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                       How To Care For A Feeding Tube

 

                  

Why does my child need a nasogastric tube inserted?  


Nasogastric Feeding Tube Insertion

Because your child cannot eat by mouth or requires extra calories to grow, you will be feeding your child through a nasogastric tube that is placed through the nose into the stomach. The word "nasogastric" comes from the combination of the Latin root words for nose (nas) and stomach (gastr). A nasogastric tube is commonly called an "NG tube." These instructions will help you place the tube.

Supplies

Inserting the tube

1.       Wash your hands with soap and water after assembling all supplies.

2.       Have your child sit on the side of the bed or on a chair. If your child is unable to sit, have him/her lie down on his/her back with arms raised above the head.

3.       Measure the tube from the tip of the nose to the ear lobe, then down to the breast bone which is located in the middle of the chest (Figure 1). Mark this point on the tube with a piece of tape. This length will allow the tube to go into the stomach.

4.       Lubricate the tube by dipping it in water or by applying water-soluble lubricant to the tube. Do not use gels or petroleum jelly (such as Vaseline®) because of the danger of the material getting into the lungs and/or clogging the feeding tube.

5.       Insert the tube through the nostril until you reach the marked point. Small sips of water may be given to your child while passing the tube to help him/her swallow.

6.       Withdraw the tube immediately if your child's color becomes blue or he/she develops breathing problems. These are signs that the tube may be in the lungs and not the stomach.

7.       When the tube is properly placed, tape the tube to your child's nose and face, being careful not to block the nostril.

8.       Always confirm the proper location of the tube before starting the feeding.

o        To check the location of the feeding tube, place a stethoscope over the stomach.

o        With a syringe, quickly insert 3-5 cc's of air into the tube while listening with the stethoscope for a "pop." The "pop" represents air rushing into the stomach.

o        The feeding should not be started if a "pop" is not heard and the tube is not in the stomach. If the tube is not in the stomach, remove it and try to place it again.

9.       Once establishing that the tube is in the stomach, the tube is ready to be used for feeding.

10.   If the feeding is not begun immediately, use the adaptor to cover the end of the tube until it is time to begin the feeding.

11.   The tube should be checked again before feeding is started to assure that it is still in the stomach.

Removing the tube

1.       Pinch the feeding tube with your thumb and forefinger when removing the tube. This prevents formula from flowing into your child's lungs.

2.       After removing the tube, rinse it with warm tap water while observing for leaks.

Note: Always wash your hands before and after handling the tube

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                   What do I need to know about my child's gastrostomy tube?


A gastrostomy tube -- commonly abbreviated as "g-tube" -- is a tube that is placed into your child's stomach. The word "gastrostomy" comes from two Latin root words for "stomach" (gastr) and "new opening" (stomy). This tube is used to vent your child's stomach for air or drainage, and/or to give your child an alternate way for feeding.

When the tube is first placed in your child's stomach it must be secured with a stitch through the skin and around the tube. This helps the tube stay in place until the gastrostomy tract is well healed. The healing takes about 21 days. After this time a natural tract is secure between the stomach and skin.

During this time a 2x2 gauze is placed around the tube to absorb any drainage from the site. Over the gauze is an infant nipple with the top cut off and holes cut around base to allow air at the site. The nipple prevents tension and kinking of the tube.

The gauze is taped to the skin. The nipple is taped to the gauze dressing and tape is secured where the tube and nipple meet. Keeping the tube anchored keeps your child comfortable and allows the tract to heal.

Supplies

Procedure

Cleaning and dressing the wound

1.       Wash your hands with soap and water.

2.       Remove the old dressing. Look at the area where the tube enters the skin. Check for redness, swelling, green or yellow liquid drainage, or excess skin growing around the tube. A small amount of clear or tan liquid drainage is normal.

3.       Clean the skin around the tube using a cotton swab dipped in half-strength hydrogen peroxide (1 tablespoon H2O2 mixed with 1 tablespoon water). Roll the cotton swab around the g-tube to remove any drainage and/or crusting at the tube. Use a clean cotton swab and clean skin away from the tube. Clean around the suture gently.

4.       Redress with a slit 2x2 gauze, nipple and tape. You may anchor the end of the tube by putting a piece of tape around the tube and pinning it to a folded piece of tape on his/her stomach, or pinning it to his/her diaper or T-shirt.

5.       After the first 3 weeks, cleaning may be done with soap and water. If irritation occurs, begin using the half-strength hydrogen peroxide. The site should be kept clean and dry. Do not use ointments around the tube site unless directed by your child's doctor.

Flushing the g-tube

Use a large catheter-tip or bulb syringe and slowly push 15-20 cc's of warm clean tap water into the tube. Flush the tube after every feeding and after all medications are given to keep the tube open and clean.

Giving medication or feeding

Before feeding or giving medication, check to make sure the tube is clear. Check for placement by attaching a syringe to the tube and pulling back to check for gastric secretions or air. Then slowly push 10 cc's of warm water through the tube.

Giving medicines

Venting the tube

You may need to vent -- remove excess air or fluid from -- your child's g-tube. Your child's doctor will tell you if this is needed. Following are two ways to vent your child's g-tube.

1.       Attaching the g-tube to a drainage device, such as a mucus trap or drainage bag, will provide constant venting. A Sims connector (cut at the third ridge of the long end) will fit the g-tube and drainage tube together.

2.       To vent the tube as needed, you may connect a catheter-tip syringe to the g-tube to aspirate the excess air or gastric fluid from the stomach. Use this method for bloating, distension or gagging. If this is a repeated need, contact your child's doctor.

Protecting the tube

Problem solving

Problems

Causes

Solutions

G-tube was pulled out.

G-tube was pulled out.

Cover the opening with clean dressing and tape, then call your child's doctor. The g-tube needs to be put in as soon as possible (within 4 hours) so the tract will not close.

Redness and irritation around the stomach, soreness, and foul odor present.

May be caused by leakage or infection.

Continue routine care and contact your child's doctor.

Large amount of leakage of fluid or mucus-like liquid present (large amounts = soaks a 4x4 gauze 3 or more times a day).

Stretching of tract.

Change dressing frequently. Call your child's doctor.

Skin or scar appears to be growing where tube enters skin. May have rosebud appearance.

Overgrowth of tissue because of movement of tube in tract.

Call your child's doctor. May need to schedule follow-up appointment. Secure tube with tape so that excess movement does not occur.

G-tube is clogged.

Thick formulas or medication.

Try to slowly push warm water into the tube with a 12 cc regular-tip syringe. Never try to push any object into the tube to unclog it. If you are unable to unclog the tube call your child's doctor.

Tips

 

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