Gavage protocol

[HurleyRN]

I have just come off orientation to NICU from an adult renal unit. I have many "how and why" questions as well as a curiosity as to how things are done elsewhere. My first inquiry is about how other facilities do gavage feeds. We use a 20 or 60 cc syringe and suspend it over the bed with a chain of rubber bands. Although there have never been problems, it just seems there should be a better way. We also have to "start" the feed by pushing with the plunger before removing it. I have noticed that the 24 cal feeds often stop.

[Jolie, BSN]

Some units use pumps for continuous and/or bolus gavage feedings. It is a closed and more controlled method, but has its drawbacks as well. Shortage of pumps is one, and mistaking formula or breastmilk for IV lipids is another (Yes, that has happened.)

I don't know of any studies showing better tolerance of feedings with a pump versus hanging.

[HurleyRN]

We have done the pump method in cases where the baby does not tolerate a fast gavage. Then we may run it over a half hour or so. I never thought about the "mistaken identity" with lipids factor! That is scary!

[texas2007, BSN, RN]

We generally put anything over 5-10 ml on a pump. Anything less is by gravity. The assignments are usually heavy where I work and we simply don't have time to watch the feed slowly moving in the tube or worrying about it falling/spilling.

[Moondance]

Do you use a new syringe each time you administer a feeding?

[HurleyRN]

We always use a new syringe, and if extension tubing is used, we replace that, too. How do you all feel about puting syringe pumps in an isolette?

[Jolie, BSN]

I don't think it is ideal, from an infection control, safety, or minimal stim standpoint. We used microbore extension tubing long enough to allow the pump to be placed on top of, or on a shelf next to, the isolette.

[NeoNurseTX, RN]

We generally put anything over 5-10 ml on a pump. Anything less is by gravity. The assignments are usually heavy where I work and we simply don't have time to watch the feed slowly moving in the tube or worrying about it falling/spilling.

Oooh, girlfriend those assignments are so far from heavy it isn't even funny!

I gravity smaller feeds depending on the size of the baby and what they are used to. Most feeds are over pumps though and they go from about 10 mins to 1 hour if they are bolus feeds.

[NeoNurseTX, RN]

We always use a new syringe, and if extension tubing is used, we replace that, too. How do you all feel about puting syringe pumps in an isolette?

No way! Those things trap sound in there so bad. I hate blood tubing because it's so short that it's hard to get the pump far enough away from the baby.

We replace tubing and syringe every feed, too. Some people leave the tubing and syringe hooked up to the baby after the feed, but I think it's kinda nasty to do that and clear the OG with air after feeds.