an angle that captured how it sits above my skin. The bottom side of the button  is much further away than the suggested (ideal)  thickness of  dime.  But, it has not been a problem at all.

At this point I have no granulation tissue (ever) no exudate.  The stoma is free of all secretions.  It is completely healthy and trouble free.

Even though AMT states all of their anti-reflux valves last significantly longer than other manufacturer’s buttons,  (and I figure that is really the only thing that would cause me to have to have a button change)  I can not find any definitive lifespan for the capsule button.  I read one reference on a pediatric hospital website saying it could easily last as long as three years.

I would think that being careful to flush adequately with water after each and every use would be the best way to ensure a long life for the anti-reflux valve, and in turn, the device itself.

Do I love it?

YES!  I absolutely do.  It has NEVER pulled, popped, or twirled on its own accord.  I no longer am host to a possessed button!

It is lighter than the AMT Mini One balloon version.  Not a whole lot lighter, but some.  And, of course significantly lighter than a Mic-Key button or dangler type tube.

The button uses the same feeding sets as the better known balloon version of the AMT Mini One. (And can use the Mic-Key sets too.)

The profile is a little lower than the AMT Mini One balloon button, all is the same except it doesn’t have the balloon port.

Holding up a previously used Mic-Key button for comparison

I have yet to find a drawback or negative of any kind for the AMT Mini One Capsule.

Here is a link to their website (they provide a video showing how it deploys)

http://www.appliedmedical.net/gi-products/minione/cap-non-balloon/

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