Nasogastric Tubes

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Nasogastric Tubes

• Karen Rankin
• Clinical Nurse Consultant
• karenr_at_chw.edu.au
• November 2008

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What are tubes used for?

• Nasogastric/Orogastric tubes for
• Bolus feeding
• Venting
• Drainage
• Diagnosis
• Transpyloric tubes for
• Continuous feeding

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What types of tubes are there?

• Long term tubes
• Weighted
• Unweighted
• Short term tubes
• Gavage salem sump

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What feeds do we use?

• Expressed human milk
• Infant formulas
• Specialised formulas
• Specialised enteral feeds for children gt1 yr
• Rehydration solutions

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Why do we use tubes

• Poor suck in premature or disabled infants
• Inability to maintain nutrition
• Anorexia
• GIT disturbances
• Post surgery
• Respiratory/airway compromise
• Unable to tolerate fluid e.g. ORS

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Insertion of a feeding tube

• Size use smallest possible size to take formula
• Correct measurement
• Ensure the infant/child is safe and prepared
• Have equipment ready including tapes

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Clinical Implications

• Always use a syringe 20 mL or greater
• Ensure child and family understand
• Explain procedure
• Ensure environment appropriate
• Ask for assistance
• Ensure the tube is measured correctly
• earlobe ? tip of nose ? xiphysternum
• Ensure tube placement is confirmed
• Document in medical record

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• Using a syringe no smaller than 20 mL aspirate
  contents and test with pH or litmus paper
• If unable to aspirate follow the algorithm
  advance the tube 1-2 cm and aspirate again
• If able to feed offer feed
• Still unable to aspirate?
• Notify senior nurse or Doctor to consider x-ray

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What is your role?

• If havent inserted a tube before ASK for
  assistance
• Always checking tube placement prior to any feed
• Tape the tube securely usually to the cheek
• Checking the nose for signs of pressure
• Record tube placement and condition in clinical
  record
• Educate the family if required
• Report any changes
• Ensure the feeds are given safely dont leave
  feeds out for more than 4 hours as they are at
  risk of bacterial growth
• Follow your Hospitals guidelines

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The Literature
There is a lot of information available on the
internet as well many journal articles on how
best to manage NG tubes, however most information
refers to adults not children.
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Tranpyloric Tubes

• Used when persistent reflux is present
• Can be placed by nurses but MUST have x-ray to
  confirm placement
• Feeds must be given continuously using a
  specifically designed pump
• Tubes block easily so must be flushed regularly
  no crushed tablets etc

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So how many patients have NG tubes at CHW?
Data collected June 4th 2006
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Any questions?