Stool Refeed Supplies

[mgturtle]

Working in a surgical NICU we sometimes refeed the stool output from an ostomy into a mucous fistula. We currently use an IV tubing and syringe because it is a larger bore tubing than feeding extension tubing. This is a safety risk as we are using IV supplies instead of enteral supplies. We can't find alternative enteral supplies to use.

Will those of you who do this practice in your facility let me know what supplies (tubing, etc.) you use? Thank you

[NICU_RNC, BSN, RN]

Hummm. I've never heard or this. What purpose does it serve to do so?

[mgturtle]

There are 2 goals:

1. Prevent disuse atrophy of the bowel

2. Increase opportunity for intestinal absorption to decrease TPN requirements

[BittyBabyGrower, MSN, RN]

We do this, especially with our short guy kids. We use our feeding set up, no IV set up for the reasons you said. Several years ago we used the IV set up and as luck would have it, a JCH surveyor saw it and we got a big ding. So now it is feeding set up with a big sticker on it that says stoma refeeding. We use an 8fr feeding tube and the usual feeding setup.

[mgturtle]

BittyBabyGrower, can you tell me what feeding extension tubing you use with it's length and priming volume? The problem we had with our feeding tubing in the past is that it would clog due to the smaller intralumenal diameter compared to the larger IV tubing that we use. Thanks and do you have any similar problems with this clogging?

[mgturtle]

BittyBabyGrower, can you tell me what feeding extension tubing you use with it's length and priming volume? The problem we had with our feeding tubing in the past is that it would clog due to the smaller intralumenal diameter compared to the larger IV tubing that we use. Thanks and do you have any similar problems with this clogging?

[BittyBabyGrower, MSN, RN]

I know it primes with 2 ml. If it clogs up the tubing, we hook the syringe right to the feeding tube and use it that way. I am on vacation for a couple of weeks and can't think of the name of our set up. It's orange lol

[kdkout, BSN, RN]

I agree with the above by "BittybabyGrower" I'm not at the same job, but was just at a job where we did this. We used the exact same indwelling feeding tubes/NGs to do this. The same exact NG we can use orally gets put inside the MF connected to the same extension set we use for cont gtt feeds.....which is why it is SO important to separate the pumps and label the pumps ("STOOL re-feed") and the TUBING!!! By all means use excellent infection control practices and be careful not to have stuff like their bulb syringe or pacifier near the stool refeed tubing. The packaging will say the priming volume. Our tubing is 2ml. I dont remember having a lot of issues with clogging because their stool was often so runny anyway - and if you did, you just pushed with the syringe a little bit to advance it (ie. like you would a think NG feed with 28 cal formula).

I think they're "Baxter enteral feeding" NGs....white and orange to go with the pump that's orange on top....we've also used similar ones that were white and purple to go with the matching purple "enteral feeding pump."

I googled it and I *think* we used the orange "Medela enteral feeding pump" that went with the tubing. They need to be ones specific for enteral feedings, not rigging something like IV tubing or using our other green "in and out one time use" OGs becasue they are a lot stiffer and not meant for this purpose. Even if it works, using IV tubing tubing for something like this is going to get your hospital in trouble so this needs to be resolved asap. I'm surprised the surgeon group isnt helping with this. Our surgeons told us what size to use and often inserted/helped us insert into the MF the first time- think it was 8fr usually - it depended on how big the MF was because you want to be careful not to poke around and make their MF bleed. It's messy and tricky to do, but is really helpful for absorption in many kids.

Your education person/manager could also contact your nearest Children's Hospital and ask about their GI dept/"short gut" or gastroschisis kids & what they use. If you dont have this equipment it will need to be approved & ordered anyway, which takes time....and there's a lot of choices on NGs but I dont know which ones go with what pumps.

I'd have your manager/Education/case mgmt person call the nearest home health care co that works with your babies that go home on NG feeds. Because they'll have the info.