DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
Procedure is the same for nasogastric and orogastric tubes. As nasogastric tubes (NGT) are more commonly used in babies, the term nasogastric will be used throughout this guideline
INDICATIONS
- Contraindications to oral feeding, or baby unable to take full requirements orally
- Nasogastric or orogastric tube in place
EQUIPMENT
- Enteral syringes (see https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiv9OmUjpv4AhVFkFwKHTs-C68QFnoECAsQAQ&url=http%3A%2F%2Fwww.premiersafetyinstitute.org%2Fwp-content%2Fuploads%2FOral-medicines-alert.pdf&usg=AOvVaw3PSI2MSRu2c0MpD7lx8Z)
- pH testing strips
- Gravity/bolus feeding set
- Feed/fluids/medication according to prescription
- Prescription chart (for medication)
PROCEDURE
Preparation
- See (see Nasogastric tube insertion guideline)
- Discuss procedure with parents/carer
- Wash hands and prepare equipment
- Bring milk to room temperature by removing from fridge and warming in a waterless warmer or in hot water. Never deliver fridge-cold milk directly via nasogastric or orogastric tube (see Nutrition and enteral feeding guideline)
Position of baby for feeding
- Baby need not be lying down. It is preferable to feed baby whilst receiving kangaroo care
- An awake and stable baby can be held for tube feed
- preferably skin-to-skin with parents holding baby in an upright position
- baby can also be placed in elevated side lying feeding position (ESLP) if skin-to-skin not possible at time of feed
- If lying flat in a cot:
- elevate mattress to 30° before feeding and return to flat position within 1 hr
Checking pH
- Check pH before every feed/use of tube according to NPSA guidelines (see Nasogastric tube insertion guideline)
- if pH 0–5.5, commence feed and document pH
- if pH 5.0–5.5 confirm pH interpretation with a second person before commencing feed
- if pH ≥6, do not commence feed. Repeat aspiration and retest
- If repeated test ≥6, seek advice from senior clinician and undertake risk assessment following NPSA algorithm (see Nasogastric tube insertion guideline). Document decision made and rationale
- If no aspirate obtained, do not feed. Follow procedure outlined in NPSA guideline
Feeding
- Avoid rigid feeding patterns (e.g. 1 bottle/2 tube, alternate bottle/tube etc.) (see Bottle feeding guideline)
- When handling tubes, ensure clean technique. Pay careful attention to feed preparation and administration
- Administer feed by gravity
- Remove plunger, connect to tube, pour small volume of feed into barrel, raise level of barrel above baby’s stomach. Control speed of administration by raising or lowering barrel
- Do not plunge feed
- Ensure tube feed takes approximately the same time as a suckling feed e.g.:
- 20 min for 3-hrly full feed volume requirement
- 10 min for 50% volume
- 5 min for 25% volume
Monitoring
- Observe baby throughout feed for signs of deterioration or distress (change in colour, cyanosis, apnoea, bradycardia, vomiting, straining, squirming, grimacing and other avoidance behaviour)
- Observe for abdominal distension following a feed
- If appropriate developmental stage/capabilities, offer small drops of milk to mouth to taste, but avoid in babies with no swallow mechanism
- Consider offering baby mother’s breast for nuzzling or non-nutritive sucking during tube feed [see Non-nutritive sucking (NNS) guideline]
- On completion of feed, instil small amount of air into tube (0.5–1 mL)
DOCUMENTATION
- Document feed details:
- pH of aspirate
- type of feed
- volume of feed
- time of feed
- behaviour/response during feed
- adverse reactions (vomiting etc.)
- Ensure feed chart is signed
FURTHER MANAGEMENT
- For administration of medication, remember to check baby identity and prescription. Follow Trust policy for administration of medicines and British Association of Parenteral and Enteral Nutrition (BAPEN) guidance
- document administration of medication on prescription chart
- Flushing of NGT is not routine in preterm babies. To avoid medication remaining in NGT try to give medications pre-feed. Where this is not possible 1 mL of feed can be used to flush tube after inserting medication
FURTHER INFORMATION
- Nasogastric tube insertion guideline