gavage feeds - page 2
Just curious what everyone did out there, for feeding their babes gavage feeds. The hospital I'm at now is very different than the one I came from in Canada. Do you guys use OGs, or NGs? And, when... Read More
Jan 9, '03Occupation: once a manager, now a staff nurse, preceptor, educator and practice member Specialty: 30 year(s) of experience in NICU, PICU, PACU ; From: FAM ; Joined: Mar '01; Posts: 2,797; Likes: 3,172Interesting topic...I always find it amazing how different things are done in places.
We mostly use #6fr silastics. We can leave them in for a month and then change them. We use 5fr on the smaller kids, these are changed every day, sometimes we go 2 days as they are not silastic. We use #8's on the bigger kids.
We tend to use NG's more than OG's. If a kid is on CPAP,NIMV, OET or has a high flow cannula on, we go OG. For your typical gainer grower or poor big kid feeder we go NG. For a kid that always has a stuffy nose, OG. A few of our attendings don't like OG's for some reason, but they just grumble about it and get over it. I do see their point that the kids can tongue them out easily, but if their little nose is swollen and bleeding, what else are you gonna do?
As for the method of feeding...it depends. Some people always run the feeds on a pump. Some always gravity it (we use a med extension tubing and it cuts down on the dumping in syndrome). On a kid with severe reflux, we usually run it on a pump over 30-60 minutes, depending on the frequency of the feeds. Personally, I don't like the pumps..if a kid starts puking, the pump just keeps pumping it in, if it is going by gravity, the force of the stomach with stop the flow and usually the feed will stop.
We generally don't stay by the bed...sometimes we have 4 kids that need to be fed at the same time. But, there are usually always 2 people in the pod so, if the alarm goes off one of us can get it. Sometimes you are sitting there catching up on charting, so I guess it just depends on what is going on and how busy you are.
I just really wish that they made #5fr silastics..I hate changing those tubes every day or so!
We also open our tubes to air to vent about 30-60 minutes after feeds for kids on CPAP and NIMV and those little chronics that gulp air and are on high flow cannulas.
Jan 9, '03Occupation: Level II Neonatal Nurse Joined: Oct '01; Posts: 76; Likes: 11In our unit we use the 5 fr silicone feeding tubes, that can stay in for a 30 days. We normally do NG feeds, but our neo is wanting to switch to all OG feeds. The nursing staff has fought this because it seems that the babies pull out the tubes less with NG.
We do not feed babies on vents or NCPAP because they are normally not on them that long. If a baby is on a vent longer than 4-5 days we ship to the Level 3, due to our NP and Neo staffing. (we are a small level 2 without 24 hour in house NNPs unless we have a vent baby) Babies on NCPAP all get an OGT open to air.
We hang all of our feeds on pumps over 30 - 60 minutes, depending on how the baby tolerates. Normally that is nursing judgment, but sometimes is ordered over an hour. The babies are fed on different "schedules" Q 3 hours, we also do all cluster care with feeds. We don't have to stay at the bedside, but there are normally 2 RN's within a few feet of the baby.
Jan 10, '03Occupation: once a manager, now a staff nurse, preceptor, educator and practice member Specialty: 30 year(s) of experience in NICU, PICU, PACU ; From: FAM ; Joined: Mar '01; Posts: 2,797; Likes: 3,172MO....who makes your #5 silastics? I would love to get our unit manager to order those~!
Jan 10, '03Occupation: Level III NICU Specialty: NICU ; From: US ; Joined: Oct '00; Posts: 1,605; Likes: 929We use 5fr. feeding tubes on most kids. Ours stay in a month also. We mostly use NG's but will drop an 8fr. OG into a CPAP baby. Seems to vent better but then the feeding tends to back up the tube more, plus it goes in much faster. We just try to be careful and use our best judgment.
