How To Care For A Feeding Tube
Why does my child need a nasogastric tube inserted?
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.
- Cup of water
- Feeding tube
- 6 cc syringe
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
What do I need to know about my child's gastrostomy
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.
- Soap and water
- Cotton swabs
- Hydrogen peroxide (H2O2)
- Clean gauze pads
- Catheter tip syringe
- 20 cc's water for flushing
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.
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.
- If medicines are liquid, mix them with warm water to make about 10-20 cc's (about 1 tablespoon) and slowly push them into the tube with the large catheter-tip syringe. Then slowly flush the tube with about 20 cc's of warm tap water.
- For pills, (check with your child's doctor first before crushing medications) crush the medicine into a powder and mix with about 10-20 cc's of warm water. For capsules, open and dissolve powder in 10-20 cc's of warm water. Using the syringe, slowly push the medicine through the tube, then flush the tube with about 20 cc's of tap water.
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
- Do not allow your child to pull on the tube. Keep the child's T-shirt over the tube. One-piece, snap T-shirts work best for infants and toddlers. Most children get used to the tube after awhile, but until they do, they may need to wear elbow splints to keep them from pulling at the tube. Ask your child's doctor about obtaining a splint if necessary.
- Be sure to keep the end of the tube closed (either plugged or, if ordered, connected to drainage bag) to keep the tube from leaking.
was pulled out.
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.
be caused by leakage or infection.
routine care and contact your child's doctor.
dressing frequently. Call your child's doctor.
of tissue because of movement of tube in tract.
your child's doctor. May need to schedule follow-up appointment. Secure
tube with tape so that excess movement does not occur.
formulas or medication.
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.
- Be sure to kink the tubing before removing the cap or disconnecting a syringe to prevent backflow.
- If your child has a balloon catheter-type tube, check for level of tube placement every day. If the length of the tube seems less than normal, call your child's doctor.
- It is important to allow your infant to have pleasant sensations during feeding. This can be done by allowing him/her to suck on a pacifier during the feeding and by talking to and allowing him/her to face you during the feeding. You may also hold your child at this time.
- Always call your child's doctor if you have questions or problems.
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