1. To provide a route for feeding and medication administration in the setting of neurobehavioral immaturity, physiologic instability, or respiratory compromise (3)

2. To sample gastric or intestinal contents

3. To decompress and empty the stomach

1. Single-lumen gastric and transpyloric tubes are made of Silastic (silicone elastomer), silicone, polyurethane, or polyvinyl chloride (PVC) and are radiopaque for location on radiography (2, 4, 5). They are incrementally marked in centimeters, and usually have two to four side holes at the distal end (Fig. 43.1).

a. Available for neonates in sizes 3.5 to 8 Fr and in a variety of lengths. The smaller-diameter tubes will have slower rates of flow. Tube length will vary depending on the depth of placement and whether the tube is to be gastric or transpyloric (2, 5).

b. Single-lumen feeding tubes maybe used for occasional or intermittent decompression of the stomach (2).

2. Double-lumen (Replogle) tubes are preferable for continuous gastric decompression or for continuous suction to clear secretions from the upper esophageal pouch in infants with esophageal atresia prior to surgery (6, 7, 8).

a. The wider lumen is attached to the suction device for gastric decompression or esophageal clearing, and the second, smaller lumen is for airflow to prevent adherence of the catheter to the mucosal wall (Fig. 43.2).

b. These catheters are also radiopaque, marked incrementally, and have multiple side holes at the distal end.

c. Available in 6, 8, and 10 Fr; vary in length. Manufacturer’s recommendations should be followed for frequency of tube change.

1. When determining oral or nasal placement, individual assessment must be done to weigh the risks of compromising the nasal airway as well as determine the potential impact on oral feeding.

2. Consider the size of the nares as well as the type and amount of respiratory support when determining placement.

3. Do not push against any resistance. Perforation may occur with very little force or sensation of resistance.

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

a. Incorrect placement of gastric and transpyloric tubes is common, with incidence ranging from 21% to 59%, and can lead to substantial morbidity and mortality (9, 10, 11, 12, 13).

5. Evaluate for possible esophageal perforation if any of the following occur (14):

a. Bloody aspirate

b. Increased oral secretion

c. Respiratory distress

d. Pneumothorax

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

7. Silastic, silicone, and polyurethane tubes are softer and can remain in situ for up to 30 days, or per manufacturer’s recommendations, although individual practice guidelines should be followed. Silastic tubes are preferred, especially in preterm infants weighing <750 g (2, 15).

8. PVC tubes are stiffer and easier to insert.

a. They are not recommended for long-term use because they stiffen over time when exposed to the acidity of the stomach and can lead to leaching of plasticizers as well as esophageal perforation (2, 4, 5, 16).

b. Manufacturer recommendations for frequency of tube change can vary so institutional practice guidelines should be followed.

9. Weighted, stylet-containing tubes are not recommended in the neonatal population due to the risk of perforation.

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 oxygen saturation and observe for arrhythmia or respiratory distress throughout procedure.

4. If possible, offer a pacifier and oral sucrose in accordance with unit policy to manage pain and encourage sucking and swallowing (17, 18).

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

6. Measure length for insertion by measuring distance from tip of the nose to earlobe to halfway between the xiphoid and umbilicus (Fig. 43.3) (2, 5, 9, 10, 12, 13, 19).

7. Mark length on feeding tube with a loop of tape (Table 43.1).

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

9. Oral insertion

a. Depress anterior portion of tongue with forefinger and stabilize head with free fingers.

b. Insert tube along finger to oropharynx.

10. Nasal insertion (avoid this route in very-low-birthweight infants in whom nasal tubes may be associated with increased respiratory effort and decreased ventilation) (2, 3).