4. 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. 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. 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. Lying prone/supine during feeding increases the risk of aspiration and therefore where clinically possible the child should be placed in an upright position. Elevate the head of the bed to a 30 - 45 degree angle during enteral feeding and for 30-60 minutes after completion. 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 The position of the tube needs to be checked 4 hourly with change of feeds It is recommended that the feed be ceased, withdraw aspirate and test pH. Feeding tube passed through the skin on your abdomen. 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 The set should be changed every 24 hours or as per manufactures instructions. For older children feeds given as a bolus should be removed from the fridge 15-20 minutes before administration to bring them to room temperature. 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. hb```\B ce`a054cJG;5JLM' Zj=,ELdR?o1=a)^oj 8.1|TWx@b`}xf .< Surgically: The gastrostomy or jejunostomy tubes can also be placed surgically. 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 If the feeding tube is placed using general anesthesia 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. 105 issue16, pp.12-13. hbbd```b``3@$ ~&c@$60VfHF]`q~0[,"g I 6?d\Q ,Rv)XLI b&j)@  The regulations at 483.25(g) require that the residents clinical condition demonstrates the use of a feeding tube to be <> Dislodgement of a Gastrostomy tube - Stop the feed/medication administration immediately. Routinely flush feeding tube with water, preferably sterile water. Peter, S Gill, F 2009,' Development of a clinical practice guideline for testing nasogastric tube placement'. 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. <> SCOPE X Professional _ Facility DESCRIPTION Enteral Nutrition is commonly defined as the provision of nutritional requirements through a tube in the stomach TUBE FEEDING -- CLOSED SYSTEM. The tube must be flushed with water (air in neonates) to prevent tube from blocking (see above). Nasogastric and Orogastric Tube Insertion procedure (RCH only.) endstream endobj 283 0 obj <. Gastrostomy and jejunostomy tubes require a procedure or surgery for placement where a stoma site is formed. Long-term enteral feedings (> 3 months) are best administered by a Consult your ward pharmacist or call Medicines Information (ext: 55208) for advice on how to prepare a drug for enteral administration. 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. 3 0 obj Clean skin around the feeding tube stoma daily. Accidental removal of a Gastrostomy tube tube needs to be reinserted as soon as possible to prevent stoma closure. Please The endoscope is inserted through the mouth and down the esophagus, which leads to This medical policy is solely for guiding medical necessity and explaining correct procedure reporting used to assist in making coverage decisions and administering benefits. Feeding tubes may be used to facilitate venting or decompression of the stomach from the accumulation of air during such interventions as High Flow Nasal Prongs, Non-Invasive or Invasive Ventilation. Enteral feeding or administration of medication may proceed in this case dependent on the individual childs condition, The tube may be clamped for 30 minutes to an hour post administration to prevent loss of feed or medication, Continuous venting may be facilitated following administration by securing the distal end of the tube above the head of the child. During Continuous feeds Nasogastric/Orogastric Tube: 1. The position of the tube needs to be checked 4 hourly with change of feeds. After the insertion/placement of the tube. If Liquid formulations may inappropriate in some patients (e.g. The position of the NG and NJ tube must be confirmed before tube feeding can commence. Jejunal Feeding Guideline. %%EOF medication administration for ALL patients of ALL age groups. Tube Feedings/Enteral Nutrition (Adult) A. Pediatric enteric feeding techniques: insertion, maintenance, and management of problems, Cardiovascular Intervention Radiology, 33, pg 1101-1110. Metropolitan working party: 2007,' Enteral tubes: Enteral feeding management best practice'. The content in this section is only intended for healthcare professionals. This usually takes three to five days, but may be longer depending on the individual condition and confidence with the tube feeding process. Phillips, N M., & Endacott, R., 2011. If the nurse is unsure