Going home with a nasogastric (NG) tube

Support

During your child’s stay in hospital, you will be taught how to test the nasogastric tube and administer your child’s feed and medications. Your Nurse will work through a training checklist with you, asking you to confirm that you are confident in the management of your child’s NG tube before your child is discharged home. This will be documented on your child’s EPIC notes.

If your child requires feeding via an enteral feeding pump, the Nurse trainer from your area will have trained you in how to use the pump. If not able to train in the hospital, it will be provided at home as soon as possible after discharge. You may be trained with the pump used in the hospital as an interim measure to either facilitate discharge home until pump training is provided or to use in one of our on-site accommodations until discharged home.

Your child will be referred to the Children’s Community Nursing Team (CCNT) for your area who will be able to provide support and replace dislodged nasogastric tubes. You will be advised of their normal working hours. If the nasogastric tube becomes dislodged outside of normal working hours, you may need to attend the Emergency Department at your local hospital to have it replaced, if no alternative service available.

A dietitian will monitor your child’s feeding at home – this may be a dietitian at Addenbrooke’s Hospital or at your child’s local hospital.

Supplies

When your child leaves Addenbrooke’s Hospital, you will be given a minimum of seven days of equipment and feed to take home unless you have a home delivery prior to discharge.

The Paediatric Nutrition Nursing Team will either contact your home delivery company (if you are local to Cambridge, Peterborough or Huntingdon) or the Paediatric Dietitian for your local area to order ongoing supplies. The home delivery company will deliver all your feed and equipment every 28 days to your home.

The home delivery company should contact you prior to each delivery to check that supplies are still required. It is possible to

place your order temporarily on hold, for example if you are finding that you are accumulating supplies or your child is being admitted to hospital. To arrange this, your local teams can be contacted.

If your child’s requirements increase, any changes will need to be made either through your local community nurse or dietitian. Your nutrition team will advise you on who this is.

If your child has been issued with an enteral feeding pump, this will have been registered to your child but remains the property of the feeding company. These supplies are purely for use at home. If your child is admitted to hospital, then the hospital should supply a pump, feed and equipment.

Equipment

Most equipment is designed for ‘single use’ only and should be discarded after use. Items displaying this symbol are for ‘single use’ only. Giving sets – please refer to the section on feeds for how often a giving set should be changed.

Reusable syringes are designed for multiple uses at home. In between uses the plunger can be removed from the syringe and the two parts can then be washed. Place the syringe in warm, soapy water and pull the plunger back and forth several times before removing the plunger from the syringe. Rinse the syringe thoroughly and allow to dry, then stored in a Tupperware box for future use.

For children under the age of one year or where there is a concern about the child’s immunity these syringes can be sterilised in between uses. Please refer to manufacture information leaflet, which you will have been provided.

Please observe syringes for signs of wear, for example, cracks, markings on the syringe wearing off, the plunger becoming stiff to use. Discard and report any problems to your community nurses.

Before using any equipment it is important to check the packaging for any signs of damage and expiry dates. The expiry date will be indicated next to or below this symbol Do not use past the expiry date.

Feeding via a nasogastric tube

Feeding may be continuous over several hours or as bolus feeds for shorter periods of time. This may be administered via an enteral feeding pump or via a gravity bolus set / open syringe. Some children may have a combination of both. Your Dietician will formulate a plan. It is important that your child’s head and shoulders are elevated at 30 to 45° for the duration of the feed and for one hour afterwards.

Pump feeding

If your child is to be fed via an enteral feeding pump, training will be arranged prior to discharge. The enteral feeding pump provided is determined by your GP’s postcode, so this may be different to the one used in Addenbrooke’s. The pump training will either be provided by the Paediatric Nutrition Nursing Team or an Enteral Nurse trainer from the home feeding company. It may be possible for the enteral pump trainer to visit your home either before the nasogastric tube is passed (if known in advance) or once your child has been discharged to provide refresher training. An instruction manual is provided with each pump. The risks associated with continuous feeding will be assessed and discussed with you by the dietitian. Each home delivery company has a 24 hour helpline for pump related problems.

Bolus feeding

• Check the position of the nasogastric tube (refer to ‘Your child requires a nasogastric tube’ leaflet).
• If using a bolus set, ensure roller clamp is ‘clamped off’ and attach to the nasogastric tube. Pour the feed into the set and then unclamp. This ensures that air is removed from the line.
• If using an open syringe, attached syringe to nasogastric tube. Pour feed into syringe.
• Allow the feed to be delivered slowly over 15 minutes.
• When feed is complete, administer a water flush and then disconnect the feeding set.

Feeds

Your feed will be provided either in a ready-made preparation or a powdered feed.

Ready-made feeds (bags, bottles, cartons, etc.)

A new giving set is required for every new feed session. The feed and giving set can stay in place for up to 24 hours if remained attached to the nasogastric tube. If disconnected a new giving set must be used for the next feed. It may be necessary to decant a bolus feed into a reservoir for a feed and then the remainder can be placed in a refrigerator for up to 24 hours. Two-way connectors are available to enable two bags to be attached to the giving set for one feed session.

Powdered feeds

Your dietitian will advise you on how to make and store your child’s powdered feed. Continuous feeds: Powdered feeds can only be kept for four hours at room temperature. Every four hours fresh feed must be added to a new sterile reservoir and giving set.

Cooled, boiled water must be used for all continuous feeds, for children under the age of one year and where there is concern about a child’s immunity. Cooled, boiled water may be stored in a clean, covered container in the refrigerator for up to 24 hours.

Tap water: under most circumstances tap water may be used to flush the nasogastric tube. Run the tap for a few minutes to ensure water is fresh and place in a clean cup.

Do not use filtered or bottled water as this may have been standing / opened for a period of time.

Administering medications through a nasogastric tube

• Please check with your nurse, doctor or pharmacist before administering any medications via a feeding tube as not all medications can be given via this route.
• Ideally, all medications given via a nasogastric tube should be in liquid form.
• To avoid blocking the nasogastric tube, thick liquids should be diluted with equal amounts of water before administering.
• If you are dispensed tablets, please check that these can be crushed or dissolved in water before administering and that the medication is completely dissolved to prevent blocking the tube. Tablets that are enteric coated or state that they are sustained, prolonged or modified release must not be crushed.
• Do not mix medications together.
• Before and after administration of each medication, the nasogastric tube must be flushed with water – approximately 2 – 5mls dependent on the age of your child.

Blocked tubes

• Prevention is always best.
• After each feed or medication it is important to immediately flush the nasogastric tube with water to prevent the tube from blocking.
• If debris is noticeable in the nasogastric tube, try massaging the nasogastric tube between your fingers to dislodge the debris.
• If the blockage does not clear try irrigating the nasogastric tube. Draw up some warm water into a 20ml syringe and use a push- pull technique to move the water in and out of the syringe to dislodge the debris.
• Contact your Community Nursing Team for further advice or a change of nasogastric tube.

Contacts / further information

Paediatric Nutrition Nursing Team (Addenbrooke’s)

Monday to Friday, 09:00 – 15:00

Telephone: 01223 274826

Addenbrooke’s dietitians: 01223 216655

Children’s community nursing team for support with NG care contact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Working hours:

• Weekdays (Monday – Friday) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
• Weekends and Bank holidays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Home delivery company to change delivery arrangements, to place order on hold, to return pump / supplies or for 24 hour helpline for pump queries please contact: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

To make changes to your child’s order please contact your:

• Local dietitian for changes to feed / equipment order

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• Children’s community nursing team for changes to equipment order

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