Help--transpyloric feeding in NICU

[crazyaaa]

Hi.people,

I had a baby with transpyloric tube the other day.For some reason we don;t have any policy about this in the ward.And i really don;t know much about it.

Any information about the following questions would be really appreciated:

(1)how to put down the tube and tape the tube on babies?

(2)How to check position of the tube?

(3)How to control the speed of feeding?i found milk goes really quickly down the tube due to the tubesize.Do we need to control the speed like NGT feeding?

I tried to google,but got nothing about it.Do u know any useful website for this?

Or if anyone got the policy about it and can share with me(if it's allowed by your working place)?my email:[email protected]

Heaps of thx.

[BittyBabyGrower, MSN, RN]

We do duodenal or jejunal feeds on kids that have had problems...our tubes are put down under fluoroscopy with a weighted tube. We tape them to the face and then farther up the head or down the back so the baby can't grab it. We always put them on a feeding pump since you don't want to dump the feed down. We don't check residuals on those feeds usually, and you can hear it with air/steth. We make sure to check the measurement every feed also because if you have a kid that pukes a lot, then the tube will migrate...usually they end back up in the stomach, which just makes them puke more.

Our policy came from the Springhouse book for nursing procedures I believe.

[dawngloves, BSN, RN]

We drop an NG into the stomach and check residuals to make sure nothing is backing up into there or the tube hasn't migrated.

[lovemyjob]

OK, we frequently do transpyloric feeds, we place it in the duodonem. This is how it is placed per our protocol.

1. Measure tube from nose/mouth to earlobe, to knee. That is your reference point for insertion. Also mark the point on the tube where you would place it in the stomach. I do this so when I get to the point of the stomach I can check placement to make sure I am not ion the lungs.

2. place a 10 ml syringe filled with air onto the tube.

3. Being to insert the tube just like you would for a gastric feed. When you get to the mark for the stomach, check placement (this is something I do, not in our protocol.)

4. PLace the baby right side lying (helps the tube enter the duodonem.

5. Have someone hold the syringe and begin pushing air as you advance the tube to the area you marked previously. Tis helps to open the pyloric sphincter.

6. You can preliminarily determine it is transpyloric by pulling back on the syringe. The syringe should pop back.....like a vaccum....very different than when it is in the stomach.

7. we then do a KUB (xray) to make sure it is in the duodonem... I thjink the tube should cross the spine once.

8. Once placement is confirmed, feeds are given continuously ONLY. No bolus feeds because there is a greater risk of perforating the bowel. We give all of our feeds on a syringe pump, at either a continuous rate or as a bolus over 30 min or up to 2hours 45 min. But, the important thing to remember here is that TP feeds should only be given as a continuous feed.

We tape to the face just like with an OG/NG tube. We havent had any problems with a tube migrating....if a kid is vomiting formula, we do a KUB to check placement, or we will put a syringe onto the tube and pull back to check fopr the pop.

[crazyaaa]

This is really helpful!

Thx,guys.

Cheers!

[lovemyjob]

good luck!!