Gravity Feeds

lvnurs9 · Jan 19, 2009

I never understood what difference it made to hold a feed for 30min or put it on the pump, but where I just left, they were anti pump feeds! We were NOT allowed to hang feeds. I think it's actually a JAHCO violation of some sort. Anyways, they made us sit there and hold it. It sucked, however, I do agree that 1- you shouldn't hang a feed and walk away. The risk in it falling over or not actually draining is too high and 2- if the baby was nippling, you would have to sit there and feed the baby, so time shouldn't be an issue. Each kid should be spaced apart by 30min. It makes things tight, but it's still do-able. I still think they should go on pumps :)

MandaAnda · Jan 19, 2009

Is it normal to give you 4-6 babies in your assignment? I live in California, and with the ratio, our max on the stepdown is four babies. I still think that is too many!

If it's busy and/or we're low on staff, then yes. Last night, I had four babies and one rooming-in with the mother. The rooming-in baby was no problem, as she was establishing breastfeeding and was doing well. I only saw her before her morning feed before I left, as I'd asked the mother to bring her in for weighing if she woke at the end of my shift for a feed. The other four: two were breastfeeding babies who were hopefully going to room-in from today, but as I was on a night shift and didn't have the mother there, they were on four hourly NGT feeds. My other two were hourly NGT feeds. It was a pretty relaxed night actually.

3yrDiploma · Jan 20, 2009

I take a little offense to the generalization you made that the younger generation has a different work ethic than you do. I am of the younger generation, and my work ethic is just fine, thank you very much. However, I still don't stand at the bedside to watch a gavage feed go in. There are other things that my time can be much better used for, and I agree that the acuity level of my patients does not often allow me to spend time standing by the bedside for the length of the feeding.
Perhaps on a public bulletin board you could avoid having the preconceived notions you have based on your work situation cloud what you think of your peers on the bulletin board.

it is simply an observation..............

3yrDiploma · Jan 20, 2009

Even if we hang our feeds, we're not allowed to leave the baby unattended. I regularly have 4-6 babies to look after with a variety of hourly, two hourly, three hourly and four hourly NG feeds (not always one of each but you get the idea) and sometimes a bottle feeder or two thrown in the mix. I never, ever, ever leave a NG feed hanging and walk away. It's a risk, and I wouldn't do it even if our unit allowed it. Even a 50ml feed doesn't take that long.There's recently been a thread on this subforum about babies falling of scales. If we know how well these guys can wiggle around and therefore wouldn't leave them unattended during weighing and wouldn't leave incubator doors open and walk away, how can it be justified with a feed?

I agree 100% with you.....well said

elizabells, BSN, RN · Jan 20, 2009

I think it's actually a JAHCO violation of some sort.

I promise that it's not. We just passed JCAHO, and while we did have to make some changes, this wasn't one of them. ALL of our cares on 99% of our babies are at 8-11-2-5, and the general practice is to do your gavage kid first, if you have one gavage and one nippler, so that if your nippler is slow, your gavage kid doesn't get off schedule. Nobody holds their gavage feeds. Not the younger, "poor work ethic" nurses, nor the older "supposedly awesome work ethic but still often found sitting watching YouTube videos or shopping online or taking multiple personal phone calls" nurses. People are people. Many of our younger nurses don't even take their full lunch break, while more than once I've waited over 90 minutes for a senior nurse to deign to show back up on the floor.

BittyBabyGrower, MSN, RN · Jan 22, 2009

Hold them if I have time, but sitting there with my hand in the air for 30-40 minutes makes for a great carpal tunnel flare up LOL We will tape them, but we don't usually go far. It is not a JCHAO requirement...and if your management told you that then they are ony telling you this as a "threat". Sometimes we will get an easy ng kid and a really, really sick kid and we will tape it up.

If you think about it, putting it on a syringe pump isn't any safer than hanging it by gravity, both had the same risks.

RainDreamer, BSN, RN · Jan 22, 2009

I guess the younger generation has a different work ethic than I was brought up in

:nono:

nicusince86 · Jan 28, 2009

We put all feeds that are over 10mls on pumps over 30 minutes, some babies with higher residual problems over one hour. This seems to alleviate emesis, as no one is trying to rush a feeding in our NICU. I am curious though as to whether other units rinse tubing and syringes to use again, or get a new one every time. We always used new, but the powers that be in the financial offices seem to think this is too costly, and have encouraged us to reuse them for a shift. This seems like a bad idea to me, especially rinsing breast milk tubing (body fluids). Any research on this?

RainDreamer, BSN, RN · Jan 28, 2009

I am curious though as to whether other units rinse tubing and syringes to use again, or get a new one every time.

We use our extension tubing for 24 hours. In between feeds we flush the tubing through with water. Works fine for us, I can't imagine why we'd need to get a new one after EACH feed.

BittyBabyGrower, MSN, RN · Jan 28, 2009

I think something did come down from IHI or CDC about changing feeding tubing, but I could be mistaken. We just changed our policy to changing tubing every 4 hours, including Kangaroo pumps, and a new syringe with every feed. We did an article in our journal club about leaving syringes and tubings up, I'll have to see if I can find it and reference it!

littleneoRN · Jan 29, 2009

I won't beat a dead horse about age and work ethic, but as a preface to my reply... I am 26. I consider myself to have a strong work ethic, sometimes maybe a little too strong in that I need to tell myself it's time to make time for break. :) I always can see about a million little things I could do in my day to improve the care and experience for my baby/babies and their families. I try to hold every single one of my kiddos (if medically appropriate) at least daily. I'm not trying to play supernurse, but what I'm trying to say is that there is so much I can be doing with a half hour of my time. We do all our feedings by pump, but my question for those who do gravity is this: What happens to all your interruptions during that time? Let's say it takes a half hour to go in. In that time, on a typical day in the stepdown area...one of "my" babies will probably have a spell and several desaturations, requiring some adjustment of his FiO2 on his cannula. The lab may call with a critical glucose from morning draws. Another of my kids might start fussing and need some cuddling. Mom of one of the kids might call with 14 (very good) questions. The NNP might need help placing a PICC. All in that half hour. How do you all deal with this without hanging the feeding from something. I will admit that I very very occasionally come back partway through the feeding (I try to check in a few times over that half hour) to find that he has pulled his NG out and it's hanging in his mouth/bed/clothing/whatever. So I understand the risk. I'm just not sure that the risk of that occurring is very much diminshed by standing their holding it. And at the same time, all those other things that we can and should be doing aren't happening. I would like to hear perspective from those who do gravity feeds on how this time is managed with a 3-4 patient assignment. Thanks!

babyNP., APRN · Jan 30, 2009

Syringe pump all the way! (for anything more than 5-10mL) Is there a reason why people don't use these or mostly just a lack of resources?