fixing nasogastric tubes in place

UK2USA · Jun 9, 2004

Yeah I agree, Tegaderm does not tend to fix a tube for very long. The problen is that any of the more adhesive tapes can damage the skin underneath (especially if the tube is in place long term - which I assume your patient's are). One idea that I have seen recently is to initially place granuflex (the sort that you find on the base of a stoma bag). You can get it in 10cm squares, just cut a strip and place this on the cheek and upper lip (you can fix it with stomahesive to make sure it stays in place). Then use elastoplast (the pink tape) to fix the NGT to the granuflex rather than the face. The cases where I have used this it seems to have worked well. It stays on for long periods and the stomahesive doesn't seem to cause the damage that elastoplast tape does. Hope this helps, let me know how you got on.

gwenith, BSN, RN · Jun 9, 2004

I like the mustash taping myself (you know to the upper lip and not to the nose) it is better tolerated and yes I will use duoderm/comfeel on the skin first (with skin prep/friar's balsam if I have it) and then tape to that.

samrakaan · Jun 9, 2004

Thank you both for the information, I have used granuflex in the past and found it to be good also, but my team seem reticent to change from their current way of doing things despite the fact that it places more of a burden on the workload. Do you know if either of these products is on the formularly, because that will be the next war cry, about granuflex or comfeel being too expensive!

UK2USA · Jun 9, 2004

Thank you both for the information, I have used granuflex in the past and found it to be good also, but my team seem reticent to change from their current way of doing things despite the fact that it places more of a burden on the workload. Do you know if either of these products is on the formularly, because that will be the next war cry, about granuflex or comfeel being too expensive!

In the BNF granuflex retails at £2.22 for a 10cm x 10cm patch, Comfeel seems to retail at about the same price. It seems a little expensive, but you are probably spending that on petrol each time you have to visit this child. Good luck with your negotiations!

Pediatric Critical Care Columnist · Jun 28, 2004

I've seen Tegaderm used very successfully to secure NGs, and I've seen it fail miserably. The skin has to be absolutely dry, the edge of the Tegaderm has to be as close to the naris as possible (without putting it in it :rotfl:,) and the biggest piece you can get on the face (without taping their eye or mouth shut :imbar ) is best. It's easiest to do well if you have three hands... If you run the tube along the cheek out toward the top of the ear, secure it to the cheek then loop the rest of the tube over the ear and secure it tot he neck, the likelihood of it staing in place is much better.

My question would be... if these kids are needing long-term tubefeeds, why do they not have gastrostomies? The aspiration risk of nasogastric feeding in the unobserved child is astronomical!

RNtoJD · Jun 29, 2004

My question would be... if these kids are needing long-term tubefeeds, why do they not have gastrostomies? The aspiration risk of nasogastric feeding in the unobserved child is astronomical!

I was wondering the same thing. Not to mention the discomfort from excoriation due to not only the tape but pressure on the skin from the tube. G-tube seems like it would be much more humane.

samrakaan · Jun 29, 2004

Thanks for that Jan, I agree that a gastrostomy would be the best option, but parents in this case are not ready for that step yet, they are still coming to terms with the long term diagnosis of this child. We are working on it though :)

I've seen Tegaderm used very successfully to secure NGs, and I've seen it fail miserably. The skin has to be absolutely dry, the edge of the Tegaderm has to be as close to the naris as possible (without putting it in it :rotfl:,) and the biggest piece you can get on the face (without taping their eye or mouth shut :imbar ) is best. It's easiest to do well if you have three hands... If you run the tube along the cheek out toward the top of the ear, secure it to the cheek then loop the rest of the tube over the ear and secure it tot he neck, the likelihood of it staing in place is much better.
My question would be... if these kids are needing long-term tubefeeds, why do they not have gastrostomies? The aspiration risk of nasogastric feeding in the unobserved child is astronomical!

Pediatric Critical Care Columnist · Jun 29, 2004

Samrakaan, I understand completely the difficulty accepting the long-term outlook for a child with chronic problems. It's something that evolves gradually as reality sinks in and hopes and dreams modify themselves to what is possible rather than what is "normal". A little bit of denial is a healthy thing for the parents but frustrating for the nurse! I imagine that while we were coming to grips with the way our lives changed when our son had his stroke that I drove my fair share of medical professionals totally squirrelly! But I know he wouldn't be anywhere near as functional as he is without me behind him pushing hard.

I've also been on the other side of the question, years ago when I was doing community nursing. A patient with holoprosencephaly was entirely NG fed, and had recurrent aspirations, in and out of hospital half a dozen times in six months. One day I watched his mom feed him, and she poured the Pediasure into him in about two minutes. I could almost see it backing up into his pharynx! When I suggested she feed him more slowly, that it might be why he was having so many aspirations, she didn't like that too much. I asked her about GT, and she refused to even consider it. Someone she knew had done it for their child and there were complications (wound infection and skin breakdown, I believe). Several months later, this boy had the surgery and his mom was amazed at how much freer they were and how much better he was. Just goes to show. There is hope for your young patient. Good luck...

Gompers, BSN, RN · Jun 29, 2004

For our home care babies, we also use comfeel and either tape or tegaderm. With the tape, we use white fabric tape and do it moustache-style. Sometimes parents don't use the comfeel under the tegaderm, but I personally don't like that. I think it sticks better with the comfeel and it also cushions the cheek against the tube - I hate seeing red grooves in a baby's soft little cheek because the tube was digging into it. Sometimes parents still have the pink Hy-tape we used on their baby in the unit and will use that. While I like the Hy-tape because it can be used for either moustache taping or cheek taping, and because it takes the place of comfeel, tegaderm, and fabric tape all in one product - it's not the stickiest stuff and it's really easy for the baby to pull it out.

We often send home babies with NG feedings, but usually it's only going to be temporary, like for a few weeks or months. With the more chronic babies, sometimes they'll put in a G-tube but you know it's such a hard thing for parents to deal with emotionally. They just think it's a failure and an admission that their baby will never do one of the most natural things expected of a baby - bottle feed. We try not to put G-tubes in babies who are even somewhat bottle-fed because eventually it often ends up being "easier" to tube feed and then they never want to touch food again. The only exception is short-gut babies who need overnight continuous feeds r/t dumping sydrome, or trached babies who are only allowed minimal oral feedings.

I should also point out that even though many parents have a lot of trouble signing that G-tube consent, I've NEVER EVER seen them regret it. Most often I hear them wish they'd have just had it done sooner becuase the kids just do so much better - and they can see their beautiful faces at last!!!

curly73, BSN, RN · Jul 6, 2004

We use the duoderm/comfeel on the cheek to nares (to dry skin, warmed with a hand to stick) with elastoplast tape on the tube, sometimes an extra elastoplast loop onto nose, but some children do react. We have also tried just using the white stretchy hypafix/fixomull tape straight to face.

Have had some recent sucess with a product by Salter Labs called a 'cannulation fixation device' or Tendergrip, which is a round dot - kind of hypafix looking, with a highly sticky clear inner section, and a clear plastic cover that is reusable/lifts up and down. The skin under tends to breathe better and we use two dots, one near nares one on cheek, to hold to NGT to a little face. We find this is also much easier for the single operator to apply or reapply as you can leave one in place while replacing other.

hope that helps

cheers

DawnE · Jul 18, 2004

We used a product called Mefix on the cheeks and then Tegaderm overtop with and just extending slightly over the Mefix. The GT is in between the two. Used this method for nasal cannula also.