Breast milk via GT

Posted
by RN_PICU RN_PICU Member

A stupid question to some, and me being new to PICU, kinda afraid to ask and maybe upset someone about this at my work...

We have a kid, 6mo who is receiving 135ml/hr Q3hrs breast milk. It's stored in freezer on the unit, labeled and all the bells and whistles are in place. But since his mother "submits" more than 135ml to each bag, approximately 160-180mls, we end up with residual after each feed. After 3 or 4 feeds there is enough for entire bolus of 135 mls to be delivered. Needles to say, it looks "not pretty" but that's what they "have been doing" for last two months of his hospitalization since breast milk from his mother "doesn't come easy."There is also an issue of GT bags and tubing being changed only every 24hrs, which I secretly change more often when no one is looking more often...

I've been looking for some research about breast milk and it's "autoimmune qualities" half life, it going bad in room temperature etc. I forgot to mention, but kid has diarrhea which I believe is directly related to bad breast milk being fed, but yet again me being new and all, I need more scientific reasoning in order to bring this point up. Any advice would be more than welcomed at this point.

Thank you all :)

umcRN, BSN, RN

Has 4 years experience. 867 Posts

"Fresh" breast milk is good for 4 days...it was 3 but apparently it has been extended

Thawed breast milk is good for 24 hours however should be re-refrigerated after thawing

IMO breastmilk should not be given in a kangaroo bag and while this is strict policy in my hospitals NICU its not followed so well in the PICU/PCICU though I am working to change this. Breastmilk should be given via syringe pump though there are special pumps parents can get at home for breastmilk these are not usually the same pumps used in the hospital.

My whole hospital has a policy of changing tubings and bags with every new feed though families will use one per 24 hours at home if they are going home on tube feeds...but families are more likely to clean these between feeds as well which may not happen in hospitals

umcRN, BSN, RN

Has 4 years experience. 867 Posts

and good for that mama...she should be proud of pumping so much 6 months out :yeah:

NotReady4PrimeTime, RN

Specializes in NICU, PICU, PCVICU and peds oncology. Has 25 years experience. 16 Articles; 7,358 Posts

There has been a lot of research done on the subject of safe handling for breastmilk. Frozen it's safe for 1 year. Fresh and thawed are safe refrigerated for at least 24 hours. Hang time should be no more than 2 hours. Feeding bags, when properly rinsed, are safe for 24 hours. The cause of your patient's diarrhea may be due to bacterial growth in the breastmilk, but is more likely to be from something the mother ate the day she produced that milk. I'll see of I can find specific references for you.

RN_PICU

RN_PICU

21 Posts

Thank you for the quick reply, very much!!! We do give it in kangaroo bags... If you have anything in writing, resources, articles or even hospital policies could you please share them with me. I have decided to make this topic my nursing residency project and make the change if need be :)

RN_PICU

RN_PICU

21 Posts

Thank you janfrn too!!! BTW its mother's 9th child... and she breast fed them all!!! LOL Good for her and all of them :)

umcRN, BSN, RN

Has 4 years experience. 867 Posts

I may have our policy printed somewhere, i'll have to dig around a bit...

in any case our lactation consultants all agree that fresh breast milk is good in the refrigerator for 4 days and thawed for 24 hours.

Are you also flushing his tube after each feed to keep it from sitting in there? those extension tubings can get nasty!

Double-Helix, BSN, RN

Specializes in PICU, Sedation/Radiology, PACU. Has 11 years experience. 1 Article; 3,377 Posts

How is the mother supplying the breastmilk? Is it in re-sealable bottles or bags? If they are re-sealable, can you just open the container, pour out the 135cc and then reseal the rest? Rather than putting 160 cc in the feeding bag and having 25 cc left over. Or perhaps you can explain this to the mother so that she can pump the right amount of milk into each container, so that you don't have so much waste.

Since the kid obviously isn't getting frozen breastmilk directly, thaw the bag, measure the 135cc and seal the rest in a labeled container in the refridgerator. Just keep adding the extra to the same container until there is enough for one feeding. Just remember that you need an extra 20-30cc to prime the tubing.

Our policy is never to add more than 2 hours worth of breastmilk to any pump, whether bag or syringe, due to spoiling and bacterial growth. The tubing should also be flushed with water after the feeding to remove any milk that might sit inside the tube.

RN_PICU

RN_PICU

21 Posts

Thanks Ashley,

I am working with our lactation specialist on this right now... Mom pumps into plastic bags, that are sealed and frozen, brought to us and we use them for each feed. Per mom, she never knows how much is in a bag "only eyeballing." It is very unusual, at least in our setting to have this "old" baby (and this kind of circumstances eg almost two months stay, vent and trach...) being on breast milk, but every one supports it. So, we're gonna figure out the best and safest way and help them grow :)

RNNPICU, BSN, RN

Specializes in PICU. Has 16 years experience. 1,251 Posts

Breast milk should always be used in a syringe pump and inverted, meaning having the syringe pointed upward, since the fat will settle to the top where all the important nutrients are. By measuring it in a syringe you will be able to pull up the exact amount.

If the patient is having a lot of residual maybe the patient is not tolerating feeds.

have a great day

NicuGal, MSN, RN

Specializes in NICU, PICU, PACU. Has 30 years experience. 2,743 Posts

We have used kangaroo pumps on kids that are older. Milk can't hang more than 2 hours, we always rinse the bags well and use only for 4 hours. We would have the moms pump and we have approved containers that hold 120mls. Is there any way you could have her pump, measure it in a bigger bottle and then label the bag so that it isn't getting wasted?

littleneoRN

littleneoRN

Specializes in NICU. Has 6 years experience. 459 Posts

I don't understand why anyone would be putting more milk in the feeding bag or syringe than the patient is due to be fed at that specific feeding. Take 135 mL out of the refrigerated supply and leave the rest refrigerated until the next feeding. Next feeding comes and you use the end of that bag and the start of a next thawed and refrigerated bag. Forgive me, but I don't understand why that wouldn't work.