q3hr bolus OG/NG feedings

Brownms46 · Oct 7, 2003

I was always told NEVER to push a feeding! I chose number 1

Tiki_Torch · Oct 7, 2003

Thank you Brownie for your post! The NICU I worked in before always fed by gravity, never by pushing the feedings.

This new hospital has me very uneasy on several points, the main one right now being this feeding thing. Not one of the nurses I've seen yet feeds their babies by gravity... they all push the feedings in! Their rationale for this is that if they are called away from the bedside during a feeding they know for sure the baby won't aspirate.

One real problem I see is that the only tape they use there is plain old-fashioned silk tape which sticks poorly... no wonder they are worried about aspirations when the babies pull their tubes out so often. They also replace the tubes each night on the 11-7 shift. This is another issue I have... why not use tubes that can be left in for a longer period of time? All that in and out business has got to be stressful to the babies and potentially rough on their mucous membranes. My previous hospital used either tegaderm or that pink Hy-Tape to secure tubes that lasted for 30 days and we never had problems with aspirations or unhappy babies developing aversions to having a tube reinserted at least once and up to several times a day.

As far as the gravity thing goes, every book I've read says to feed by gravity "which allows for a natural burp and to avoid direct forceful pressure into the GI tract".

I told my preceptor that I am absolutely uncomfortable pushing feedings and she told me I can gravity feed if I want to, so I've been doing that while staying at the bedside with the baby until the feeding is completed. At least I can sleep at night.

I've been beginning to think I'm loosing my mind in this place. I guess I should have known to expect things like this when I initially walked in and noticed the isolettes were not covered and all the babies were lying on their backs with their legs spread out like little frogs ready to be dissected. The isolettes look more like aquariums than baby beds. :rolleyes: I will say however that I covered my patient's isolette with blankets and no one who came behind me for the rest of the week removed them. Maybe I can slowly, by example, help this place learn more about developmental care... wish me luck!

Thanks again for your reply Brownie!

Brownms46 · Oct 7, 2003

You're very welcome Tiki_Torch, and I would share your concern, as it seems to me, maybe you can lead by example. Maybe that unit needs someone with a spine!!!

And the units I have worked in also used the pink Hy-Tape, and I agree with all the changing of the tube stuff! I don't get that!! How would they like to have that happen to them??? I don't think so! The only time I ever saw that done, was a lazy male LPN I worked with, and they usually kept him in level I nursery, because he was too unconcerned...you know the type...or maybe blessfully not! But he would OG every baby he had, and sit down and read the newspaper in between feedings:((((!!!!

But you keep up the good work, and listening to your conscious!! And you're very welcome indeed:D

Mimi2RN, ASN, RN · Oct 7, 2003

We can do gravity feeds or push them, sometimes it depends on the time factor, as well as the baby's tolerance. I would rather push them than leave them hanging, with the potential for aspiration if you are looking the wrong way when the baby has an emesis.

I've never heard of leaving a tube in for 30 days, we are lucky if they last the three days, without the baby's grabby little fingers pulling them out. Unfortunately, once our babes are nippling half their feeds, the docs want the tubes pulled and replaced as they don't think the babies can nipple as well with tubes in their mouths. I think they do just fine, until they are really ready to nipple everything. Sometimes we'll use NG's at that point. I hate putting those in......I've had testing done with an NG, and I can sympathise when that tube goes in. It makes me cringe!

Tiki Torch, good luck! You have your work cut out, but take your time, they will notice how you cover the isolettes. We had a similar problem, bright lights and no covers. Now we have quilts on all the isolettes, made by the volunteers. We also have the overhead lights turned down as much as possible. The positioning also needs work. Some of those tiny ones will have hip problems in the future.

I know our babies aren't as little as yours, but they need the same care for quite a while.

iceNICUnurse · Oct 7, 2003

We use gravity only. Mostly b/c we have so many babys per person that we wouldn´t have time to manually feed them all.

We replace our NG tubes 2-3 times a week and when the kids manage to pull them out.

Brownms46 · Oct 7, 2003

My problem is with the nightly tube changes. When I did work NICU, we only had 1-2 in Level III, and 2-3 in Level II, depending on acurity, and we had the time to watch them. Maybe this has changed. Also I have had an NGT in, and I wouldn't want anyone pushing anything down my tube.

cindylouwho · Oct 7, 2003

we use all gravity feeds unless there are strange circumstances.....how do you have time to stand there and watch a gravity feed go in?...I've never done that and have never had any problem with aspiration in all my years.... I may have 4 babies due at the same time so there's no way to stand there and watch the feeding...never heard of such a thing...

