Yet ANOTHER question for you...

  1. When do you use orogastric tubes on babies and when do you use nasogastric? What are the differences? I know neonates are obligate nose breathers and so orogastric is preferred at first. When do you start using nasogastric or do you ONLY use orogastric in the NICU?
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  2. 14 Comments

  3. by   NICU_Nurse
    We generally use OG unless it's absolutely contraindicated for some reason. In babies that are learning to nipple feed, we'll usually place an NG for two reasons: 1) They can't feed well working around the tube, and 2) If they have an OG tube, and we take it out to feed, and they won't nipple, we have to reinsert the tube to finish the feeding; with the gag reflex, this would usually end up in reflux of everything they just took (however small) from the bottle.

    Basically, we start out with an OG tube, and if it's not working due to circumstances or situation, we re-evaluate and move on to an NG. We also don't start off with an NG because it's much more painful to insert (the back of the nasal passage is EXTREMELY sensitive, as in adults, can be very painful and cause bleeding from irritation), blocks the passageway, and usually our babies have weak or no gag reflexes, so inserting the OG is the most painless, least difficult method of the two.
  4. by   VickyRN
    Thank you very much!!!!
  5. by   prmenrs
    We use NG; OG's are only used for decompression. Like if a kid is on NCPAP.
  6. by   dawngloves
    We use OGs if the kid is on NC or CPAP. Then they yank them out every shift!
  7. by   corks
    we use ogt when babies are on ncpap for either decompression of the stomach or when these babies are ready to start feeding. I must admit I prefer ngt, I have had a few litmus positive test on ogt when the tube has been curled up in the babies mouth. something to look at when you have a baby who is desaturating during and post feeding. Corks
  8. by   NICU_Nurse
    Okay, which is better- leaving an OG in for 24 hours (our policy is to change them q24 or PRN) or taking it out and reinserting it for every feed? Any opinions? I only know what my facility does.
  9. by   fergus51
    We leave ours in for 72 hours. I don't know why you'd have to change them every 24. We would never take them out and reinsert them for each feed. Too much negative simulus for the baby. We harass them enough without doing that!
  10. by   NICU_Nurse
    We used to have these silicone OGT's that were supposed to be good for much longer, but they were deemed too expensive. The tubes we use now are cheaper, and we were told that it's an infection control principal, as well as making sure that they were moved and re-taped to another area of the face to avoid skin breakdown?
  11. by   NicuGal
    We use mostly NG's, but OG's for Cpapers and teeny ones that are on NC.

    We have the silastics and they are good for 30 days. The others we have to replace every 24 hours. The rep told us that they aren't meant to withstand the stomach acids more than that. I can remember taking one out of a kid that had been there for about a week and the end was BLACK EWWWWW. We have had kids that we have had to take them out and reinsert them for every feed because they vagal stim'd so horribly.

    I don't see how using a new tube everyday can be cost effective, especially if you aren't changing them but every month! I know they are pretty expensive, but I would think in the long run it would have to even out.
  12. by   CatRN
    Hi Everyone.....
    New poster here....I have been traveling for over two years and have seen different things done at different places. Most places used NGT's and used OGT's for decompression for babies with NCPAP. Some places change them every 24hr and some places use a 50cm NG that stays in as long as baby keeps it in! I even worked at a place that used a "gavage kit" which consisted of an 8fr OG that was placed in for the feed and then pulled out after feed, regardless if baby was all gavage. I personally couldn't do that, with risk of aspiration and vagal stim....but that was their policy. The nurses there knew of no other way to do it. I personally like the long term NG's, but have found that they stay in for quite some time and sometimes cause breakdown of the nare, and sometimes they are in so long....the baby grows beyond the depth and it needs to be pushed in further or simply changed. I label mine with the date and time inserted. Hope this helps.
  13. by   NICU_Nurse
    Yes, we use the 24 hr kind; the silastics were the ones I meant (that we got rid of due to costs, etc.). Our policy states they are to be changed qD or as necessary (due to pulling out, etc.). A problem we had a while back was that people weren't taking off the old tape, moving the OG's to another area of the mouth to relieve pressure, applying new tape, etc. like they should have been, which was causing a pressure-ulcer issue and causing dents/pressure deformities on the gums and lips from one catheter being in the same place for too long. To combat that, they dumped the long-term caths and went to the cheaper ones that had to be changed more frequently because of product breakdown- necessitating a change every day.

    I'm wondering what your criteria is for deciding to use a 5fr vs. an 8fr tube? Is it by visual assessment, or standard weight/size criteria? This is yet another raging debate in my current unit. Some people claim that the smaller tubes don't infuse the feeds properly, whether by gravity or by pump, due to the decreased diameter and openings of the tubes, so they use 8fr religiously. Others claim that the 8fr are too large for most babies on our units, and have other criteria for choosing size. What do all of you do?
    Last edit by NICU_Nurse on Jul 31, '03
  14. by   CatRN
    Dear Kristi,
    8Fr tubes are usually only for decompression in my experience, and also used for feedings and decompression for babies on NCPAP. I have used 8Fr's on kids who are large >3kg, or if the baby happened to be on rice cereal, which some NICU's still use for reflux which makes for a heck of a fun gavage feeding by gravity!! I prefer 5fr's or 6fr's for indwelling NGT's.....unless of course the kid is huge and an older baby. Ever since how quick a feeding goes in by gravity with an 8fr? What baby can drink that fast, let alone who's belly can be literally "dumped" with a feed that quick? Again, nursing preference unless ordered. Those are just my personal preferences, there are of course exceptions

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