Q: What do I do if the tube falls out?

A: Gently ‘thread’ the feeding tube back into the fistula to the pre-determined marking. Use The Insides® Neo Clip to secure the tube to the bag. Ensure that the tube fits in the groove, on the back of The Insides® Neo Clip. This will stop it from slipping. In addition, it can be helpful to gently advance the feeding tube into the mucous fistula an extra 10 mm with the understanding that when you secure it with The Insides® Neo Clip, it will slip out slightly and sit at the correct marking on the feeding tube. 

Q: What do I do if the O-ring dislodges?

A: If the O-ring has moved, you can slide it back in place. To prevent the O-ring from moving, use water-based lubricant and a gentle, slow, push and twist motion when inserting the housing through the port of the ostomy appliance. 

Q: Why is chyme leaking from the bottom of the bag?

A: There are two things that could be happening.

• If the housing is not in place, it will leak through the port of the ostomy appliance.
• If the adapter is not properly connected to the housing, chyme may leak out through the device. Ensure to push the adapter all the way, until you hear and feel a ‘click’ and this should resolve the issue. You should be able to see the nose of the housing in the centre of the adaptor. The adaptor should sit flush against the end of the ostomy appliance.

Q: What should I do if the infusion pump keeps alarming ‘Occlusion’

A: A few things to try if the pump is continuously alarming ‘occlusion’.

• Is the chyme too thick? You may need to consider a larger sized feeding tube. 
• Check that all the lines are open, unclamped and unkinked from the pump, all the way to the patient (including the feeding tube). 
• Change the extension set (The tubing between The Insides® Neo and the infusion pump). The extension set should be replaced every 24 hours, but sometimes a small blockage may form, and it will need to be replaced more frequently. 
• Check the patency of the feeding tube. Stop your infusion and gently withdraw the tube from the fistula so it sits in the stoma bag. (Do not take off the ostomy appliance.) Flush a small amount of sterile water or chyme manually through the tube. There may be a small blockage you can dislodge using the method of “push and pull” with the syringe.  If you are unable to flush the feeding tube, you will need to remove and replace the ostomy appliance.  Consider a larger gauge feeding tube at this time.

Q: Why am I unable to syringe chyme out of the bag when I can see there is chyme in there?

A: Ensure chyme is sitting at the bottom of the bag. The Insides® Neo draws chyme through the valves in the housing, therefore must be submerged in chyme.

Q: What ostomy appliances does The Insides® Neo work with? Will more brands be added? 

A: At the moment, Hollister™ Newborn Pouch “Pouchkins™” 3778 and Coloplast® “Sensura® Mio Baby” appliances work with the device. The Housing component is custom fit to prevent leakage from the bung of the ostomy appliance. Other brands will be included soon with device iterations.

Q: What is the size of the tubing inside the stoma bag?
A: The feeding tube is not part of the device, we do not provide information on it but we have suggestions here as guidance only: 

www.theinsides.co/training-portal-neo/prior-to-reinfusing-with-the-insides-neo

Q: I have some concerns about how The Insides® Neo handles thick/viscous chyme, and how to address this?
A: The patients will only be on parenteral nutrition/enteral nutrition/breast milk (if they're eating solids, The Insides® Neo is contraindicated). The Insides® Neo will be able to handle Curds that may form in the ostomy appliance. Note: If the nursing team are using a syringe driver to reinfuse, the extension set between the syringe and Adapter on the ostomy appliance, will likely need to be changed daily because it may block.

Q: What feeding tube and syringe is required for the Adapter and the Housing?
A: EnFit™ connection

Q: Can babies with an ECF/Fistula use The Insides® Neo?
A: If a baby develops an ECF they can use The Insides® Neo if it fits within the confines of the Hollister 3778 ostomy appliance

Q: Does refeeding with The Insides Neo supplement total parenteral nutrition (TPN) or replace TPN?
A: The Insides® Neo is intended to supplement and replace TPN. 
Neonates/Babies have a similar goal to adults where the primary goal is to wean off or reduce the amount of TPN being administered. 
To wean off TPN, this is achieved by increasing the volume of chyme reinfusion and utilising one of the three nutritional sources below. This reduces/removes the risk of complications associated with being on TPN. Once weaned, a neonate/baby will maintain their nutrition by chyme reinfusion (with The Insides Neo) and one of the following means:

• Naso-gastric enteral nutrition feeds (e.g. Pepti-Junior) and naso-gastric breast milk (expressed from Mum) or,
• Only naso-gastric enteral nutrition feeds or,
• Only naso-gastric breast milk

‘Coloplast’, ‘SenSura® Mio ’ are registered trademarks of Coloplast Corporation. The use of the trademarks ‘Coloplast’, ‘SenSura® Mio ‘in these instructions is strictly for informational purposes to provide accurate product information to our customers. The Insides Company Limited does not connote any endorsement, affiliation, sponsorship, or approval by Coloplast Corporation. We hereby affirm our recognition of Coloplast Corporation 's exclusive intellectual property rights in the trademark ‘Coloplast’, ‘SenSura® Mio,' and any references to said trademark are made in good faith to truthfully describe the compatibility or usage of their product.

‘Hollister’, ‘Pouchkins™’ are registered trademarks of Hollister Incorporated. The use of the trademarks ‘Hollister’, ‘Pouchkins™‘in these instructions is strictly for informational purposes to provide accurate product information to our customers. The Insides Company Limited does not connote any endorsement, affiliation, sponsorship, or approval by Hollister Incorporated. We hereby affirm our recognition of Hollister Incorporated 's exclusive intellectual property rights in the trademark ‘Hollister’, ‘Pouchkins™,' and any references to said trademark are made in good faith to truthfully describe the compatibility or usage of their product.

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