Tiki_Torch · Oct 7, 2003

many thanks to everyone who has voted in this poll and for all the wonderful input you've contributed!!!

i've never been a patient with an ng tube myself, but i've seen patients gag and look like they might vomit when nurses irrigated their ng tubes and i thought about just how truly awful it must feel for them. the extra pressure, no matter how slight, forced into our stomachs just doesn't seem like a good thing... it simply goes against nature on every level, in my humble opinion.

my previous hospital encouraged ng over og tubes whenever possible (not used with babies on supplemental oxygen where the ng tube would compete with the nasal cannula for physical space). we chose the ng route so the baby wouldn't feel the tube in his mouth when trying to learn to nipple feed. we wanted to make nipple feeding as natural as possible. if they got tired nippling or were to nipple once a shift, etc. we'd leave the ng tube in place and use it for feedings that the baby couldn't nipple him/herself.

we also chose ng over og because the babies hardly ever pulled them out with their hands, or pushed them out with their strong tongue movements. we found placing a small piece of clear occlusive dressing on their cheek or chin, then the tube placement, then a second piece of occlusive dressing over the tubing and the base dressing worked absolutely wonderfully. the tubes stayed in place and we could easily read the marks on the tube as well. the parents could see their baby's faces better without all the tape, the occlusive dressings breathe, and are easy to remove by pulling at the opposite edges and leave no marks or skin tears when removed correctly.

our tubes could be in place for up to 30 days but we dated them and changed them every two weeks anyway. they were made of a special plastic that was able to last long term. when our unit began to focus strongly on developmental care, this was one of the things our cns pushed for. i don't remember the brand of tubes but i did find this exerpt in my core curriculum for neonatal intensive care nursing book (edited by beachy & deacon; endorced by awhonn & nann; recommended by the majority of sources as the book to study for taking the neonatal certification exams--- and the one i used to study when i passed and received my rnc from ncc):

"non-intubated infants who are exhibiting mild respiratory distress should be fed via on orogastric (og) feeding tube rather than a nasogastric (ng) feeding tube because infants are mainly obligatory nose breathers (van somersen et al, 1984). however, the nasal route is easier to secure, which may decrease the risk of tube displacement and potential for aspiration. parenteral nutrition may be required to supplement enteral intake when feedings are being initiated. intermittent gavage feeding routine: a 3.5-8.0 fr feeding tube is inserted using a standard measuring technique: from the nose to the ear to the lower end of the sternum and adding 1 cm, or from the ear to the nose to a point midway between the xiphoid process and the umbilicus (weibley et al, 1987). the tube should be secured into place with tape. proper placement should be assessed after insertion and prior to each feeding by (1) aspirating stomach contents (2) slowly injecting 0.5 - 1 cc of air into the feeding tube while auscultating the stomach with a stethoscope. polyvinylchloride tubes may be indwelling for 1-3 days or may be removed following each feeding, depending on clinical preferences. (frequent insertion of tubes may cause mucosal trauma and is stressful for infants; therefore, indwelling tubes are recommended.) silastic or polyurethane tubes do not harden over time and may be left in place for several weeks to months, but they are slightly harder to secure with tape because the outer surface is slippery. administer feedings by gravity over 15-30 minutes; gravity allows for a natural 'burp' through the tube and avoids direct, forceful pressure into the gi tract. during the feeding, the infant should be closely observed for intolerance and complications (e.g., emesis, bradycardia, apnea). following the feeding, the tube should be cleared with air and the tube capped off to air. if the tube is to be removed following each feeding, remove tube by pinching it off and withdrawing it quickly. following the feeding, the infant should be burped and positioned on his or her right side or abdomen with the head of the bed elevated at a 30 degree angle..."

as i mentioned before, all my books (and i've got plenty of good neonatal nursing & medicine ones) recommend gravity feedings. i am aware that all hospitals (neonatologists) are not alike, so i'm incredibly grateful to everyone for their input!!!!! if anyone knows of any books that endorse manually pushing og/ng feedings, or any studies/literature on the subject, i'd be grateful beyond belief for you to share it with me!!!!

thanks again so much to everyone and i look forward to any more responses that anyone would like to share!

:kiss

TeenyBabyRN · Oct 8, 2003

With the exceptions of trophic feeds or parents who want to participate by holding the syringe for baby to NG by gravity, I have never used either method. Everywhere I have worked, all feedings that were not PO were put on a syringe pump to run over, usually, 30 minutes. As for the tubes themselves, we place NG unless a nasal cannula is in place, then would change to OG. We secure our NG's with clear, occlusive dressings and leave them in place for 1 week.

nfprn · Oct 8, 2003

Our OG tubes are replaced Q72 hours. Ususally if the feeding is 10 mls, we put it on the med pump over 30-45 mins.

Mofe'ny · Oct 8, 2003

We run all feeds on a pump over 30 minutes unless otherwise specified. We also use silastic tubes, that, according to policy, can stay for 30 days. I have never seen one last that long before it got pulled out.

Another question- the textbook that Tiki quoted said something about burping the baby at the end of the NG feed. I have never done this or even heard that this should be done. I was taught that with NG feeds there isn't air swallowed, so no need to burp. So, do you burp your babies after the NG feed, or did I read that post wrong?

q3hr bolus OG/NG feedings

When feeding bolus OG/NG feedings, does your unit policy say: