Nasogastric tubes in PICU patients

Rationale

• Nasogastric (NG) tubes provide a route for giving medication, an ability to drain the stomach, and access for nutrition.

• NG tubes can be uncomfortable, difficult to place in older children and they have rare but serious complications.

Routine use

• All patients who will be intubated and ventilated for >12 hours (with the exception of postoperative cardiac patients > 5 years old who are expected to be extubated within 24 hours)

• Postoperative cardiac patients < 5 years old (NG tubes are usually placed on admission to PICU while the patient is still anaesthetised and their position checked on the postoperative CXR)

• All patients on bubble CPAP or high flow nasal prong oxygen

• All patients requiring enteral feeds or medications who are unable to take these orally

• All patients who require gastric decompression/drainage

Contraindications

To any gastric tubes: (discuss with surgeon)

• Oesophageal tumour/stricture/varices/surgery/trauma

• Tracheal surgery

• Postoperative cardiac patients 5 years or older who will be extubated within 24 hours

To nasogastric tubes:

• Basal skull fracture

• Maxillofacial trauma/surgery

• Coagulopathy (relative), ECMO patients

Confirming placement

You must use one of these methods and feeds must not be started until the position is confirmed.

1. Aspirate the gastric tube and check pH of aspirate ( ≤5 = gastric). Ensure you have aspirated a volume greater than that of the lumen of the tube to ensure you are testing stomach content, not the tube flush solution. If pH is ≥5 attempt to reposition tube first, if unsuccessful an x-ray must be obtained to confirm placement.

2. Obtain x-ray to confirm placement.

Associated guidelines

For insertion and care of gastric tubes please see the Starship nasogastric and nasojejeunal tube guideline

For feeding commencement please see the PICU enteral feeding guideline

For feeding single ventricle cardiac patients please see the feeding algorithm for single ventricle infants

For feeding/fasting pre-operative PICU patients please see pre-operative feeding  guideline