High Intensity Module Enteral (Naso-Gastric Tube Jejunum or Duodenum) Feeding and Management The electronic version of this document is the master copy. Observe and document the position marker on NGT/OGT compare to initial measurements. Durai, R et al 2009,' Naogastric tubes 1: insertion technique and confirming position', Nursing Times, vol. e 2udo fduh hyhu\ vkliw f :hhno\ zhljkwv )rupxodv d &khfn wkh pdqxidfwxuhuv h[sludwlrq gdwh ehiruh xvh e &ryhu dqg uhiuljhudwh irupxod diwhu lw lv rshqhg dv uhfrpphqghg e\ wkh Feeding tube passed through the skin on your abdomen. Endoscopy: The gastrostomy tube can be inserted using an endoscope. Should gastric aspirate be discarded or retained when gastric residual volume is removed from gastric tubes? hYmo9+bXK_rE!7Msb7PP$E# hBjCc28at-B]R`iTkF#$fPZiAA. Viscous liquid medications may require dilution to prevent clogging of the enteral tube., If a liquid formulation is not available consult a pharmacist to confirm if the tablet form can be crushed to a fine powder and then dispersed in water, or whether a capsules can be opened to disperse the contents in water., Do not crush enteric coated or sustained/controlled release medications., Interaction between gastric acid, formula and medications, Interactions between medications if tube is not flushed between medications, Inappropriately prepared medications e.g. Nutrition in PICU (RCH only). If the tube cannot be reinserted consider using a foley catheter to keep stoma patent until an appropriate tube can be found. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 11 0 R 18 0 R 19 0 R 20 0 R 21 0 R 22 0 R 27 0 R 41 0 R 43 0 R] /MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> or soft cloth to remove oil or food. Enteral feeding is a method of supplying nutrients directly into the gastrointestinal tract. Check infusion hourly and document intake. Pump: Formula is placed in a tube feeding bag, The Great Ormond Street Hospital, Manual of Childrens Nursing Practices. Aspirate minimum 0.5 - 1ml of gastric content (or sufficient amount to enable pH testing). Discuss with senior nursing staff or medical staff. 105 issue16, pp.12-13. Endoscopy: The gastrostomy tube can be inserted using an endoscope. Gastrostomy Tube Feeding - Slow Drip/Continuous Method with Residual Check. The time from procedure to first feeding can vary, however you will be kept informed by the healthcare team and the dietitian. Nasogastric and Orogastric Tube Insertion procedure (RCH only.) Wiley-Blackwell : West Sussex, United Kingdom. Should there be any dispute as to the position of the tube, do not recommence feeds. Medication administration via enteral tubes: a survey of nurses practices, Journal of Advanced Nursing, 67(12), 2586-2592. If very small rates are required, consider using frequent syringe bolus feeding techniques as an alternative.. Gilbertson, H., Rogers, E., & Ukoumunne, O., 2011. Specialised nutritional formulas contain the same nutrients (protein, fat, carbohydrates, vitamins and minerals) found in a healthy diet. hb```&[B or jejunostomy tube contact the medical team immediately.. You can find more information about the types of feeding tubes here. endobj endstream endobj startxref Nasogastric (NG) and nasojejunal (NJ) tubes do not require surgery for placement and are most often used for shorter term tube feeding. Further guidance regarding the management and return of GRVs can be located under NO. Peter, S Gill, F 2009,' Development of a clinical practice guideline for testing nasogastric tube placement'. 4 0 obj Link for insertion of Nasogastric and Orogastric Tube Insertion policy, Nutrition on PICU Guidelines and Jejunal Feeding Guideline. Using only one feeding set per RTH container helps control the introduction of microbes from touch contamination. Phillips, N M., & Endacott, R., 2011. Turgay, A S., & Khorshid, L. 2010. They may be removed from the fridge 15-20 minutes prior to administration to bring it to room temperature and should not hung for longer than 4 hours use the dose limit function on the feed pump to ensure this occurs.. endstream endobj 226 0 obj <. Referrals to speech therapy and/or occupational therapy. A percutaneous endoscopic gastrostomy (PEG) is a procedure for placing a feeding tube directly into the stomach through a small incision in the abdominal wall using an instrument known as an endoscope. If the nurse is unsure regarding the position of the gastrostomy Paediatric Nursing,vol.14 issue 1, pp. Please note: patients who have a history of Liver Failure and known/or suspected oesophageal varices should not have a gastric aspirate removed from the NGT. hbbd``b`$ Q$X D F]KD]P@;0012e``! ? Using a gravity feeding set with the roller clamp closed, attach the set to the feeding container with the correct prescribed amount of feed and hang the container on the pole. endstream endobj 283 0 obj <. 