regarding the position of the gastrostomy endstream endobj 226 0 obj <. %PDF-1.5 % A feeding tube is required for people who are unable to eat, or are unable to eat enough to meet their nutritional needs. CONSIDERATIONS REGARDING THE USE OF FEEDING TUBES . Gilbertson, H., Rogers, E., & Ukoumunne, O., 2011. When the healthcare team is satisfied with the progress made, feeding will start through the new tube for the first time. - j80b!yQ#-l >c`,b PV`` l@* 4 ?C If reading greater than 5, cease the feed for 30 minutes, aspirate and test pH. Infinity pumps are now in use throughout RCH and the giving set can be primed by pushing the fill set button. Turn off enteral feeding 1 hour before the individual needs to be repositioned at less than 30 degrees. If the feeding tube has an external fixator, it is important to follow the advice that was given by the healthcare team. short-term methods (<3 months) of enteral tube feedings include nasogastric, nasoduodenal or nasojejunal tubes. This guideline will use this term describe Orogastric, Nasogastric and Gastrostomy tube feeding. Datford and Gravesham, ' Paediatric enteral feeding guidelines & operational policy (infants & children)', Jan 2007, NHS Trust. This Attach the syringe to your feeding tube or button adapter, if youre using one. Attach the syringe filled with 60 mL of water to your feeding tube. Close the plug or reattach the cap at the end of your feeding tube. After taking the medication (s), pull the syringe apart and wash all of the equipment with warm water. Tube feeding is now legally regarded as medical treatment. 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. The procedure is performed as a means of providing nutrition to patients who cannot take food by mouth. <>/Metadata 5021 0 R/ViewerPreferences 5022 0 R>> Should there be any dispute as to the position of the tube, do not recommence feeds. %PDF-1.5 % # 1020 Page 4 of 12 . Juve-Udina, M. Valls-Miro, C., Carreno-Granero, A., Martinez-Estralella, G., Monterde-Prat, D., Domingo-Felici, C., & Llusa-Finestres, G., 2009. 225 0 obj <> endobj Observe child for any signs of respiratory distress, Enteral/oral syringe 5ml 20ml for aspiration; , Attach a 10-20ml oral/enteral syringe to the enteral tube in the infant/child, Attach a 5-10ml oral/enteral syringe to the enteral tube in a neonate. Insertion of a nasogastric (NG) tube takes five to 10 minutes and generally involves these steps: Your provider will numb your throat with a spray that contains a local anesthetic. Procedure Details. When preparing to administer feeds nursing staff must confirm the position of the enteral tube. Use the following equation or the table below to calculate the drip rate: (ml/hour) /3 = drops/minute. The surgeon will use the endoscope to place the feeding tube in the stomach and secure it in place. Consider providing education regarding expressed breast milk (. If you receive a continuous feeding, flush the tube and the extension set tubing at least three times daily. 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. The purpose of flushing is to check for tube patency and prevent clogging of enteral tubes. Observe and document the position marker on NGT/OGT compare to initial measurements. 3. Things to consider: Be sure to take steps to ensure patient privacy when performing procedure. Remove the cap from the distal end of the tubing. Squeeze the drip chamber and fill half way. Endoscopy: The gastrostomy tube can be inserted using an endoscope. 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. Aspirate minimum 0.5 - 1ml of gastric content (or sufficient amount to enable pH testing). After the procedure you will be given advice by the healthcare team and they will explain how long you or the person you care for might have to stay in hospital. Link for insertion of Nasogastric and Orogastric Tube Insertion policy, Nutrition on PICU Guidelines and Jejunal Feeding Guideline. Policies & Procedures: Enteral Tube Feeding -Adult I.D. Open and close the roller clamp until the desired drip rate is set correctly. Horn, D., Chaboyer W., & Schluter, P., 2004. 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. JRY Hosting Services, 100 Mason Road, Texas, USA. Evidence Table - Discuss with senior nursing staff or medical staff. hb```&[B General anaesthetic = medications used to cause a loss of consciousness so a patient is unaware of surgery. Medication administration via enteral tubes: a survey of nurses practices, Journal of Advanced Nursing, 67(12), 2586-2592.

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