Insertion of The Gastric Tube
Management guidelines for students, interns and registrars on a variety of routine and emergency situations in our neonatal service at Tygerberg Children’s Hospital. Published in 2014.
Indications
- Babies < 34 weeks gestation (with feeding problems).
- Abdominal distention secondary to nasal CPAP, bowel obstruction, necrotising enterocolitis, etc. Tube inserted for bowel decompression
- Babies with respiratory distress.
- Babies with feeding difficulties.
- Babies with certain neurological difficulties.
Requirements
- Nr 5 F feeding tube if required for feeding
- Nr 8 F feeding tube for bowel decompression
- Plaster for fixation
- Syringe
- Litmus paper
- Gloves
Technique
Mark off the correct tube length.
Tube length = LENGTH (manubrium of the sternum to the xiphisternum) x 2 plus 2.5 cm.
or LENGTH from nose tip to earlobe, plus length from earlobe to xiphisternum (head positioned in midline).
Feed the tube in through the mouth until the mark. Tubes should never be inserted through the nose of baby as this increases airway resistance and increases the work of breathing in small neonates substantially.
To confirm the correct position of the tube, inject 1 ml of air slowly while listening over the epigastrium for a bubbling sound.
Aspirate the abdominal content and test the pH with Litmus paper (blue paper should turn pink/red).
When removing the feeding tube, remember to occlude the proximal end. This prevents fluid running out of the tube and possibly causing aspiration while being removed.