282 0 obj <> endobj Making the decision to start tube feeding - for parents, A practical guide to tube feeding for adults, A practical guide to tube feeding for parents, How do you feel about tube feeding - for parents, Things to check when you are feeding away from home. Gastrostomy feeding tube (G-tube) insertion is done in part using a procedure called endoscopy. The right tube feeding schedule will enable the child to: grow appropriately, tolerate tube feedings comfortably, continue to eat orally (if able), and be fed at convenient times A tube x\YSH~'P Tcb"a"a,v24~3IA:+++/IYiV>>iv/nUVjy|^t~}{>%I4t}`e~x_lyx{`csqFp5]Q>9a_w?euUU9_soM]4v$){n >{IyaFK{zMfiis8My/z4H ,D q[an" ,`tI;Gd_%[;dxa9.9:QU#9Gskn57_{-^gi0:=gk% u?K8D~p_^`psB\J" Ew>d9T^H+aRm/_ >C%=W=],\P'WzeCQZ.OOS\UF+-lNWWZ^iy9rT]V v7*(TLmN:OMG"MG&XW"8,I. OR If a member utilizes an enteral tube and oral feedings then utilize the route that is the more prominent source of nutrition (>/= 70% of caloric need). For children who have a newly established enteral tube feeding regime: Do not administer feeds through enteral tubes that are being used for aspiration or are on free drainage.. Department of health, Western Australia. To unblock enteral tubes, flush the tube in a pulsating manner (push/pull) with 10-20ml with warm water, if it is safe to do so taking into account the childs age, size and clinical status. For further information regarding the use of the infinity pump please see the 225 0 obj <> endobj 3 11. Dislodgement of a Gastrostomy tube - Stop the feed/medication administration immediately. An enteral feeding pump can be used intermittent, bolus or continuous administration of feeds, but is best suited for continuous feeding when tolerance to rate of feeding is an issue. For further information regarding nutrition in PICU please see the, For further information regarding Preterm Infants please see the. This is a way of looking inside the body using a flexible tube with a small camera on the end of it. Pour the prescribed amount of water into the syringe and allow to flow through to flush the feeding tube appropriately. E., Bruce. Surgically: The gastrostomy or jejunostomy tubes can also be placed surgically. l)dJv0$30120a`2' 9g Flushing is not routine on the Neonatal unit and flushing with air is the preferred method. %%EOF It is passed through the mouth and throat, down the oesophagus and into the stomach (PEG) or small intestine (PEG-J). If PURPOSE : To define the procedure for hanging, maintaining and caring for patients with enteral To check the position of the tube nursing staff members need to have prepared the following equipment: Some medications and formulas may affect the pH reading. The family should be offered a dietician review while they are an inpatient to ensure the current feeding regime meets the ongoing nutritional needs of the child. Please note this guideline does not refer to the management of Jejunal tubes, for information regarding care of these please see the <> For children who have enteral feeding regimes at home: Speak with the family and child to establish normal feeding regimes and where possible, considering the reason for admission and clinical condition of the child, continue this regime in hospital, Ensure the medical team/dietitian have ordered the childs home feeding regime, Formula can be ordered from the Formula Room, Discuss feeding options with the family if the infant is usually breast fed, but cannot continue whilst hospitalised. Abrupt cessation of tube The position of the NG and NJ tube must be confirmed before tube feeding can commence. If it is safe to do so and the child is able to tolerate oral intake consider providing them with a drink and attempt aspirate in 15-30minutes, If no aspirate obtained, advance the tube by 1-2 cm and try aspirating again. Sutherland, A 2009, 'Guidelines on administration of medication via enteral feeding tubes', NHS. Stoma site = an opening from the outside of the body through the skin where the feeding tube enters into the stomach or the small intestine (jejunum). Policy: It is the policy of the facility to provide specific guidelines in regards to a closed system enteral feeding as directed by the physicians orders. 