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Health’s Intranet, ‘The Wave.’ Any copies of this document appearing in paper form should
ALWAYS be checked against the electronic version prior to use.
Preamble:
Definitions:
Nasogastric Tube or (NGT): a polyethylene or weighted enteral silastic feeding tube that
is inserted into the nares and passed through to the stomach for the purpose of stomach
decompression, feeding, or medication administration.
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accepts no responsibility for use of this material by any person or organization not associated with Lakeridge Health. No
part of this document may be reproduced in any form for publication without the permission of Lakeridge Health.
NICU—Enteral Tubes for Feeding or Drainage Care Guidelines
Guidelines:
a) Initiation and Maintenance Guidelines:
Insertion, position verification, tube utilization, and removal of a Nasogastric Tube
(NGT) or Orogastric Tube (OGT) will be performed by a Registered Nurse.
Larger size enteral feeding tubes will be utilized for gastric drainage or
decompression (i.e. 8Fr) (AHA/CPS/AAP, 2006; PPPESO, 2008).
Utilization of enteral tubes for infants with certain conditions (i.e. facial or
tracheoesophageal congenital anomalies) will be done cautiously and in
consultation with a physician (AWHONN, 2006).
Polyvinyl Chloride (PVC) tubes will be routinely changed every 72 hours—
alternating nares as possible (PPPESO, 2008).
Weighted enteral feeding tubes will be changed every 4 to 6 weeks or by order of
the physician (PPPESO, 2008).
Tube placement verification frequency recommendations (PPPESO, 2008; PPPESO,
2008b):
o Intermittent feeds: after tube insertion and prior to beginning each feed
o Continuous feeds: after tube insertion and every four hours
o Medication administration: after tube insertions, prior to medication
administration, prior to tube irrigation, or prior to any fluid instillation
Tube placement will completed by(PPPESO, 2008; PPPESO, 2008b):
o Measurement of enteral tube via centimeter marking are nares OR
measurement of tube from nares to end of tube (if no centimeter marking
available)
o Auscultation of gastric ‘pop’ prior to EACH feeding
o Gastric pH testing and assessment of gastric aspirate after insertion, prior
to the first feeding session of a shift, and as needed for the duration of the
shift based on nursing assessment
o Weighted enteral feeding tube placement will be verified via x-ray
confirmation
A registered nurse will remain present throughout the enteral feeding session
(Merenstein & Gardner, 1993; PPPESO, 2008b).
An infant receiving enteral feedings will have a functional suctioning system and
emergency oxygen with a bag-mask set up at their bedside.
Infants being continuously monitored will have monitors ON with audible alarms
set for duration of feeding to support assessment of tolerance and potential signs
b) Equipment:
1. Sterile feeding tube of appropriate size (Merenstein & Gardner, 1993;
PPPESO, 2008)
5 Fr tube utilized for infants less than 1500 kgs
6 Fr tube utilized for infants greater than 1501 kgs
8 Fr tube utilized for gastric drainage or decompression
2. Clear, non-allergenic tape, transparent semi-permeable membrane
dressing, or other (i.e. Hypafix or Mepore)
3. 10 mL syringe
4. Non-sterile procedure gloves
5. Stethoscope
6. Measuring Tape
7. pH testing stripes
8. Water based lubricant or sterile water
9. Feeding system set-up (syringe, feeding bag, extension tubing, and/or
syringe/feeding pump)
c) Insertion Procedure:
Lakeridge Health Corporation Page 4 of 12
NICU—Enteral Tubes for Feeding or Drainage Care Guidelines
Respources:
Refer to Wong’s Nursing Care of Infants and Children, page 1133-1134 for
detailed procedure:
Hockenberry, M. J., & Wilson, D., (2007). Wong’s Nursing Care of Infants
and Children. Mosby Elsevier: St. Louis, Missouri.
b. Continuous Feeds:
Turn feeding pump off and detach feeding tube
Attach syringe to feeding tube and inject 1-3 mL of air to clear
tube
Apply gentle suction and withdraw approximately 1 mL of
gastric contents
Apply gastric contents on pH testing strip—ensure saturation of
testing square—remove excess fluid by placing strip on its side
—test pad may take up to 10 minutes for complete colour
change
e) Feeding:
1. Assemble equipment
Sterile syringe of appropriate size for feed
Expressed breast milk or formula
Sterile water
Feeding or syringe pump and extension tubing as required
4. Feeding Administration
g) Tube Removal (Cloherty & Stark, 1991; Merenstein & Gardner, 1993; PPPESO, 2008):
1. Obtain equipment as necessary
2. Explain procedure to parents if present
3. Position infant prone or lateral
4. Loosen tapes
5. Pinch tubing while withdrawing tube in a steady motion
6. Complete nasal and/or mouth care as required
h) Documentation:
• As per Lakeridge Health Corporation Documentation Standards.
References:
American Heart Association (AHA), Canadian Paediatric Society (CPS), & American
Academy of Pediatrics (AAP). (2006). Neonatal Resuscitation Textbook. 5th Edition.
Canadian Paediatric Society: Ottawa, ON.
American Academy of Pediatrics (AAP) & American Heart Association (AHA). (2005).
Pediatric Advanced Life Support Professional Provider Manual. 5th Edition. American Heart
Association: Dallas, Texas.
Boiron, M, Da Nobrega, L., Roux, S., Henrot, A., & Saliba, E., (2007). Effects of oral
stimulation and oral support on non-nutritive sucking and feeding performance in
preterm infants. Developmental Medicine & Child Neurology. 49(6), 439-444.
Hockenberry, M. J., & Wilson, D., (2007). Wong’s Nursing Care of Infants and Children.
Mosby Elsevier: St. Louis, Missouri.
Kirk, A. T., Alder, S. C., & King, J. D., (2007). Cue-based oral feeding clinical pathway
results in earlier attainment of full oral feeding in premature infants. Journal of
Perinatology. 2007(27), 572-578.
May, S., (2007). Testing nasogastric tube positioning in critically ill: exploring the
evidence. British Journal of Nursing. 16(7), 414-418.
Merenstein, G. B. & Gardner, S. L., (1993). Handbook of Neonatal Intensive Care. 3rd
Edition. Mosby Year Book: St. Louis, USA.