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If you are unable to obtain any aspirate or pH is above 5.5, refer to WoS guideline “ Nasogastric / Orogastric Tubes: Confirming Position” for troubleshooting information.
QFEED FOR TUBE FEEDING NARES CODE
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Non-nutritive sucking and/or sucrose, may reduce distress to the infant during the procedure and may also stimulate peristalsis. If the obstruction continues, try the other nostril. If there is any obstruction, pull the nasogastric tube back and re-advance. A nasogastric tube should be gently passed into the nostril then advanced carefully in an upward, backward and slightly medial direction.Orogastric tubes are obviously passed by the oral route and are indicated for smaller babies with consequently small nasal passages on nasal CPAP or in any other conditions involving blockage or obstruction of the nares. If the tube is being replaced, try to pass it down the opposite nostril to that used previously. If the nasogastric tube is being passed for the first time, either nostril can be used.NB smaller babies, or those with damaged skin, should have a hydrocolloid dressing applied under the tape Nasogastric tube fixed in position with an indelible pen marker 1cm from nose. Measurement to be taken for passage of a nasogastric tube Place marker pen line or tape approx 1cm away from nose or mouth. Note the measurement and mark the tube accordingly (see photographs below).
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With the head in the neutral position, determine the length of tube to be inserted by measuring from the earlobe to the tip of the nose (nasogastric) or from the earlobe to the centre of the lips (orogastric), then to the midpoint between the xiphisternum and the umbilicus.The tube is then secured to the hydrocolloid dressing using tape. The baby’s face should be gently cleaned with water, dried and then a small strip of hydrocolloid tape applied to the face either level with the nostrils or at the sides of the mouth.Ensure the infant is in a comfortable position and swaddled if required.Assemble equipment and place in an accessible position for carrying out the procedure.Carry out hand hygiene before handling the baby, non-sterile gloves can be worn if preferred.The x-ray will confirm the position of a tube even if you are unable to obtain an aspirate. NB - If a chest or abdominal x-ray is being performed in a baby who is likely to need a feeding tube it is best practice to ensure that the tube is passed prior to the x-ray being performed.