0 The CMS Interpretive Guidelines for Nasogastric tubes updates clarify expectations for long-term facility accountability in regards to use of feeding tubes; requiring that the The procedures must reflect current standards of practice, including but not limited to; types of medications that may be safely administered via a feeding tube; appropriate dosage forms; techniques to monitor and verify that the feeding tube is in the right location (e.g., stomach or small intestine, depending on the tube) before Despite this, doctors have misgivings about the removal of feeding tubes and feel that cessation of tube feeding can be a direct cause of death. endstream endobj startxref If you'll need a feeding tube for a month or less, your doctor may recommend inserting a tube through your nose and into your stomach (nasogastric tube) or your small intestine (nasojejunal tube). The purpose of flushing is to check for tube patency and prevent clogging of enteral tubes. Please note this guideline does not refer to the care of trans-anastomotic tube (TAT), these remain in-situ post-operatively and should not be removed or replaced. If the feeding tube has an external fixator, it is important to follow the advice that was given by the healthcare team. Risks and potential complications of a feeding tube placement include:Adverse reaction or problems related to sedation or medications such as an allergic reaction and problems with breathingBleeding of the surgical site or from the noseBlockage, movement, or displacement of the tubeInfectionInserting a feeding tube through the nose into the windpipe instead of the esophagusMore items To keep nurses up to date on the latest evidence-based practice, the American Association of Critical-Care Nurses recently updated its AACN Practice Alert, Initial Copyright 2022 JRY Hosting Services. Please seek urgent medical attention if you or the person you care for are experiencing any of the following symptoms within the first three days following your procedure: Glossary If reading greater than 5, cease the feed for 30 minutes, aspirate and test pH. inadequately crushed tablets, Small internal diameter of the tubes and longer tubes, Viscosity of some liquid preparation, Bacterial colonization of the nasogastric tube. The endoscope is inserted through the mouth and down the esophagus, which leads to Enteral feeds can be ordered from the RCH formula room. Coughing, vomiting and movement can move the tube out of the correct position.The position of the tube must be checked: Nursing staff should perform the following observations and obtain a gastric aspirate to establish tube position. If unable to sit up for a bolus feed or if receiving continuous feeding, the head of the bed should be elevated 30-45 degrees during feeding and for at least 30 minutes after the feed to reduce the risk of aspiration. This may be attached to the end of a 5 or 10mL enteral/oral syringe with the plunger removed to create a reservoir should gastric contents reflux. Routinely flush feeding tube with water, preferably sterile water. To return or to discard? endobj Australian College of Critical Care Nurses, 23, pg 215-217.. 1. Not all the procedure mentioned above require a general anaesthetic. The procedure for the feeding tube placement depends on the type of tube that has been recommended by the healthcare team. Nurses who are preparing and administrating medication via an enteral tube must adhere to theMedication Management Procedure.. Enteral feeding refers to the delivery of a nutritionally complete feed via an enteral tube directly into the stomach, duodenum or jejunum and includes nasogastric tubes (NGT), nasojejunal tubes (NJTs), percutaneous endoscopic gastrostomies (PEGs), and percutaneous endoscopic jejunostomies (PEJs). immunocompromised patients, Enteral tubes should be flushed with between 5 20mls of water depending on the viscosity of the feed/medication, the childs fluid status balance and the childs size (The minimum volume required to clear the tube is 2mls. EFFECTIVITY DATE PAGE NO. This will allow fluid to accumulate in the stomach and try aspirating again. Remove and replace the tube. Utilising pH indicator strips a reading of between 0-5 should be obtained and documented., Turn the patient onto their side. If a child belches immediately following air insufflation, the tip of the tube may be in the oesophagus. sorbitol can cause diarrhoea). dressing to remain in contact with the skin. Get The Best Streaming Servers For Media Streaming & Unlimited Bandwidth Upto 1GBPS, Buy The Best VPS Plan Which Suits Your Needs, Select The Best AMD Ryzen Servers - Perfect For Gaming & Media Streaming - Less Than 24 Hours Delivery, Chose the Best Dedicated Server & Customize the Servers - DMCA Free Dedicated Servers, Get The Dedicated Servers For Gaming,Business & Capable Bandwidth Upto 1GBPS Network Port, Get The Dedicated Servers For Media