Tube feeding with a nasogastric or nasojejunal tube for babies and children — Canterbury Whāngai ā-ngongo ki te ngongo ā-ihu mā ngā tamariki

The NG and NJ tubes allow your tamaiti to take special liquid food (feed), medications and fluids if they cannot meet all their nutritional needs by eating normally.

Tube feeding

Flush the feeding tube with warm water:

• before and after your tamaiti has a tube feed
• before and after you put medications down their tube
• every 3 to 4 hours during the daytime whether or not your tamaiti is feeding — to stop the tube from blocking.

If you have safe drinking water, you can use tap water to flush an NG tube. Otherwise, use cooled boiled water.

If your tamaiti has an NG tube, there are 3 ways of tube feeding:

• gravity feeding
• bolus feeding
• pump feeding.

Your dietitian will decide which type of feeding is best for your tamaiti.

If your tamaiti has an NJ tube, you can only use pump feeding.

Gravity feeding

This is where the feed flows out of a syringe or feed bottle and into the feeding tube by gravity.

Bolus feeding using a syringe

This is when your tamaiti has a set amount of feed at specified times during the day. This is like having meals at mealtimes.

Pump feeding

This is when a pump is used to continuously deliver a set amount of feed through the feeding tube over a set amount of time.

Your dietitian will discuss these options with you in more detail and provide you with a feeding plan and instructions when needed.

• After feeding, wash the syringe with mild dishwashing detergent, rinse thoroughly and leave it to air dry.
• Place the syringe in a clean zip-lock bag or a clean container with a lid. Store it in the fridge to prevent it being contaminated by germs (bacteria).
• You can use each syringe for about 2 weeks.
• Giving sets (only used for pump feeding) can only be used for 24 hours. Throw them away after you have used them for 24 hours and do not reuse them.
• Cover open cans or bottles of feed and store them in the fridge. Throw away any open, unused feed after 24 hours.
• You can use open ready-to-hang bottles of feed for 24 hours. Throw away any open unused feed after 24 hours.
• The feed should be at room temperature when you use it. If it has been in the fridge, leave it for 30 minutes before using it.

The feeding tube may block if you do not flush it regularly or you do not give your tamaiti their medications correctly.

You can stop the tube from blocking by flushing the tube with warm water. You need to do this before and after each feed, and before and after giving medications. You also need to do it every 3 to 4 hours during the daytime whether or not your tamaiti is feeding.

If the tube gets blocked, try the following, which may clear it:

• check for any kinks in the tubing
• massage the tube from the nose end, out towards the end of the tube
• insert a 60 ml syringe into the end of the tube
• pull back the plunger and withdraw as much fluid as possible from the tube
• take the syringe out of the tube and throw away the fluid you withdrew
• half-fill a 60 ml syringe with warm water and attach it to the end of the tube, move the plunger back and forth to try to dislodge the blockage
• massage the tube again and then use the back and forth action with the plunger to try to clear the tube
• if you have repeated this 3 or 4 times and you cannot unblock the tube, contact the Children’s Outreach Nursing Service (in normal working hours) or Children’s Emergency Care (after hours) — see contact details below.

The hospital pharmacist will review your child's medications before you go home. They will make sure your tamaiti can take the medications through their feeding tube. There are some important points to note.

• Use the main port of the feeding tube for medications.
• Use the bolus feeding method (see above) to put medications down the feeding tube unless your dietitian or nurse tells you to do it another way.
• Flush the tube with 10 ml warm water before and after giving medications. This helps to stop the feeding tube from blocking.
• If your tamaiti has more than 1 medication, give them each one separately. Flush the feeding tube with 5 ml to 10 ml of warm water between each medication.
• Finely crush each solid medication separately (a mortar and pestle is best for this). Mix it with 5 ml to 10 ml of water before putting it down the feeding tube.
• You can put liquid medications down the feeding tube without diluting them.

When your tamaiti is discharged from hospital, the ward will give you a small supply of nose plasters, syringes and giving sets.

Your dietitian and the Children’s Outreach Nursing Service will organise your first supply of syringes and giving sets. For an ongoing supply, contact Nurse Maude Supply Services (contact details below).

Give as much notice as possible. Let them know if you cannot collect the giving sets — they can courier them to you. There is no charge for giving sets or syringes but there is a small fee for delivery.

If you live in Ashburton, phone the Ashburton Supply Department (contact details below). You will need to collect the giving sets from the supply department.

If your child needs a prescribed feed, your paediatric dietitian will prescribe the feed and organise for it to be delivered to your home. If you need to contact your feed supplier because your feed has not arrived, use the contact details below.

Within Canterbury, contact your dietitian by email for a new prescription when you have a 10-day supply of feed left.

• email: paediatric.dietitians@cdhb.health.nz

Children's Outreach Nursing Service

To contact the Children's Outreach Nursing Service:

• phone: 03 364 0033

Our hours are Monday to Friday, 8:00am to 4:30pm

For urgent help after hours, for example, if your child's tube falls out, phone Christchurch Hospital and ask to speak with Children’s Emergency Care.

• Christchurch Hospital, phone: 03 364 0640

Nurse Maude Supply Services

To contact Nurse Maude Supply Services:

• phone: 03 375 4297
• email: supply@nursemaude.org.nz
• address: 21 Hawdon St, Sydenham, Christchurch.

Our hours are Monday to Friday, 8:30am to 4:30pm

Ashburton Hospital Supply Department

To contact us:

• phone: 03 307 8462
• address: Ashburton Hospital, Entrance D, 12 Elizabeth St, Ashburton.

Open for collection Monday to Friday, 10:30am to 2:30pm.

Feeding pump suppliers

For any issues with your pump, use the following contact details:

FreeGo pump — Abbott Nutritionexternal link

• phone: 0800 738 090

Nutricia Flocare Infinity Pump II — Nutriciaexternal link

• phone: 0800 222 430

Feed suppliers

Abbott and Nestle feed (through Unichem Ilam HealthWorks Pharmacy)

• phone: 03 351 8633

Nutricia feed

• phone: 0800 688 747