gavage feeds

Then NICU I work in just hang the gavage feedings to NG tubes mostly I have not seen it done to GT as yet. but we do not just walk away we monitor the child at all times. I hope that helped.

It depends. Is the baby on CPAP? THen OG, NG on NC, vent

or room air. We hang it and walk away mostly. So we can hang two more feeds or PO feed another. I don't have 15 minutes like that to spare!

This depends on my units, as well. If the baby is on O2 of some sort (NCPAP or NC), we use an OGT. If the baby is a larger baby with a stronger gag reflex, or if he/she has a habit of yanking it out, we do an NGT. Babies on RA get an OGT usually. I NEVER walk away during feeds- learned the hard way that when my back is turned, it's almost a surety that my baby will be the one to regurg and choke! Now I keep an eagle eye on all of them. If I have time, I will do it by hand, but this isn't always possible (with more than four babies, I usually put it on a syringe pump while I'm hand feeding another at the same time, then move on to the next two, etc.). I have seen other nurses simply hang the feed to go via gravity and walk away, but I HATE this method for various reasons. Mostly, I can't stand to see it because inevitably, they will get busy with another baby, and the feed runs dry, and then the tube is just open to air for God knows how long (until they realize the feed is done and come over to unhook the syringe from the tube). I just do not feel comfortable with that at all. Times vary, as well- if a baby has a h/o reflux, etc. I'll usually run it on a pump over a longer time (i.e., 30 minutes instead of 15). You know, now that I think of it, I thought of another reason I don't like the hang-and-run method: the feeds go in too quickly. I wouldn't let a baby gobble down a bottle in less than 10 or 15 minutes if they were nippling- why would I want to let that happen just because they're being gavaged, you know? I'm very picky. ;>) I'm one of those 'It has to be done a certain way or I'll go mad" people.

Originally posted by Kristi2377

Mostly, I can't stand to see it because inevitably, they will get busy with another baby, and the feed runs dry, and then the tube is just open to air for God knows how long (until they realize the feed is done and come over to unhook the syringe from the tube). I just do not feel comfortable with that at all.

That's funny, becasuse it's our policy to have OG tubes OTA with babies on CPAP, allows air to escape the belly.

We only hook feeds to a pump if the baby has regurge, usually over an hour, sometimes two, sometimes continous.

You see, where I worked in Canada, we would sit at the bedside with our gavage feeds. This would allow us to watch for feeding tolerance, so if they regurged, desatted or had a brady, we could adjust the feed height immediately. We also fed everyone at different times, to allow time to do this. Yes, perhaps it is time consuming, but my #1 priority is that baby. At my current hospital, everyone feeds the babies at the same time. They hang all the feeds, and walk away. I've seen so many babies regurging, or desatting, or having an apnea and bradycardia, and no one is there immediately to help them. In Canada, we use OG for tiny babes (usually under 1000g), who are fed q1h or q2h. Otherwise, we use the NG, to help them tolerate oral feedings better. We change the NG q week, using a different nare. Also, in Canada we use #5 or #6 French tubes for indwelling use. Here, I've seen them have #8 tubes indwelling! These are garden hoses!

I've yet to see any ramifications from leaving the bedside of a baby with a feed hanging. It the baby is going to brady, or puke he'll do it if I'm there or not. Someone is there within seconds.

We use a #5 on all sizes and change them QD.

This is interesting...I'm going in to work tonight. I'm going to ask around and double-check our policy. The logic makes sense to me (wouldn't be the first time on this unit I'd been taught something incorrectly!).

Edited to add:

My unit also (or I should say co-workers) tend to stick with the 8fr tubes, despite the size of the baby. Only rarely have i seen others use a 5fr (only if the baby is particularly small). I personally have never understood thr reasoning for this, as I tend to base the size of the tube on the size of the baby (isn't that what we're supposed to do?), but I have been told numerous times that I shouldn't use a 5fr because it takes too long to feed through...??? Does your policy state which tube should be used on which baby? I'm definately going to check tonight on ours.

In our level II, for feedings, we use 5fr for most babies. Our policy states we can use 8 fr for babies over 1500 gms. We also feed the babies at different times, we are a small unit and it's easier if someone has to leave for a delivery if we have staggered feedings. If a feeding is hung, you stay near the baby. Some of the bigger r/o sepsis babies are ad lib.....he (or she) who screams loudest gets fed first!

Originally posted by Kristi2377

Does your policy state which tube should be used on which baby? I'm definately going to check tonight on ours.

I don't think so, but since that's all we have on the unit....:chuckle

I think I have found a couple of 8s in the back of the closet to drop down kids with NEC, but thank goodness it's been a while.

In all of the units I have worked we most typically go OG feeds. Using an 8fr OGT, unless it is a micro premie, then we use a 5fr.

Most of our feeds are to gravity, with the nurse @ the bedside until feeding is finished. On reflux kids we can do pump feeds over 30" to an hour. I would not leave a baby with a gravity feed until finished due to the risk of the baby dislodging their feeding tube and aspiration.

I disagree with the notion of well they are going to do it regardless of whether I am there or not. At least if I am at the bedside I can respond promptly to that baby's needs of an open airway.

We often place OGTs on vent babies and leave open to vent air from the stimach. If this baby is feeding we will leave it open and suspended above the level of the baby after feeds for the same reason.

We use 5-6fr og/ng for 1800g and below & 8fr for those above 1800g.

In the Lv III unit I work in it is our Policy to NOT hang gavage feeds, I have seen it done, but the nurse usually didn't know the policy, i.e. came from a facility where it was allowed, so they were gently corrected.. :)

=Greg

You guys must work on really big units. There is always a nurse a couple of seconds next to a baby, but not standing right there in front of them.

Lisa, if an ETT was placed correctly, why the need for an OTA OG? Did you mean CPAP? I'd worry about placement if my vented babe had a belly full of air.