Giving tube feeding at home through a nasogastric tube

Giving tube feeding is a nursing technique. But after explanation, instruction and supervised practice, you as a parent/guardian may also give tube feeding. The pediatric nurse inserts the nasogastric tube. The home care pediatric nurse does this at home.

Checklist

To learn the different actions for tube feeding, there is a checklist. When you have gone through a step of the checklist, you can sign it off together with the nurse. Once the checklist has been completed and signed, you as a parent/guardian can independently, safely and responsibly administer tube feeding to your child. You will receive the checklist from the nurse.

Prepare

You can prepare tube feedings separately for each feeding or once every 24 hours. Good hygiene is important here. Food attracts bacteria, causing it to spoil quickly. This may cause your child to have diarrhea or nausea. Therefore, always wash your hands with soap and water when preparing food. And further:

• Opened and/or pre-prepared tube feeding can be stored in a refrigerator for 24 hours in a sealed package.
• Write on the package the date and time of starting or preparing.
• You can flush the tube feeding system with water. The same goes for the syringes.
• Replace the system and syringe once every 24 hours.
• Infant formula and home-prepared food has a shelf life according to the instructions for use on the packaging.
• Food from the refrigerator can be brought to body temperature with the microwave, a bottle warmer or a pan of warm water.
• Make sure the food is not too hot. This gives an unpleasant feeling in the stomach and can even cause a burning sensation in the stomach. Your child may also feel sick or vomit.
• Make sure there are no lumps in the food. This can cause the nasogastric tube to become blocked.
• Is it very hot outside? Pay extra attention to hygiene and store food in the refrigerator.
• In hot weather, also keep an eye on whether your child needs extra fluids.

Amount of tube feeding

Tube feeding provides the energy and all the nutrients your child needs. It is used as a replacement for normal food. Or as a supplement if your child cannot or cannot eat and/or drink independently. In babies and toddlers, you can also give normal infant formula through the nasogastric tube.

The doctor or dietician will discuss with you how much tube feeding your child needs, which diet is most suitable and which tube feeding schedule is feasible in your family.

A nasogastric tube is stuck with one or more plaster(s). Check that the patches are still firmly attached. After bathing or showering, also check whether the nasogastric tube is still firmly attached. Are the plasters dirty or loose? Then remove the plasters and stick new ones on.

NB
Do you need to change the patches? Make sure that the nasogastric tube does not move. Otherwise, the probe may go too deep (into the small intestine) or too shallow (into the esophagus).

Points of attention

• Tell your child what you are going to do.
• Wash your hands with soap and water.
• The nurse will tell you how deep the nasogastric tube should be inserted. You can also see this by the marked line on the nasogastric tube.
• Cut the patches to size.
• Carefully remove the old patches from the nose and nasogastric tube.
• Hold the nasogastric tube firmly in place with one hand. And note the marking on the nasogastric tube for depth.
• Reattach the nasogastric tube. Make sure that the nasogastric tube does not touch the nostril.
• Place the patch (if possible) in a different place to avoid pressure marks.
• Check whether the nasogastric tube is correctly positioned.
• Depending on which nasogastric tube your child has, it must be changed regularly. Write down when that should happen. The home care nurse can then change the tube.

The plastic of the nasogastric tube can become stiff. If it stays in place for too long, it can irritate the nose, esophagus and/or stomach. Make sure that the nasogastric tube hangs freely from the nostril (not against the edge), as this can cause irritation and wounds.

A nasogastric tube gives more chance of a stuffy nose and that can get in the way of breathing. Therefore, clean the nose regularly with a wet gauze. This can also be done with physiological saline. Go to the pharmacy or drugstore for this. You then rinse the nostrils with a few drops. This will dissolve the mucus easily.

Especially for children who do not or hardly eat themselves, good oral care is very important to prevent infections and inflammations. Take care of the mouth before each feeding. By means of:

• clean the mouth with a wet cotton swab or wet gauze (in children under one year).
• brush your teeth regularly.
• regularly rinse the mouth with water.
• lubricate your child’s lips with a greasy cream. For example vaseline. This prevents the skin from drying out and cracking.

• Always put your child to sleep on their back.
• Stick the nasogastric tube to the clothes on the back. This will prevent the probe from getting stuck around the neck if your child moves while sleeping.
• Your child should still be able to move his head sufficiently.

With small portions of food, the food can be given by siphoning. Are the portions larger than 60 ml? Then the feed is given with a feed pump. The supplier of the pump will give you instructions on how to operate the pump. The nurse will also explain the pump to you on the ward before you go home.

