Gavage Feeding Rep

Gavage feeding
PURPOSE: To pass a feeding tube through the nasopharynx, or oropharynx, as ordered by the physician, for the infant who is unable to suck because of prematurity, illness or congenital deformity such as cleft palate. A gavage tube is indicated for the infant who risks aspiration because of gastro-esophageal reflux or lack of gag reflex or because he/she tires easily, including cardiac or breathing problems. OBJECTIVE: To safely administer orogastric or nasogastric feedings to infants. EQUIPMENT: NOTE: All tubing and syringes for feedings have an orange stripe to identify them. Only use this equipment when delivering feeds.
Assemble the following:
1. Feeding tube (#5 or #6.5 French for feeding premature infant; #6.5 or #8 French for others); 2. Syringes: 3ml, 6ml, 12ml, 20ml, 35ml, 60ml, depending on feeding volume; 3. Prescribed formula or breast milk; 4. Sterile water 5. Stethoscope and 6. Pacifier PROCEDURE: 1. Formula or breast milk may be warmed in a warm water bath. Place the milk container in a clean baggie to avoid getting the patient label wet. 2. Wash hands thoroughly. 3. Remove 3ml syringe from reservoir and open sterile water and feeding tube package. 4. Measure from tip of infants nose to mid-ear to tip of the breast bone with catheter to determine the length needed to ensure placement. Note the marking on tube at the appropriate distance. 5. Place the infant in a supine position or tilted slightly to the right, with head of the bed slightly elevated. Checking tube position Feeding 7. Stabilize the infants head with one hand and lubricate the feeding tube with sterile water with the other hand. 8. Insert the tube smoothly and quickly up to the
premeasured mark. For oral insertion, pass the tube toward the back of the throat. For nasal insertion, pass the tube toward the occiput in a horizontal plane. 9. Synchronize tube insertion with throat movement as the infant swallows to facilitate its passage into the stomach. During insertion, watch for choking and cyanosis, signs that the tube has entered the trachea. If these occur, remove the tube and reinsert it. Also, watch for apnea and bradycardia resulting from vagal stimulation. If bradycardia occurs, leave the tube in place for 30 seconds while checking for return to normal heart rate. If bradycardia persists, remove the tube and notify MD. 10. If the tube is to remain in place, secure it flat to the infants face (cheek or chin). To prevent possible nasal skin breakdown, do not secure the tube to the bridge of the infants nose. 11. Connect syringe to feeding tube. Place stethoscope over infants stomach and rapidly inject 1-2 mL of air. Listen for the whoosh of air and withdraw air injected. 12. Check the tube is in the stomach by slowly aspirating residual stomach contents with the syringe. Note the volume obtained, and then slowly return aspirate to avoid altering the infants buffer system and electrolyte balance unless otherwise ordered. If ordered, reduce the volume of the feeding by the residual amount, or prolong the
interval between feedings. If more than half of the previous feed, consult physician 13. If the tube does not appear to be in place, insert it 1 to 2 cm further and test again. DO NOT begin feeding until you are sure the tube is positioned properly. 14. When the tube is in place and secured, connect the tubing to the syringe with the prescribed formula or breast milk. To initiate gravity flow, gently advance the plunger into top of syringe and remove plunger. 15. If the infant is sitting on your lap, hold the container 4 inches (10cm) above his abdomen. If he/shes lying down, hold it 6 to 8 inches (15 to 20cm) above his/her head.
Removing tube Mouth care 16. Regulate flow by raising and lowering the container so that the feeding takes 15 to 20 minutes, the average time of a bottle feeding (2-3 mL/minute). To prevent stomach distention, reflux and/or vomiting, do not let the feeding proceed too rapidly. 17. When the feeding is finished, pinch off the tubing before air enters the infants stomach to prevent distention and to avoid leakage of fluid into the pharynx during removal with possible aspiration. Then, if ordered, withdraw the tube smoothly and quickly.
18. Otherwise, the tube is to remain in place, flush it with 1 to 2 ml of sterile water place cap over end of tube. 19. Place on abdomen or right side for one hour after feeding, to facilitate gastric emptying and to prevent aspiration. 20. Tube position must be checked before each feed. 21. Pinch tube closed and pulls it out quickly. 22. If tube is used for intermittent feeding, infant may need to be burped. 23. it may be necessary to clean babys nose and mouth with warm water POINTS OF EMPHASIS: 1. Use nasogastric approach for indwelling feeding tube. It is more stable than orogastric insertion. However, nonintubated infants exhibiting mild respiratory distress should be fed via orogastric rather than nasogastric because infants are obligate nose breathers. 2. Alternate the nostril used at each insertion to prevent skin and mucosal irritation. 3. Observe for indication of readiness to begin bottle-feeding at 32-34 weeks. Utilize criteria for initiating breast/nippling attempts. Document results of first eight feeding attempts on this population only (unless otherwise indicated). 4. Provide a pacifier during feeding to relax infant, prevent gagging and to promote an association between sucking and the feeling of fullness that follows feeding. 5. For nasal placement, the tube is rotated each nares each time it is changed.
qProblems/hazards: 1. Regurgitation may cause loss of nutrients. a. Stop feed and allow to rest 2. If regurgitation occurs, do not count the emesis amount in final volume fed. 3. Indwelling nasogastric tube can cause: a. Nasal airway obstruction. b. Irritation of skin or mucous membranes. c. Epistaxis (bleeding) d. Stomach perforation. 4. A feeding tube may kink, coil, know or become obstructed. a. Remove tube and reinsert 5. Bloody or green tinged residuals a. Remove tube and inform physician 6. Infants spits, gags or becomes restless, pinch tube, stop feed and allow to rest until recovered. DOCUMENTATION: Document under intake and output.

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