by nicunursejen

We are currently revising our policy/procedure book in our NICU, which is severely outdated. My current project is a policy on gavage feedings and I wanted to know what the other NICUs are doing.
1. First off, we are only allowed to do OG tubes (our neo doesn't like NG tubes). As far as measuring, I have seen several different methods in articles. Can someone tell me the most updated way to measure? (nose to ear to xyphoid plus 1 cm?, etc)
2. Second, is the size of OG tube based on a certain wt? Our policy states 5 Fr for less than 2500 gm and 8 Fr for greater.
3. How much air is usually injected? Our policy states 3 mls! But, typically we do no more than 1 ml.
4. And how much residual is considered to be too much. Currently we hold for residuals > 1/3 of the feeding.

Re: Gavage Feeding Policy Revision

and when you have residual, do you put it back and subtract it from the feed, throw it away, or add it to the feed?

Re: Gavage Feeding Policy Revision

and one more thing.... we use Bard infant feeding tubes made of plastic, and we change them every 72 hrs, does that sound reasonable?

Re: Gavage Feeding Policy Revision

1) That's how I measure
2) We use common sense...smaller ogt for smaller babies. No specific weight.
3) I do like 1 ml, if I don't hear it then pull that out and put in a little more. I usually go more by if I aspirate gastic contents though, since you can hear the air all over the belly in the tiny tiny ones.
4) We call if the residual is >25% of the last feed, or a funky color. What we do next depends on what the MD wants. Sometimes we chunk the residual and start with a fresh feed, sometimes we chunk the residual and make npo and get a kub, sometimes we give the kid more time to digest, sometimes we subtract that amount from the next feed, sometimes we keep feeding...sometimes the MDs will actually write an order to not check residuals (usually on kids that are recovering from NEC or what have you)....but I will still check it just for peace of mind. We do have a lot of NEC FWIW.
5)We use the orange anti-iv feeding tubes and are supposed to change them every 3 weeks.

Re: Gavage Feeding Policy Revision

Originally Posted by texas2007

1) That's how I measure
2) We use common sense...smaller ogt for smaller babies. No specific weight.
3) I do like 1 ml, if I don't hear it then pull that out and put in a little more. I usually go more by if I aspirate gastic contents though, since you can hear the air all over the belly in the tiny tiny ones.
4) We call if the residual is >25% of the last feed, or a funky color. What we do next depends on what the MD wants. Sometimes we chunk the residual and start with a fresh feed, sometimes we chunk the residual and make npo and get a kub, sometimes we give the kid more time to digest, sometimes we subtract that amount from the next feed, sometimes we keep feeding...sometimes the MDs will actually write an order to not check residuals (usually on kids that are recovering from NEC or what have you)....but I will still check it just for peace of mind. We do have a lot of NEC FWIW.
5)We use the orange anti-iv feeding tubes and are supposed to change them every 3 weeks.

I was about to say same at my place..but...no wonder, hah!

Although I can't find anything at work that says to call if it's >25% of the last feed. I've asked around for when to call for that and keep hearing there's no policy...which irks me.

Re: Gavage Feeding Policy Revision

thank you for your input, so what if your residual is less than the 20 or 25%? Do you return residual and add the total feed or subtract the residual from the prescribed feed?

Re: Gavage Feeding Policy Revision

Is it more accurate to listen for the air or to feel for it? We are taught to listen but I've noticed that a lot of people feel. I have tried feeling and noticed in really little ones I can actually feel it in the tummy whereas the sound may be all over the abdomen. I was also told that even if you hear (feel?) the air in the stomach it is not down far enough unless you get the air back. Opinions?

Re: Gavage Feeding Policy Revision

The only truly accurate way of checking placement is an Xray. As those are not done on most babies, we go by aspiration, auscultation, and common sense. An OG at 16cm at the lip or nare, on a 18" baby, no residual, that feels "dead" when you aspirate is probably in the esophagus. I've been told "no resids all day", but a new OG and correct placement about 1cm below the zyphoid process will sometimes give back several ml's of partially digested milk. I think there is also a feel to correct placement, that sometimes comes with experience. Sometimes it's the common sense that's lacking..... Unfortunately, that can't be written into any policy.

Re: Gavage Feeding Policy Revision

Originally Posted by HappyBunnyNurse

Is it more accurate to listen for the air or to feel for it? We are taught to listen but I've noticed that a lot of people feel. I have tried feeling and noticed in really little ones I can actually feel it in the tummy whereas the sound may be all over the abdomen. I was also told that even if you hear (feel?) the air in the stomach it is not down far enough unless you get the air back. Opinions?

Confirmation on xray and remember where the cm mark is. If it's in the esophagus, you can still hear it in the stomach, esp on micros.

Re: Gavage Feeding Policy Revision

Originally Posted by nicunursejen

thank you for your input, so what if your residual is less than the 20 or 25%? Do you return residual and add the total feed or subtract the residual from the prescribed feed?

Return it and feed the next feed as prescribed...no subtracting.