Gavage feeding in Pediatrics

Gavage Feeding is commonly called tube feeding involves insertion of tube via nose or mouth with the tube ending in the stomach. It is otherwise called nasogastric or orogastric feeding.

Indications

Short-term Enteral Feeding

 It is indicated for the children who have a functioning gastrointestinal (GI) tract but cannot ingest enough nutrients orally.

• The child may be unconscious or have a severely debilitating condition that interferes with his/her ability to consume adequate food and fluids.

Other Conditions Include

• Failure to thrive
• Inability to suck or tiring easily during sucking
• Abnormalities of throat or esophagus
• Swallowing difficulties or risk for aspiration
• Respiratory distress
• Metabolic conditions
• Surgery
• Severe trauma

Equipment Needed

A tray containing:

• Ryle’s tube (6-8 Fr) for insertion
• Sterile water in a bowl to lubricate the tube and check placement of the tube
• 5-mL syringe for aspirating gastric contents and feeding
• Feeding cup with water for flushing the tube
• Prescribed formula for feeding
• Adhesive tape and scissors to fix the tube in position
• Cotton tip applicators to clean the nostrils

General Instructions

• Position the baby on the back with folded towel placed under the shoulders to elevate the head slightly.
• In the case of older children, head end of the bed to be elevated during feeding.
• Application of mummy restraint may be necessary to control the child’s movement during tube insertion.
• Infant’s hands may be restrained using a soft restraint to prevent grasp of gavage tube and its removal.
• For gavage feeding of infants, sterile equipment should be used.
• Feeding amount should be calculated.
• Use sterile water or saline to lubricate the tube. Do not use oil because of the dangers of aspiration into the lungs.
• For small infants, pass the tube through mouth because infants are nasal breathers.
• The flow of feeding should be slow. Do not apply pressure.
• Elevate the reservoir of feed 15-20 cm above the child’s head.
• Feeding should be given about 5 mL/5-10 minutes or 15-20 minutes total time.
• Weigh the child daily.
• The feeding formula should be at room temperature.

Preparation

• Verify the order for the gavage feeding.
• Explain the procedure to the child and parents using appropriate language geared to the child’s developmental level.
• Gather necessary equipment.

Procedure

• Wash hands and put on gloves.
• Inspect the child’s nose and mouth for any deformities that may interfere with the passage of the tube.
• Position the infant supine with the head slightly elevated and with the neck hyperextended so that nose is pointed upward.
• Assist the older child to sitting position if appropriate.
• Alternatively have the parents or another person to hold the child to promote comfort and reassurance.
• Determine the tubing length for insertion measure from the tip of the nose to the earlobe to the middle of the area between the xiphoid process and umbilicus. Mark this measurement on the tube with indelible pen or with a piece of tape.
• Lubricate the tube with generous amount of sterile water or water-soluble lubricant to promote the passage of the tube and minimize trauma to the child’s mucosa.
• Insert the tube into one of the nares or the mouth. Direct nasally insert tube straight back toward the occiput; direct an orally inserted tube toward the back of the throat.
• Advance the tube slowly to the designated length. Encourage the child if capable of swallowing frequently to assist with advancing the tube.
• Watch for signs of distress such as gasping, coughing, or cyanosis indicating that tube is in airway.
• If these signs develop withdraw the tube and allow the child to rest before attempting reinsertion.
• Check for proper placement of the tube by attaching a syringe to the end of tube and aspirate stomach content.
• Return any aspirated contents to the stomach.
• Secure the tube in cheek.

Post procedure care

Document the type of tube inserted, length of tubing inserted, measurement of external tubing length after insertion, and conformation of placement.

Administering Tube Feeding

Tube feeding can be given continuously or intermittently (bolus feeding).

Bolus feedings: A specified amount of feeding solution is given at specific intervals, usually over a short period of time, such as 15-30 minutes.it can be given via syringe, feeding bag, or infusion pump.

Continuous feeding: Given at a slower rate over long period of time and enteral feeding pump is used to administer the solution prescribed rate.

Steps

1. Check for the tube placement.
2. Measure the gastric residual (the amount remaining in the stomach indicates gastric emptying time) by aspirating gastric contents.
3. Place the child in supine position with the head and shoulders elevated approximately 30.
4. Flush the tube with small amount of water to clear it.
5. Place the feed in barrel of syringe or into a feeding bag attached to the feeding tube and allow it to flow by gravity.
6. Monitor the child’s tolerance to the feeding.
7. Once the feeding is complete but before the formula completely empty from the container, flush the tube with water.
8. As the water leaves the syringe, clamp the tube to prevent air from entering the stomach.
9. Disconnect the syringe or tube feeding bag from the tube.
10. Burp the infant during and after tube feeding.
11. Position the baby on his or her right side with head slightly elevated (30°) for about 1 hour after the feeding to facilitate gastric emptying and reduce the risk of aspiration and regurgitation.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
4. Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
5. Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/

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