Alternative feeding techniques : Gavage feedings

    • Alternative feeding techniques
      • Gavage feedings
        • Preparations
          • A suitable tube selected according to the child’s size, the viscosity of the solution being fed, and anticipated duration of treatment
          • A receptacle for the fluid; for small amounts, a 10- to 30-mL syringe barrel or Asepto syringe is satisfactory; for larger amounts, a 60-mL syringe with a catheter tip is more convenient
          • A 10-mL barrel syringe to aspirate stomach contents after the tube has been placed
          • Water or water-soluble lubricant to lubricate the tube; sterile water is used for infants
          • Paper or nonallergenic tape to mark the tube and to attach the tube to the infant’s or child’s cheek (and nose if placed through the nares)
          • pH paper to determine the correct placement in the stomach
          • The solution for feeding
        • Procedure
          • Be careful so that breathing is not compromised
          • Feeding the child in a sitting position helps maintain placement of the tube in the lowest position, thus increasing the likelihood of correct placement in the stomach.
          • Place child supine with head slightly hyperflexed or in a sniffing position (nose pointed toward ceiling).
          • Measure the tube for approximate length of insertion and mark the point with a small piece of tape.
          • Insert a tube that has been lubricated with sterile water or water-soluble lubricant through either the mouth or one of the nares to the predetermined mark. Because most young infants are obligatory nose breathers, insertion through the mouth causes less distress and helps stimulate sucking. In older infants and children, the tube is passed through the nose and alternated between nostrils. An indwelling tube is almost always placed through the nose.
            • When using the nose, slip the tube along the base of the nose, and direct it straight back toward the occiput.
            • When entering through the mouth, direct the tube toward the back of the throat.
            • If the child is able to swallow on command, synchronize passing the tube with swallowing.
          • Confirm placement
          • Stabilize the tube by holding or taping it to the cheek, not to the forehead, because of possible damage to the nostril. To maintain correct placement, measure and record the amount of tubing extending from the nose or mouth to the distal port when the tube is first positioned. Recheck this measurement before each feeding.
          • Warm the formula to room temperature. Do not microwave! Pour formula into the barrel of the syringe attached to the feeding tube. To start the flow, give a gentle push with the plunger, but then remove the plunger and allow the fluid to flow into the stomach by gravity. The rate of flow should not exceed 5 mL every 5 to 10 minutes in premature and very small infants and 10 mL/min in older infants and children to prevent nausea and regurgitation. The rate is determined by the diameter of the tubing and the height of the reservoir containing the feeding and is regulated by adjusting the height of the syringe. A usual feeding may take 15 to 30 minutes to complete.
          • Flush the tube with sterile water (1 or 2 mL for small tubes to 5 to 15 mL or more for large ones) to clear it of formula
          • Cap or clamp indwelling tubes to prevent loss of feeding.
            • If the tube is to be removed, first pinch it firmly to prevent escape of fluid as the tube is withdrawn.
            • Withdraw the tube quickly.
          • Position the child with the head elevated 30 to 45 degrees or on the right side for 30 to 60 minutes in the same manner as after any infant feeding to minimize the possibility of regurgitation and aspiration. If the child’s condition permits, burp the child after the feeding.
          • Record the feeding, including the type and amount of residual, the type and amount of formula, and how it was tolerated.
            • For most infant feedings, any amount of residual fluid aspirated from the stomach is refed to prevent electrolyte imbalance, and the amount is subtracted from the prescribed amount of feeding. For example, if the infant is to receive 30 mL and 10 mL s aspirated from the stomach before the feeding, the 10 mL of aspirated stomach contents is refed along with 20 mL of feeding. Another method can be used in children. If residual fluid is more than one-fourth of the last feeding, return the aspirate and recheck in 30 to 60 minutes. When residual fluid is less than one-fourth of the last feeding, give the scheduled feeding. If large amounts of aspirated fluid persist and the child is due for another feeding, notify the primary care provider.

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