Feeding tubes.

elizabells, BSN, RN · Jun 13, 2008

We don't really have a policy on changing them out. Some (the OCD among the staff) change them every shift even if you tell them you just changed before shift change because they like things their way. I personally change them if I'm concerned about placement or they're bowing out of the mouth/nose, or the tegaderm is peeling/icky.

As far as OG vs. NG, usually a CPAP kid will have an OG and everyone else NG. On the longer-term bigger kids we sometimes do NG with CPAP if there's enough surface area on the face and under the CPAP moustache to properly secure a tube. I've seen nasty divots in the front of the upper gum from long-term OG use, especially on a kid who needs a chinstrap. It's also harder for them to self-soothe or use a paci with an oral tube. Personally, if I have a one-sided choanal atresia (or just really tight passageway) situation I'll go OG rather than partially block the patent naris.

What I really hate is the little kids on CPAP who need a short 8Fr for venting. The short 8 is just too thick and stiff to not bow out of the mouth and you end up replacing it all the time.

Sweeper933 · Jun 13, 2008

For babies

For babies >36 weeks, they can be left in for a month. Obviously they rarely stay in that long - between getting pulled out and having to advance the placement because the baby is growing.

There should be a thread on this topic not too long ago...

Preemienurse23 · Jun 13, 2008

I searched and didn't find the thread. We have gone to a policy of everyone getting an OGT unless we have an order from the NNP or MD. The logic behind this is we have had a high rate of NEC lately. (I dont know how much the whole, putting down their mouth allows less bacteria to enter the stomach vs the nose theory is true, but that is the OGT logic on that one) People are putting big NGTs down some of these kids with narrow passageways and are on nasal cannulas. Any CPAP/vent kid have OGT's. Apparently the OGT's are supposed to even be placed in kids who are nipple feeding. To me it seems like it would be harder to try to nipple with a tube in your mouth.

I talked to our NNPs, and asked for more specific guidelines. The message we got was entirely too specific.

I know our manufacture says that the tubes can stay in for about a month before being replaced. But we are changing them week now.

littleneoRN · Jun 13, 2008

Our kids who are starting to bottle or breast all have NGs, even if they have nasal cannulas. But we only use 3.5 fr tube, except for really big kids (and sometimes not even then...grrr). Ours are changed every 5 days per manufacturer policy, but the 5 fr tubes on our bigger kids can technically go a month. Which wouldn't happen, as above poster mentioned. :) When we change them out, we also change side of the face it's anchored on. If they're self removed, then we can wash them with sterile water. But if I see that they're kinked or generally gross, I get a new one. The only time these kids get OGs is for LIS, not feeding. I can't imagine trying to bottle with a tube over your lip!