nasogasatric feeding practices!

Specialties NICU

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Specializes in neonatal.

hello everyone!

I am just interested to get some views on practice in your respective units. We use a 2 ml syringe to aspirate stomach then a 10ml to give feeds. Most people do gravity feeds but i prefer to slow push them.

i dont know of any evidence for these practices and am interested in how other units do this etc.

also, we change our (vygon) ngt's 5 daily, again, not evidence based... thanks, look forward to hearing back... leo (uk)

Specializes in NICU.

We change our NG's every 3 days. Another local hospital is every 5. We generally use a 10 cc syringe to check residuals and whatever size we need for a feeding. We use a pump for feedings but used to feed by gravity. It's mostly nursing preference and feeding tolerance of the baby.

Specializes in Nurse Scientist-Research.

We used to change our NG's every 3 days then we started using the soft silastic Vygon tube. We recently changed to a different brand but it's essentially the same thing. When we changed to the silastic tubes we went to changing them every 21 days. We use 5 F for 1250 grams or less, 8 F for >1250 grams with some room for nursing judgement (such as some kid's nostrils are too small for an 8 F even at >1700 grams).

As for what size syringe we use to check and feed, there is no set unit policy. I use 10 ml to check residuals because I'm superstitious and I think it wards off evil spirits (high residuals). As for feeding, we use the size syringe needed for the feeding; a 15ml feeding goes in a 20ml syringe, a 33 ml feeding goes in a 60 ml syringe. Probably half our kids are on syringe pumps for feeds to help with reflux/spitting.

We usually use a 10 ml syrange to check for residuals.

Then we use 20 ml for the feeding. We feed by gravity almost all the time. We only use pumps if the baby does not toleate the feeding well.

This works wery well most of the time.

And we change our NG tubes every 3 days or so or more often if the taping gets wet or the baby pulls out the tube. We always use 5 fr. tubes.

We change our NG/OG tubes Q48, but I have heard from some of the other level IV units we transport to (we're a large level III) that they actually insert only for the feed and then remove. They are doing this based on a reported correlation with long-term NG/OG and reflux. Based on the amount of reflux we see, it wouldn't surprise me if this was true. Anyone else heard of this??

Rainbows

We change our NG/OG tubes Q48, but I have heard from some of the other level IV units we transport to (we're a large level III) that they actually insert only for the feed and then remove. They are doing this based on a reported correlation with long-term NG/OG and reflux. Based on the amount of reflux we see, it wouldn't surprise me if this was true. Anyone else heard of this??

Rainbows

Oh my!

Inserting a new tube 8 times a day...that cant be good for the baby. They get so angry sometimes when we put down that tube.

Specializes in NICU, PICU, educator.

Vygons can be left in place for 30 days. We do this and have never had a problem :) Some kids with really bad reflux, we will use a 5fr but we usually use a 6fr on all the babes. We have had a few kids that benefit from the removal of the ng after each feed, but it is usually the smaller ones that don't retch and gag!

As for feeding...some kids do better with gravity, some on a pump. The really bad refluxers I get nervous with pump feedings...if they are going to puke, at least a gravity feed will stop where as the pump just keeps pumping! Everyone uses a different size to check the tube, but it is the size of the feed that determines the size of the syringe. For q2h feeders we will draw up two feeds in one syringe if we are using a pump.

We change our silastic feeding tubes every 7 days. Nursing preference on checking residuals and the feedings go in whatever syringe is appropriate for the feeding amount. We put almost all our feedings on syringe pumps.

Specializes in neonatal.

isn't it amazing how different all our practices are between different units! Thank goodness there are forums like this, where at least we can learn by sharing ( and, hopefully, learning!).

I have heard of the practice of using a new ng every feed, but it seems a little intrusive and passing an ngt is not entirely without potential for complications huh!?

On our unit we hardly ever use continuous pumps because of the risk of aspiration if the tube gets dislodged. If we do use one, we check tube placement regularly!

Isnt it funny how we have all these diverging ideas and yet each unit swears by it and claims to have best practice!

Oh my!

Inserting a new tube 8 times a day...that cant be good for the baby. They get so angry sometimes when we put down that tube.

I wonder how many NEC workups these kids get from the heme positive stools they have from their bloody noses! :uhoh21:

Specializes in NICU.

Our unit changes the NGT/OGT's every 5 days. We use a #5fr for babies under 1500 grams and #6 for those over 1500 grams. I have heard of the in/out q feed but that sounds ridiculous to me as it's not a nice procedure! We use "sucrose" prior to insertion. (Anyone else use sucrose?) We do the occasional bolus/gravity feed but not as many as we used to. Now, the "fad" seems to be "slow bolus" over an hour on a pump. Syringe size depends on size of feed. We have 12cc syringes (monojects) and 20cc and 60 cc's. I don't recall ever seeing a 10cc one! I agree it's neat to see everyone's different practices.

Specializes in neonatal.

we started using sucrose on our unit a few months back, but not for inserting ngt's! We use it for things like cannulating and guthries etc and it seems to help. We use a 33% solution, diluted 50/50 with water to a 1 ml volume.

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