FEEDING SUPPORT PROCEDURES AND DEVICES

This sub-chapter deals with some common feeding support devices in normal or sick children.

Nasogastric intubation is a common pediatric procedure for diagnostic as well as therapeutic purposes.

Indications: (a) nasogastric feeding or drug administration,

(b) gastric decompression, e.g. in paralytic ileus, intestinal obstruction, GIT hemorrhage or peri-operative cases,

(c) gastric lavage in poisonings, GIT hemorrhage,

(d) diagnostic gastric aspiration in poisonings, hema- temesis, AFB detection, and (e) for diagnosis of esophageal anomalies, e.g. esophageal atresia or strictures.

Contraindications: (a) corrosive acid/alkali poisoning, (b) deep necrotic esophageal ulcers.

Instruments: Two types of tubes are used for nasogastric intubation: (a) Ryle's tube or nasogastric tube in older children, and (b) infant feeding tubes for newborns, infants and younger children (Fig. 32.28).

• Nasogastric tube (Ryles tube) is a long PVC tube of variable length and diameter (size 5-24 fG) with blind blunt tip on one end and stopper on other open end. The blind tip is filled with 2-3 lead shots and has 3-4 lateralized openings. Lead shots help in radiological localization of tube in situ, as well as facilitate tube insertion due to weight. Main body of the tube has three transverse markings, indicating the position of the tip of the tube in the gastrointestinal tract.

• Infant feeding tube is similar to Ryles tube with two differences: (a) thinner diameter (size 5-12 fG), and (b) absence of lead shots at the tip.

Fig. 32.28A to C: (A) Ryles tube; (B) Infant feeding tube; (C) Method to determine desired length of nasogastric tube.

Sterilization: Both tubes are available as disposable presterilized units (gamma sterilization), in variable size, numbered according to their length and diameter.

Uses: While Ryle's tube is exclusively used for nasogastric intubation, infant feeding tube may also be used as: (a) umbilical cannula, (b) venesection cannula for CVP monitoring; (c) urinary catheter in infants, (d) nasal oxygen catheter, (e) suction catheter, or (f) tourniquet.

Procedure: Determine the proper length of tube, necessary to reach stomach* gt; lubricate the tip gt; inserted through nostril gradually, asking the patient to swallow it, till desired length is inserted gt; confirm it presence in stomach**.

*Desired length of the tube that needs to be inserted, is determined by measuring the distance form tip of the nose to tragus and from tragus to xiphisternum.

**Intragastric position of tube may be confirmed by: (a) aspiration of gastric contents, and (b) auscultation of bubbling sounds over stomach, when the air is pushed into the tube via a syringe.

Complications: (a) nasal trauma/hemorrhage, (b) esophageal ulceration, perforation or hemorrhage, (c) aspiration due to coiling of the tube in the pharynx.

32.3