HOW TO: insert a Nasogastric or Orogastric feeding tube - Tala Talks NICU

[@tamiwallace9881]

Recent literature suggests that auscultation for air is not sufficient for assessing placement in the newborn.

[@TalaTalksNICU]

Absolutely right- auscultation is not perfect. And at some point an Xray would be recommended. But repeating that each time an NG were replaced would be unrealistic. What do you do in your NICU?

[@tamiwallace9881]

@@TalaTalksNICU Parker, Leslie A. PhD, ARNP (NNP-BC); Withers, Jessica H. MSN, RN, RNC-NIC; Talaga, Elizabeth MSN, ARNP, RNC-NIC Comparison of Neonatal Nursing Practices for Determining Feeding Tube Insertion Length and Verifying Gastric Placement With Current Best Evidence, Advances in Neonatal Care: August 2018 - Volume 18 - Issue 4 - p 307-317 doi: 10.1097/ANC.0000000000000526 Kemper, Carol PhD, RN, CPHQ, CPPS; Haney, Barb MSN, RNC-NIC, CPNP-AC, FELSO; Oschman, Alexandra PharmD, BCPPS; Lee, Brian R. PhD, MPH; Lyman, Beth MSN, RN, CNSC, FASPEN; Parker, Leslie PhD, NNP-BC, FAAN; Brandon, Debra PhD, RN, CNS, FAAN Acidity of Enteral Feeding Tube Aspirate in Neonates, Advances in Neonatal Care: August 2019 - Volume 19 - Issue 4 - p 333-341 doi: 10.1097/ANC.0000000000000591 Wallace T & Steward D. Gastric Tube Use and Care in the NICU, Newborn and Infant Nursing Reviews, Volume 14, Issue 3, 2014, Pages 103-108, doi.org/10.1053/j.nainr.2014.06.011.

[@TalaTalksNICU]

Oh thank you so much for references!!! Including one you wrote!! What protocol do you have in your unit?

[@tamiwallace9881]

@@TalaTalksNICU Well, I do not totally agree with the policy in place in my system. They did not want to deal with bedside pH testing so this is not in their protocol. They did do one very smart thing that I like. Any infant who is neurologically depressed (medically paralyzed, etc) must have an xray for gastric tube placement. If an infant cannot cough or choke, they get an xray. I personally believe that the nurse should have a range of options and a step wise guideline to follow. For example: Measure using NEMU, then aspirate for gastric contents, if you get a volume greater than the volume of the tube, it looks gastric, and it is not green....you are done. If you don't get a residual, reposition and try again. PH testing should be available. Xrays should be an option, but the last one. This is not full proof, but it is pragmatic and decreases the number of films.

[@susanwoods3507]

@@TalaTalksNICU In AU we do not routinely X-Ray for an NGT or OGT anymore either. We use the Litmus test only and aspiration. An x-ray is only used if required for other reasons such as RDS.

[@vonnynasr2278]

Dr T we missed you! Pls carry on with the videos - although Alison is very very professional - we love your cheerfulness.

[@TalaTalksNICU]

Hello loyal viewer! Allison is amazing!!! I'll be coming back next week :)

[@malikkamuki]

It would be super helpful to get a video on pneumothorax, when to treat , needle options , pig tail insertion vs regular chest tube insertion technique

[@TalaTalksNICU]

Hello! Yes! I think we’ll do a couple of videos on chest tubes and pneumos next! Thanks so much for your suggestion!

[@mukeshnayak429]

Hi. Enjoy learning through your videos. Kindly teach us about inotropes in NICU and neonatal shock. Thank you

[@TalaTalksNICU]

Hello Mukesh- we will be talking about inotropes and shock relatively soon. Thank you so much for your kind words.

[@mariaaudu3898]

Thanks for the video, how often should a nasogastric tube be changed

[@TalaTalksNICU]

This is an excellent question Maria. The answer is- we don't really know. On paper, we can keep savage tubes in until they come out (or ~ a month). But more recent NEC data has suggested that changing NGs more often (~ once a week or even more often) may decrease the incidence of NEC. Obviously you're balancing out the trauma and discomfort of placing the NG tube with any bacterial build-up you may be getting on the tube. Most institutions have their own policies- so check in your NICU. Thanks!!

[@kaneshamcdowell1231]

Can you do a video on Pulmonary interstitial emphysema and Air leaks in the neonate such as pneumothorax, pneumomediastinum, and pneumopericardium

[@TalaTalksNICU]

Hello Kanesha! This is a great idea for a lecture- but we're having problems getting actual X-rays (copyright issues, HIPAA etc.) . We just put out a request for people to send us X-rays (with no identifying data) if they have them so we can use them. We're also reaching out to various researchers asking permission to use their X-rays (in articles etc)- but it's harder than we thought it would be. We promise we'll get there though!

[@cheriefern]

Hi. Is it standard for all intubated babies to have a ng tube inserted to be kept on free air drainage while they’re on npo?

[@TalaTalksNICU]

Generally yes- we have a NG or OG tube in - usually to feed but sometimes to drain if baby is NPO. Obviously less air is going into the belly as compared to Cpap but often babies can have a leak and some of that air goes into the belly.