Most of our feedings go in by gravity, which we hang and leave. We do not stay by the bedside holding the feeding. We usually don't have time for it and we are never far away if a monitor goes off. I suppose a baby could pull our a feeding tube while it is going in, but we tape them down pretty good with tegaderm and I've really only seen a baby pull out a tube DURING a feeding a handful of times. Compared with how many feedings I've given... that's just not very often. Babies with reflux or feeding intolerance will have feedings go in via pump for 30-120 minutes (or continuous).
We have no policy on who gets an NG vs. an OG or 5fr vs. 8fr. tubes. Nurses' discretion. If we do use an 8fr., it's always OG, and we rarely cram 8fr. tubes down preemies.
Jan 10, '03Occupation: Level II Neonatal Nurse Joined: Oct '01; Posts: 76; Likes: 11Nicugal, I will have to look & see who makes our 5 FR silicone tubes. I work again Saturday night, so will try to look then.
Jan 19, '03Occupation: Registered Nurse - Neonatal ICU Joined: Dec '01; Posts: 140; Likes: 1On our unit we do OGT and NGT. For babies who wer are attempting to nipple but aren't very good at it, we usually do the NGT just so it is easier for them when they attempt to bottle feed or breastfeed. Some babies constantly gag on their OGTs so we will give them a NGT. It depends on the baby and the situation. The one thing I have seen some nurses do which I don't like is have a baby on a nasal cannula and have and NGT tube in, that is a little rough on the nares.
For our gavage feeds we usually hang the feed but leave the cover on the isolette folded back so that everyone knows the feed is hanging and to keep an eye on the baby. If we have time to hold a baby and hold his or her feed we will.
Jan 21, '03Occupation: Nurse leader Specialty: 26 year(s) of experience ; Joined: Dec '02; Posts: 43; Likes: 3It is very interesting, how everyone does something a little different. Here's a tidbit, though. A couple of weeks ago, a little 1kg babe pulled out his tube (just a little!), during a feed. No one was right at the bedside, so, by the time the monitor went off, and someone responded, he already had an aspiration pneumonia! The CXR even showed the OG halfway up his throat! So, now that the feeds have been restarted on this babe, due to his frequent pulling on the tube, I have heard some nurses tell me it's easiest just to tie his arms down, during the feeding! Poor baby!!
Jan 22, '03Occupation: NICU RN Joined: Oct '00; Posts: 2,537; Likes: 369Originally posted by kimmy2
I have heard some nurses tell me it's easiest just to tie his arms down, during the feeding! Poor baby!!
Jan 22, '03Occupation: Level III NICU Specialty: NICU ; From: US ; Joined: Oct '00; Posts: 1,605; Likes: 929No, you can swaddle them with their arms across their chest so they can't reach their face with their hands to pull on the tube. I don't think she meant actually use restraints.
Jan 22, '03Occupation: Nurse leader Specialty: 26 year(s) of experience ; Joined: Dec '02; Posts: 43; Likes: 3Actually, it isn't just swaddling (almost all the babes are on skin probes). The nurse told me that they were literally using tape to hold the baby's arms down. I'm sure JCAHO would have something to say!
Jan 22, '03Occupation: Respiratory Therapist Technician Joined: Jan '03; Posts: 1Nurses here in Puerto Rico sit by each infant and hold the gavage. They are too afraid to just hang and watch and yes! They use OG's and NG's too!! Minina
Jan 22, '03Occupation: Level III NICU Specialty: NICU ; From: US ; Joined: Oct '00; Posts: 1,605; Likes: 929Hmm, tape wouldn't be very nice.
Jan 26, '03Occupation: RN, NICU Joined: Jun '01; Posts: 104We use all silastic tubes....generally first oral tubes because of different vent support is used. Ussually gastic feeding sometimes dued. feeds. As babes get older we have this protocol and now place NG 5f tubes they stay even as a babe progresses on oral feeds. If a baby can not take the total 2 hour volume they are given the rest by NG over 30 mins (we put the feeding on a pump). We have guidelines for progression of oral feeds brst ,bottle, or cup...babys are given a feeding score through this guideline....and If a baby can take a 3 hour volume orally we than go to every three hour feedings.