Streaming & Unlimited Bandwidth Upto 40 GBPS Network Port, Buy The Storage Dedicated Servers For VOD's & Movies, Secure your domain name by registering it today, Transfer now to extend your domain by 1 year. F. (2012). JRY Hosting Services, 100 Mason Road, Texas, USA. endstream endobj startxref No, I am not a healthcare proffesional (exit this section), A support group for people receiving artificial nutrition, A support group for young people receiving artificial nutrition. These tubes are more visible than a gastrostomy or a jejunostomy and their placement may cause some discomfort. Contact the medical team and/or Gastroenterology Clinical Nurse Consultant to review., Clinical Nutrition Manual, Enteral Nutrition Administration tube feeds, Nutricia Advanced Medical Nutrition, June 2008. Check the drip rate regularly to ensure the feed is still running at the required rate. The healthcare team will discuss and explain the procedure and ask you to sign a consent form. Open the roller clamp and set the flow rate by counting the drops per minute. It is important to follow the advice that was given by the healthcare team. If the patient is receiving a medication which is known to alter pH readings notify medical team, pharmacy and senior nursing staff, a clear plan for confirming the tubes position should be documented in the progress notes. When titrating a feed down nursing staff should document why the feed was titrated down, notify dietician and/or medical team to inform them that the child is not tolerating feeds and make a plan to ensure the child is still receiving adequate nutrition and hydration. Determination of a practical pH cutoff level for reliable confirmation of nasogastric tube placement, 35(4), pg 540-544. Elevate the head of the bed to a 30 - 45 degree angle during enteral feeding and for 30-60 minutes after completion. Prior to and after feeds nurses should adequately flush the enteral tube. Feeds should be titrated up in a slow but steady manner, which may need to be adjusted if the child is not able to tolerate the rate/volume of feed. Please note there is no evidence to support the practice of using carbonated drinks such as Coca Cola to unblock enteral tubes. <> Gastrostomy tubes should be reinserted and taped into position if the balloon has burst. If the TAT is dislodged inadvertently, immediately notify the neonatal and surgical teams. Use a syringe in the side tap of your feeding tube. Published December 2017., 50 Flemington Road Parkville Victoria 3052 Australia, Site Map | Copyright | Terms and Conditions, A great children's hospital, leading the way, Nasogastric and Orogastric Tube Insertion policy, P&P: Standard Precautions Infection Control, Nasogastric and Orogastric Tube Insertion procedure, High Flow Nasal Prong (HFNP) therapy clinical guideline, Enteral Nutrition for Preterm Infants guideline, Breastfeeding support and promotion clinical guideline, Nasogastric and Orogastric Tube Insertion Procedure, Enteral Feeding and Medication Administration, Facial or oesophageal structural abnormalities, Administer bolus, intermittent feeds and continuous feeds, Facilitate free drainage and aspiration of the stomach contents, Facilitate venting/decompression of the stomach. When the healthcare team is satisfied with the progress made, feeding will start through the new tube for the first time. Liquid formulations may inappropriate in some patients (e.g. manufactures instructions. The method selected is dependent of the nature of the feed and clinical status of the child. Infinity pumps are now in use throughout RCH and the giving set can be primed by pushing the fill set button. Port. Nurses should consider titrating feeds down or ceasing feeds for a short period of time depending on the clinical status and nutritional needs of the child. Special Edition - Streaming Servers - US/UK, AMD Ryzen - 1 GBPS - Super Dedicated Servers, DMCA - UKR - Dedicated Servers - 1GBPS To 10GBPS Port Speed, Metered Servers - Limited Speed - Upto 1GBPS, Unmetered Media Servers - Upto 10 GBPS | 40 GBPS. There is limited evidence available to support one method of feeding over the other. This the carbohydrate content may be too high for patients on a ketogenic diet). Pediatric enteric feeding techniques: insertion, maintenance, and management of problems, Cardiovascular Intervention Radiology, 33, pg 1101-1110. Feeds should NOT be warmed in a microwave or in jugs of boiling water. Rinsed out with warm water (tap or sterile). You or the person you care about will be discharged home when feeding is established and well tolerated. TUBE FEEDING -- CLOSED SYSTEM. 