Securing OGTs

Specialties NICU

Published

I need some suggestions on how to secure OG tubes with babies on NCPAP. My unit is currently using NG strips, but they are constantly getting wet from the CPAP and oral secretions and causing the tubes to become too shallow or come out. Does anyone do something differently? Anyone secure them somehow to the CPAP hat? Thanks.

Specializes in NICU.
we change about q24 unless, as above, there's a compelling reason not to. We feed q3, usually, so what I try to do is pull it soon after the feeding is done to give the skin a chance to rest, and then drop the new one for the next feeding. I haven't had any really unstable kiddos, though, so it might be different for them.

Wow, your hospital makes you drop a new tube with every feeding? I thought that practice was outdated. They have started manufacturing feeding tubes that are designed to be left in place for up to one month, to limit trauma to the babies.

There are certain tapes you can use that are better for the baby's skin, therefore you don't need to let the skin rest by removing the tape every time. If anything, taping in a tube, then pulling it out every feeding is worse on the skin because you keep stripping the upper layers of skin off every time you do it. It's not rest that the skin needs - it's protecting it from repeated trauma and harsh adhesives.

For our non-intubated babies, we use the pink Hy-tape for securing NGs and nasal cannulas. The back of the tape is made with zinc, which is a well-known skin protectant. We are seeing much less stripping of the skin than we have before with tegaderm and duoderm. It's also a whole lot easier to use than tegaderm! We are sending it home with parents, too, for the babies who go home with NGs and cannulas. Our current medical supply company that services the home care population doesn't offer it yet, and teaching the parents to use duoderm and tegaderm is so much harder than teaching them to use the Hy-tape!

Up Vote Up Vote ×

We change our silastic tubes every 3 weeks and remove and clean them once a week. We use tegaderm or 2 stips of "pink" tape one wrapped around the tube and then the other over that piece of tape. If they are really wet from just starting CPAP, I will do the 2 strips of pink tape and then cover that with a piece of tegaderm. We do alot of "bubble cpap" and this seems to work pretty good.

Up Vote Up Vote ×
Specializes in NICU.
Wow, your hospital makes you drop a new tube with every feeding? I thought that practice was outdated. They have started manufacturing feeding tubes that are designed to be left in place for up to one month, to limit trauma to the babies.

Oh, nonono, we don't drop for every feeding. Just that when I DO drop (usu q24h) I pull after a feed and drop just before the next one. Maximizes time w/o tape on skin, lets it breathe, etc.

Up Vote Up Vote ×

are they the clear tubes with the green lines going down the sides and a green plug?? Maybe you can mention the availability of 30 day tubes and see if there is a reason not to use them. I am sure they are more economical (we use them, they MUST be!!) and def are less traumatic on the babies!! Let us know if there are reasons for using 24hr tubes!

Up Vote Up Vote ×
Specializes in NICU.
are they the clear tubes with the green lines going down the sides and a green plug?? Maybe you can mention the availability of 30 day tubes and see if there is a reason not to use them. I am sure they are more economical (we use them, they MUST be!!) and def are less traumatic on the babies!! Let us know if there are reasons for using 24hr tubes!

They are in fact the green stripe tubes. Honestly, I couldn't tell you the reason. I was a student on that floor and didn't know about the 30 day-ers. If I get hired (everybody cross your fingers!) I'll try to find out.

Up Vote Up Vote ×
They are in fact the green stripe tubes. Honestly, I couldn't tell you the reason. I was a student on that floor and didn't know about the 30 day-ers. If I get hired (everybody cross your fingers!) I'll try to find out.

One of the things I dont like about the green ones are that when you gp to pull air off the stomach or when you check residuals, you can very easily irritate the lining of the gut because those tubes are so rigid. Have you ever pulled the tube out and seen blood at the end of the catheter? With the 30 day tubes, they are much softer and you can pull to your hearts content and never see blood in the tube, at least that is my experience. Also, they are more comfortable for the kids and they gag on them less because it is so flexible.

Good luck!!

Up Vote Up Vote ×
Specializes in NICU.

I have always wondered if the units that change tubes every day have lower rates of NEC. We use the 30-day tubes, and while we don't get tons of NEC, we do get our fair share. I wonder if dropping a clean tube everyday makes any difference?

Up Vote Up Vote ×

My thoughts exactly Gompers. We use the green tubes too, but change them every 3 days. A product rep for the 30 day tubes showed me something on the green tubes I'd never noticed before. There are holes along the distal side of the tube, but no hole in the end. Which means a small amount of formula/BM can sit in the bottom.

Up Vote Up Vote ×
Specializes in NICU.
I have always wondered if the units that change tubes every day have lower rates of NEC. We use the 30-day tubes, and while we don't get tons of NEC, we do get our fair share. I wonder if dropping a clean tube everyday makes any difference?

heeee, I was going to ask the same question in the opposite direction. We have what seems like a LOT of NEC. But then, we're also the top NICU in the area and a regional referral center (we don't send ANYTHING out, do it all, including transplants) so maybe we just have sicker babes.

Up Vote Up Vote ×
Specializes in NICU.
My thoughts exactly Gompers. We use the green tubes too, but change them every 3 days. A product rep for the 30 day tubes showed me something on the green tubes I'd never noticed before. There are holes along the distal side of the tube, but no hole in the end. Which means a small amount of formula/BM can sit in the bottom.

I think all the tubes are like that - they all have holes along the side but the end is rounded so insertion is easier and so it doesn't dig into the stomach. But there might be differences between companies where some have holes much closer to the bottom of the tube while others are further up, you know? We should all measure them and get back to each other.

Gotta wonder about NEC. With the new tube every single day, I'd think there is much less chance for bacteria to colonize in the end of the tube. However, by opening up a new tube every day, you also run the risk of contamination every day by either the practitioner's hands/gloves or the bacteria in the baby's nasal passages - precisely where MRSA lives.

I wonder if there have been studies done about this...

Up Vote Up Vote ×

OUr NM has been very good about running studies to check for inceases/decreases in blood stream infection and nec and such compared to when we change protocols (like when we started using chlorahexidine for picc drsg changes), and I am sure she wouldnt have switched us permanantly unless she had seen results for it. I will have to ask to see if it was tested.

Up Vote Up Vote ×
Specializes in NICU, Infection Control.

We use Argyles--they have a blue connector. We don't change them unless they come out! Every once in a while, I realize the kid has outgrown his feeding tube!

But, this is a Level 2, very low risk for NEC babies. I don't think changing the tube has much to do w/NEC, tho. jmo

Up Vote Up Vote ×
+ Add a Comment