1.1.     Giving nasogastric tube feedings

        Equipment: Liquid food at room temperature and water in pour container, feeding tube, adhesive 1-cm or ½-inch tape, water, syringe, stethoscope.

        Positioning for procedure:

o       On parentís lap on infantís right side,

o       or reclining him in an infant seat.

        Measuring the tube for the exact distance (See picture):

o       Hold the tip of the tube on the childís stomach (midway between the belly button and the highest point of the lower rib cage).

o       Extend the tube up to the childís ear lobe then out to his nose.

o       Mark the spot at the nose with the piece of tape.

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        Inserting the tube:

o       Dip the tip of the tube in clear water to moisten

o       Insert the tip of the tube into one nostril guiding it toward the back of the childís throat

o       Ask the child to swallow or give him some water to help the tube pass

o       Quickly insert the tube to the tape mark on the tube.

o       If the child begins coughing or has any other problems, remove the tube at once.

o       Tape the tube to the childís upper lip and cheek.

        Check the placement of the tube:

o       Place 5 cm³ of air in the syringe, connect the syringe to the tube

o       Place the stethoscope over the childís stomach area.

o       Inject the air into the tube while listening for the sound of gurgling through the stethoscope.

o       With the syringe connected to the tube, gently pull back the plunger. Ifcontents appear in the tube, it is the correct place.

o       If not, place the child on the left side or advance the tube a short distance. Pull back on plunder again to check for stomach contents.

o       Return the stomach contents.

o       Disconnect the syringe from the tube and remove the plunger from the syringe.

o       Reconnect the syringe to the tube.

o       Fill the syringe with the right amount of food.

o       If necessary push gently with the plunger to start the flow of food. Then remove the plunger and allow the food to flow by gravity.

o       The bottom of the syringe should never be held higher than the childís chin.

o       Continue adding food until the right amount has been fed. Do not allow the syringe to become empty.

o       When the food is at the bottom of the syringe, add 1 teaspoon (5 ml) of water to rinse the tube.

o       Place the clamp on the tube if it will be left in place between feedings.

o       Hold, cuddle and burp the child.

o       Write down the time and amount of the childís feeding.

        To remove the tube:

o       Loosen the tape that is holding the tube.

o       Fold the tube and pinch it tightly together.

o       Pull the tube out quickly.

o       Hold, cuddle, and burp the child.

        Care of the nasogastric tube and syringe

o       Wash with soap and water, and rinse the inside well with clear water.

o       Dry and store in a clean, dry container (e.g., plastic bag, margarine container).

o       If the tube remains in place between feedings, always check to make sure the tube is in the right place before adding formula.