Securing NGT's in a developmentally friendly way

GoForIt · Apr 26, 2004

Hi all,

I'm a RN working in a newly opened Level II (with CPAP)unit, with nurses from different hospitals and backgrounds(good for exchange of ideas).

I am looking at the best way to secure the ngt's so that it is gentle on the skin and secured in a way that it supports developmental care.

Currently, some staff prefer taping the ngt with it hanging in front of the baby's mouth, with brown tape wrapped around it and stuck on the top lip like a moustache.

We have trialled taping to the side on the cheek and using thin 'duoderm' on the skin and placing clear 'tegaderm' over the top, we have had good feedback from parents i.e.thay can see their baby's face better, it looks cleaner and it doesn't get in the way of breastfeeding. Staff have commented in the same way and that the tubes stay in better.

However, some staff felt that the tube was too short once it was taped on the cheek and when the duoderm was removed it still left the skin quite pink.

I am interested in how you secure your ngt's, hanging in front of the face or to the side on the cheek and what products you found the best and skin friendly?

Does anyone know of any articles that discuss the optimum taping position that supports developmental care to back up the use of cheek taping?

Your input will be gladly received, Thanks

Jen

Gompers, BSN, RN · Apr 26, 2004

I'm on my unit's developmental/skin care committee. We've had good response to Hy-Tape (aka "pink tape") recently. For one thing, it's gentle on the skin and contains zinc to help soothe and protect it. It's pretty easy to remove and there is much less skin stripping than with duoderm (or other hydrocolloid barriers) or tegaderm. The skin on our tiniest preemies is intact with very little redness after removal. It works well for long term with preemies - but with larger kids who sweat you'll find it looses it's stick after a day or two. (Though it's so gentle that retaping isn't traumatic to the skin.)

The thing I like most about the tape is that you only need one product. With typical NG taping, you've got your hydrocolloid barrier, your fabric tape, and/or your tegaderm. I know that some people just tegaderm the tube without the hydrocolloid, but I've seen some nasty grooves left in babies' cheeks because there was no cushioning. With the hy-tape, you eliminate all of that stuff. No more wrestling with tegaderm! Just don't put it on top of hydrocolloid barriers - it'll form like a cement-like adheisive and you'll never get it off! If I'm taping onto one cheek, I'll put down a small strip of hy-tape first and put the tube on top of that so the tube isn't digging into the skin. (This tape is also excellent for nasal cannulas, but I again recommend putting a strip down first so the cannula isn't directly against the skin.)

We have the inch-wide tape and usually trim it down to 1/2 inch for the smaller preemies. We either do the moustache tape or on one cheek. I prefer the moustache method myself because the tube isn't so short that way, no matter what the baby's position is, and also because it's easier for the baby to get his fingers under the tube and pull it out if it's just taped to one cheek.

http://hytape.com/hytape/

dawngloves, BSN, RN · Apr 27, 2004

The thing is we change our NG/OGs every 24 hours. :rolleyes: It is a drag as we have to pull the tape off the kiddos face. We are trialing long term tubes though.

fergus51 · Apr 27, 2004

We keep ours in for 72 hours and usually just use plain duoderm taped right at the corner of the mouth. I have never seen it leave a mark, even on really young premies, when removed with care. I use a little water or a little detachol. I have seen marks when it was ripped off. If the babies are breastfeeding, we make sure to put it in the nares instead of the mouth and tape it to the cheek.

Gompers, BSN, RN · Apr 27, 2004

The thing is we change our NG/OGs every 24 hours. It is a drag as we have to pull the tape off the kiddos face. We are trialing long term tubes though.

That sucks that you have to change them so often! We use the ones that can stay in for 30 days, but I do wonder if there is less incidence of NEC with the short-term tubes?

I know that the Hy-Tape is supposed to be used for long-term taping, but you know as compared to removing duoderm or tegaderm, the hy-tape comes off much easier, even after a few hours. Or else maybe using a duoderm base and taping the tube with white fabric tape, then removing only the tape daily and leaving the duoderm on?

I hope you find a tube you guys like!

GoForIt · Apr 30, 2004

Hi, Many thanks to all who have replied so far to my initial enquiry, especially Gompers for your detailed response, its appreciated.

I have emailed the Hy-Tape company to enquire if they distribute it in NZ. We were using 'Leuko tape' which is also a zinc oxide based tape.

Our 40 cm NGT are changed 48 hrly,in UK we changed them 72 hrly and Middle East every 5 days as suggested in a JNN article! different units, different products and different practices.

Its great to share ideas.

Thanks again for the feedback so far, keep them coming.

Over and out for now. :rolleyes:

Tiki_Torch · May 1, 2004

My previous hospital was big on developmental care so we had the tubes that could stay in for a week at a time. Whenever a baby had no respiratory problems but needed gavage feedings we would put down an NG tube using either Hy-Tape or a transparent occlusive dressing (like Tegaderm or Opsite). If the baby had a nasal cannula we'd put down an OG tube and tape it to their upper lip (like a mustache) instead of their cheek or chin because they seemed to stay in better than taping them on their cheek.

In each case, we'd place a piece of either Hy-Tape on the skin (or occlusive dressing) and then lay the NG/OG tube on the piece of tape and then place another piece of tape/occlusive dressing on top of the tube. (We'd use two pieces of Hy-Tape or two pieces of occlusive dressing... does this make sense?)

If the baby had an NG tube, when replacing it we'd use the opposite nare the next time and tape on the other cheek in order to let the skin have a rest. The good thing about Hy-Tape is the tape often continued to stick well even with slobbery babies who dribbled milk on their chin (when the tape was for an OG tube taped on their chin). Using occlusive dressings on the chin never worked too well because milk would ooze inbetween the two pieces of dressing and became gross pretty quickly. As long as we removed the occlusive dressings properly (by pulling from opposite ends in a pulling-out-horizontally maneuver, the tegaderm never caused any problems. Each box of Tegaderm has a leaflet describing what I'm talking about....

My new hospital only uses OG tubes and replaces them every 24 hours. They also only use silk tape. The silk tape never causes skin problems but also hardly keeps the tubes in place for even 3 hours. We are forever replacing the tape and praying the babies don't pull the tubes out. Actually the weight of the tubes and miniscule movement pulls the tubes slowly out... silk tape is not effective at all for keeping OG tubes in place unless they are taped over the top lip with a tail wrapping around the tube (like when taping ET tubes). Obviously my new hospital has little regard for developmental care. :angryfire

Enough of my soapbox! :uhoh3:

I love this thread! I love learning better ways to do things and how other units work. I enjoy this allnurses site so much!

:)

Gompers, BSN, RN · May 1, 2004

Tiki, you make some good points! I agree that silk tape SUCKS - whenever we have a kid come up from surgery, it's always what the antesthesiologist used to tape the ETT and most of the kids self-extubate because it just doesn't stick at all! Hy-tape is waterproof, which is great especially for oral ETT and OG tubes because otherwise the tape gets all cruddy and slobbery.