[Kerrirn]

I was wondering if anyone had any experience with this. This patient has a history of NEC with bowel resection and an illeostomy. We have started refeeding the illeostomy output through the lower mucus fistula, hoping to wean off of TPN. I am looking for technical tricks as this is new to us. What size and type of catheter do you use, how fast do you infuse, how do I keep it from leaking back on me ( ) Any practical advice would be helpful!
Thanks.....

[traumaRUs]

I'm not a med-surg RN and I gather the purpose is to re-infuse the ileostomy drainage in order to wean off TPN? I guess I don't see how this re-infusion is nutrition. I'm probably not understanding what you are trying to say. Could you rephrase this? Thanks so much!

[Kerrirn]

sorry.... apparently, the idea is that since he is dumping the GT feedings so rapidly out of the illeostomy, there is only minimal absorption. By feeding this output into the mucus fistula, it provides added absorption by the lower intestine and colon while minimizing the electrolyte loss (I think ) and encouraging intestinal development. As of today he is back on TPN with decreased feeds, though, so I'm not sure how effective the feeding has been
HMMMM...........

[traumaRUs]

Wow - now I understand. No offense - but it sounds pretty messy??!! Would a piston or toomey syring work and then you could do it q2-4 hours?? Is this a common practice?

[BittyBabyGrower]

We have done this and ewwww We use a number 8 feeding cath...soft vygon and just insert it in there and infuse. We infused it over usually the same amount of time as a feeding...because it was usually the same amount as it came right back out the ileo within a short period of time. If it were more, then we just infused over an hour or so.

The thought is that since it is coming out as fast as it goes it, then you just put it thru the large bowel for more absorption of nutrients and water. We haven't used it to wean kids off of HAL, but we have done it from a nutritional aspect.

We all draw straws for that kid...ewww LOL Just kidding!

Do you guys window your HAL's at all? We do this on all our gut kids from day one...we even delay putting them on HAL until they are feeding just to try to keep their livers intact for a bit.

[traumaRUs]

Okay - sorry for the dumb posts from me! I didn't realize this was a baby!! Stupid me! Sorry for the questions. (I should have looked at what forum I was posting under). Sorry!

[Gompers]

I know it's gross, but we did this for awhile. Maybe worked on 2 babies, out of about 10. Yes, the point is to increase fluid, electrolyte, and nutrition absorbtion and to keep the lower GI tract functioning because it's usually months before they'll reconnect these kids. It does make quite a bit of sense, but it's one of those things that sounds a lot better in theory!

We used an 8 french feeding tube (we have the 30-day ones) and the way we stabilized it might sound funky but it sometimes worked. We'd take a nipple - just the regular yellow Similac ones - and remove the ring. Then we'd poke the feeding tube through that and into the baby's fistula a few centimeters. Making the nipple flush against the baby's abdomen, we'd tape it in place, and tape the feeding tube to the nipple as well (but it usually stayed well on its own so long as you didn't enlarge the original hole). We'd change this q24 hours, if it lasted that long. We'd do these kids vitals q4h and they were always on continuous feeds - so we'd simply change their feeding syringe or add formula to their kangaroo bag q4h and empty the ostomy bag, running those contents into the fistula over the next 4 hours.

We considered holding off on the TPN for gut babies, but our surgeons and neonatalogists feel that the babies won't heal well from their surgeries if they don't have the protein and such from TPN. Our babies are on TPN from the day they are born until the day they hit full feeds. We should start cycling way before we usually do though - they wait forever here! They don't like to cycle the preemies' TPN because they're afraid those kids will go hypoglycemic. I've wondered why we can't just hang a little D10W during that time to prevent that, yet still have the TPN turned off. When we do cycle, it's 20 hours on and 4 hours off.