Gastric Tube Use and Care in the NICU

Tamara Wallace, DNP, APRN, NNP-BC; Deborah Steward, PhD, RN

Disclosures

NAINR. 2014;14(3):103-108. 

In This Article

Abstract and Introduction

Abstract

Orogastric and nasogastric tubes are used for both decompression and feeding in the NICU. The placement and use of these tubes are one of the most frequent nursing procedures in the NICU. These tubes are essential to the wellbeing and growth of critically ill infants and yet there is little empiric evidence to guide practice in the newborn. This paper will review the science available to guide practice, discuss controversies and examine interventions to improve safety.

Introduction

The placement and use of gastric tubes are one of the most common nursing procedures performed in the newborn intensive care unit (NICU). These tubes are used for gastric decompression, enteral nutrition and medication administration. Few patients in the NICU will avoid having a gastric tube placed at some point during their hospitalization. Placing a gastric tube in a term or preterm infant is a multiple step process involving a series of decisions. The initial decision-making involves determining the type and size of tube to use, measuring for depth of placement of the tube, accurate assessment of successful placement, and planning for ongoing care of the tube.

Despite the regularity with which this procedure is performed, there is a surprising lack of empirically derived evidence to guide the performance of gastric tube placement and care in neonates. Much of current practice has been borrowed or modified from practice in older children and adults. This is unacceptable given the importance of these tubes to the safety and feeding of these vulnerable infants. Good nutrition and growth are essential for good outcomes. The insertion and use of gastric tubes pose a risk of injury to the infant. Safety issues include misplacement of the tube into the lung or small intestine, migration of the tube outside of the stomach, perforation of the trachea, esophagus, or stomach, and aspiration of the feeding into the lungs.[1] Because of these potential adverse events, it is critical that protocols developed for this procedure in neonates be based on the best available evidence for neonates. This paper will review the current evidence available and attempt to make some initial recommendations for evidence-based practice.

Sick neonates exhibit at least three risk factors that make them uniquely susceptible to the complications of tube placement and gavage feeding. These risk factors include their immature anatomy and physiology, the lack of evidence to guide care, and the rapidly changing equipment and technology in the NICU. The first risk factor is not easily modified, but empirical studies of the practice of gavage feeding and the associated technology used to provide these feedings may offer insight into the prevention of complications. These studies need to be specific to the neonate and include infants of all sizes and gestations.

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