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The use of feeding tubes in paediatrics

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Paediatric nasogastric tube use

Nasogastric is the most common route for enteral feeding. It is particularly useful in the short term, and when it is necessary to avoid a surgical procedure to insert a gastrostomy device. However, in the long term, gastrostomy feeding may be more suitable.

Issues associated with paediatric nasogastric tube feeding include:

  • The procedure for inserting the tube is traumatic for the majority of children.
  • The tube is very noticeable.
  • Patients are likely to pull out the tube making regular re-insertion necessary.
  • Aspiration, if the tube is incorrectly placed.
  • Increased risk of gastro-esophageal reflux with prolonged use.
  • Damage to the skin on the face.

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Inserting the nasogastric tube

All tubes must be radio opaque throughout their length and have externally visible markings.

  1. Wide bore:

– for short-term use only. – should be changed every seven days. – range of sizes for paediatric use is 6 Fr to 10 Fr.

  1. Fine bore:

– for long-term use. – should be changed every 30 days. In general, tube sizes of 6 Fr are used for standard feeds, and 7-10 Fr for higher density and fibre feeds. Tubes come in a range of lengths, usually 55cm, 75cm or 85cm.

Wash and dry hands thoroughly. Place all the equipment needed on a clean tray.

  • Find the most appropriate position for the child, depending on age and/or ability to co- operate. Older children may be able to sit upright with head support. Younger children may sit on a parent’s lap. Infants may be wrapped in a sheet or blanket.
  • Check the tube is intact then stretch it to remove any shape retained from being packaged.
  • Measure from the tip of the nose to the bottom of the ear lobe, then from the ear lobe to xiphisternum. The length of tube can be marked with indelible pen or a note taken of the measurement marks on the tube (for neonates: measure from the nose to ear and then to the halfway point between xiphisternum and umbilicus).
  • Lubricate the end of the tube using a water-based lubricant.
  • Gently pass the tube into the child’s nostril, advancing it along the floor of the nasopharynx to the oropharynx. Ask the child to swallow a little water, or offer a younger child their soother, to assist passage of the tube down the oesophagus. Never advance the tube against resistance.
  • If the child shows signs of breathlessness or severe coughing, remove the tube immediately.
  • Lightly secure the tube with tape until the position has been checked.

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  • Estimate NEX measurement (Place exit port of tube at tio of nose. Extend tube to earlobe, and then to xiphistemum)
  • Insert fully radio-opaque nasogastric tube for feeding (follow manufacturer’s instructions for insertion)
  • Confirm and document secured NEX measurement
  • Aspirate with a syringe using gentle suction

 

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Administering feeds/fluid via a feeding tube

Feeds are ordered through a referral to the dietitian.

When feeding directly into the small bowel, feeds must be delivered continuously via a feeding pump. The small bowel cannot hold large volumes of feed.

Feed bottles must be changed every six hours, or every four hours for expressed breast milk.

Under no circumstances should the feed be decanted from the container in which it is sent up from the special feeds unit.

All feeds should be monitored and recorded hourly using a fluid balance chart.

If oral feeding is appropriate, this must also be recorded.

The child should be measured and weighed before feeding commences and then twice weekly.

The use of this feeding method should be re-assessed, evaluated and recorded daily.

 

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Part A

TIME: 15 minutes

  • Look at the four texts, A-0, in the separate Text Booklet.
  • For each question, 1-20, look through the texts, A-0, to find the relevant information.
  • Write your answers on the spaces provided in this Question Paper.
  • Answer all the questions within the 15-minute time limit.
  • Your answers should be correctly spelt.

The use of feeding tubes in paediatrics: Questions