Chapter 40 ■ Gastric and Transpyloric Tubes 279

Oral or Nasal Gastric Tubes

A. Indications (1)

1. Neurologic immaturity or impairment

2. Poor oral skills

3. Respiratory instability

4. Physiologic instability

B. Contraindications

Recent esophageal repair or perforation

C. Limitations

1. Size of nares

2. Type and amount of respiratory support

3. Congenital anomalies of the nasopharynx

D. Equipment

1. Suction equipment

2. Cardiac monitor

3. Infant tube of appropriate size

4. 0.5-inch hypoallergenic tape

5. Sterile water

6. 3- or 5-mL syringes

7. Stethoscope

8. Gloves

E. Precautions

1. When determining oral or nasal placement, individual

assessment must be done to weigh the risks of compromising the nasal airway.

2. Measure and note appropriate length for insertion.

3. Have suction apparatus readily available in case there is

regurgitation.

4. Do not push against any resistance. Perforation may

occur with very little force or sensation of resistance.

5. Do not instill any material before verifying tube placement.

6. Evaluate for possible esophageal perforation if any of

the following occur (8,13–15)

a. Bloody aspirate

b. Increased oral secretion

c. Respiratory distress

d. Pneumothorax

7. Stop the procedure immediately if there is any respiratory compromise.

F. Special Circumstances

1. Feeding with umbilical catheters in situ is controversial

and should be done with caution, as there are insufficient data to guide practice (8,16).

2. Tubing should be vented between feedings if continuous positive airway pressure is in place (3).

G. Technique

1. Wash hands and put on gloves, maintaining aseptic

technique.

2. Clear infant’s nose and oropharynx by gentle suctioning as necessary.

3. Monitor infant’s heart rate and observe for arrhythmia

or respiratory distress throughout procedure.

4. Position infant on back with head of bed elevated.

5. Measure length for insertion by measuring distance

from tip of the nose to ear to halfway between the

xiphoid and umbilicus (3,17) (Table 40.1). Mark length

on feeding tube with a loop of tape.

6. Moisten end of tube with sterile water or saline.

7. Oral insertion

a. Depress anterior portion of tongue with forefinger

and stabilize head with free fingers.

b. Insert tube along finger to oropharynx.

A B

Fig. 40.1. A: Silastic gastric feeding tube. B: Double-lumen replogle tube.