256 0 obj <>/Filter/FlateDecode/ID[<94BAF902F154334DB17A9829D25E9268><57FB7909F893334DBF8936FCB5105F9D>]/Index[225 60]/Info 224 0 R/Length 137/Prev 171340/Root 226 0 R/Size 285/Type/XRef/W[1 3 1]>>stream care information, essential policies and procedures, and vital regulatory and safety requirements. 307 0 obj <>/Filter/FlateDecode/ID[<707B69DC27CEE545A2FA790D07768142><54D501EFB3241F4FB8B623AC7BA02FE1>]/Index[282 42]/Info 281 0 R/Length 117/Prev 178856/Root 283 0 R/Size 324/Type/XRef/W[1 3 1]>>stream Do not administer drugs through tubes used for aspiration or on free drainage unless specifically directed by medical staff. Squeeze the drip chamber and fill half way. Options may include: Feeding tube passed through the nose. B. Tube placement for feeding should optimally be performed during daytime hours when care can be escalated to more senior personnel if attempts are unsuccessful or complications Holding the syringe and enteral tube straight, pour the prescribed amount of feed into the syringe. Small-bore tubes can be difficult to aspirate therefore the following are suggested techniques to try enhance the ability to obtain aspirate: Correct placement of the tube should be confirmed prior to administration of an enteral feed by checking insertion site at the abdominal wall and observing the child for abdominal pain or discomfort. White R., Bradnam V., Handbook of Drug Administration via Enteral Feeding Tubes, Pharmaceutical Press 2007, Wilkes-Holmes, C 2006,' Safe placement of nasogastric tubes in children', Paediatric Nursing , vol.18 issue 9, pp. The healthcare team will advise you on the estimated length of stay and post-operative feeding regime for you or the person you care for's individual circumstances. The site of the gastrostomy/jejunostomy may look a little red and ooze a bit, but this will settle down a few days after the operation. CONSIDERATIONS REGARDING THE USE OF FEEDING TUBES . Please Endoscope = a slender tube used to examine the inner part of the body with an attached instrument for biopsy or surgery. Enteral feeding tubes should be flushed regularly with water (or sterile water if appropriate): Nurses should prepare an enteral/oral syringe, enteral tube connector and water for a flush. You or the person you care for will be discharged home when feeding is established and well tolerated. That you are a healthcare professional and are following the appropriate guidance in your country. This may move the tube away from the wall of the stomach. This will allow the tip of the tube to move to a position where fluid has accumulate, Using a 10-20ml oral/enteral syringe (5-10 ml in neonates) insufflate 1-5ml of air (1-2 ml in neonates) into the tube. Routinely flush feeding tube with water, preferably sterile water. If reading greater than 5, cease the feed for Turn off enteral feeding 1 hour before the individual needs to be repositioned at less than 30 degrees. 775 0 obj <> endobj Prior to accessing a NGT/OGT for any reason nursing staff members must ensure that the tube is located in the stomach. hb```\B ce`a054cJG;5JLM' Zj=,ELdR?o1=a)^oj 8.1|TWx@b`}xf .< High acuity and intensive care patients may require management of Gastric Residual Volumes (GRV) to assist in management of gastric emptying delays, feeding intolerance, electrolyte balance and patient comfort. Let it flow slowly through the tube e.g. Feeds given as a bolus may be warmed in an approved bottle warmer. Blood samples may be taken to check if you're well enough before the operation. EFFECTIVE DATE : June 30, 2020 . 814 0 obj <>stream Continuous feeds should NOT be warmed. Policies & Procedures: Enteral Tube Feeding -Adult I.D. %PDF-1.5 % x oa`yCOvKoE9>L@MR7.l#ulhhc2LYS aLU Only prime the giving set with formula immediately prior to feeding time. Tube feeding is Liquid formulations are usually preferred for enteral tube administration, unless the formulation contains other ingredients that could cause unwanted side-effects (e.g. 1. If a reading greater than 5 is obtained leave for up to 1 hour and try aspirating again. 1 0 obj 2 0 obj Caution should be taken if titrating feeds up and down in patients with a metabolic condition. Procedure Details. %PDF-1.5 % Metropolitan working party: 2007,' Enteral tubes: Enteral feeding management best practice'. Attach the tip of the giving set tube to your feeding tube Turn on pump and set rate Give the prescribed water flush, every four hours. The stoma site in the stomach/jejunum is then stitched closed around the tube. %%EOF Gastric residual volumes in critically ill paediatric patients: A comparison of feeding regimens, Australian Critical Care, 17(3),pg 98-103.
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