NB
Never give tube feeding if you are in doubt about the position of the nasogastric tube. Always contact the home care nurse.

Check nasogastric tube

A nasogastric tube is a thin, flexible tube. This runs through the nose to the stomach. It is important to check the position of the nasogastric tube. It may happen that the probe has moved and no longer enters the stomach. How do you check the position of the nasogastric tube?:

• Check whether the nasogastric tube is properly taped and the plasters are still firmly attached.
• Check whether the marked line on the nasogastric tube can still be seen in the same place (close to the nose).
• When the nasogastric tube was inserted, the pediatric nurse marked the nasogastric tube with a waterproof marker. Directly where the nasogastric tube comes out of the nostril.
• Look in the mouth to make sure that the end of the nasogastric tube is not visible in the mouth.

Preparation for tube feeding

There are several ways to give nutrition through the nasogastric tube. By injecting it slowly with a feeding syringe, by siphoning it, or by administering it via a pump at a certain speed.

When giving tube feeding, you must make the following preparations.

1. Have all materials ready:
   – 60 ml Enfit syringe with pestle when siphoning the nutrition or correct nutrition. Possibly with a nutrient container if you use a pump.
   – 10 ml Enfit syringe with water to flush the nasogastric tube after feeding.
   – 10 ml Enfit syringe to check the position of the nasogastric tube if necessary.

2. Prepare your child well for what you are going to do.

3. Take the food that will be given.

4. Wash your hands with soap and water to work as cleanly as possible.

5. Give tube feeding via pump or syringe. Check that the food is not too hot: put a few drops of food on the inside of your wrist.

Eating in addition to tube feeding

In addition to tube feeding, your child may also eat or drink something himself. You can discuss this with your doctor or dietitian. If your child is allowed to eat and/or drink in addition to tube feeding, a number of nutritional recommendations are important:

• It is especially important for an infant that the natural need to suck is stimulated. You may first try a bottle with a little food and give the rest of the food through the nasogastric tube (to save energy for your child).
• You can also let your baby suck on a pacifier.
• Take your baby on your lap during feeding. Basically just like you would when giving the bottle. In addition to the contact that infants need, this is also good for burping.
• Take the time for breast or bottle feeding and tube feeding. This way you prevent unrest and distraction.
• Also provide a quiet environment.
• Give tube feeding after your child has been cared for. This prevents vomiting and/or choking.

Is your child a bit older? Consult with the dietitian or doctor whether you can also give your child small snacks. Especially to let your child get used to (or get used to) eating. And further:

• Because tube feeding ends up directly in the stomach, your child will not taste anything. Always have your child sit at the table with you when you eat yourself or when you give your child something to eat.
• Give the tube feeding after eating. Otherwise, your child will not be hungry and eat less quickly.
• Give especially small portions and change the structure. Think of a piece of cheese, a cracker, a piece of fruit or yogurt.
• Let your child taste as much as possible while you are eating.

The tube should be checked every time you administer medication through the nasogastric tube.

• See the guidelines under ‘Check tube feeding’.
• Maintain good hygiene.

Inform your pharmacy

Not all medicines can be given together with food. Some medicines do not work well when they come into contact with food or have to be given some time before or just after food. There are also medicines that cannot be given through the nasogastric tube. Inform your pharmacy that the medication is given through a nasogastric tube. And not all tablets can be crushed just like that. If possible, the pharmacy will give the medicines in oral solution.

You can read in the table below what to do in case of certain problems.

Table of brochure Giving tube feeding at home via a nasogastric tube

Problem	Cause	What do you have to do?
Nasogastric tube is blocked	Medications / food has not been flushed after administration	Flush with 10 ml of lukewarm water
Skin irritation		Change the patch Ask the doctor for skin protection
Probe has shifted		Slide the probe back slightly, up to the notched line Replace the patch if necessary
Probe vomited		Remove the probe Ask KinderThuisZorg to place a new one
Nausea, vomiting, diarrhoea	Food goes too fast Too large amount Incorrect position of nasal/gastric tube	Stop the power supply Check the speed Check expiration date Do not store food for more than 24 hours Probe may be too deep. Then call KinderThuisZorg
Dry mouth	No or insufficient oral intake	Toothbrushing Take a wet gauze through the mouth Rinse mouth
Plaster is loose		Peel off the plaster. Hold the hand on the probe so that it does not move. And apply a new patch
Pressure spot nostril	Plaster is too tight Nostril scab Redness

Do you have doubts about the location of the probe? Or has the probe gone out? Then please contact Children’s Home Care.

For general probe information, please call:

Department of Pediatrics

088 624 14 35 (available 24 hours a day)