ICUGUIDELINECAREANDMANAGEMENTOFNASODU.docVIP

ICU GUIDELINE: CARE AND MANAGEMENT OF NASODUODENAL FEEDING TUBES A GENERAL CONSIDERATIONS:Nasoduodenal feeding tubes NDFT allow for enteral nutrition EN when gastric stasis and/or aspiration risk e.g. gastroesphageal reflux precludes the nasogastric NG route. NDFT can be placed manually for direction re bedside manual placement technique refer to resource entitled “ICU Guideline: Manual ND Feeding Tube Placement” , endoscopically, or by fluoroscopic technique. NDFT must be managed carefully in order to ensure safe and cost-effective EN. B GENERAL GUIDELINES 1 PREVENTING TUBE DISLODGMENT: SECURING THE NDFT 1 Wipe nose with alcohol swab to remove oil. 2 Prepare nose with a barrier/adhesive product.3 Prepare silk tape.4 Place tape on nose a ; pinch tent tape at nostril to reduce contact pressure. 5 Wrap legs b of tape along a 3-inch 8 cm length of tube.6 Secure tape a on nose with 2nd piece of tape c .7 Check tube security daily tug tube . 8 Replace tape as indicated. 2 FEED INITIATION AND TITRATION: Initiate feeds at 25 ml/hr and increase by 25 ml/hr Q4H to goal rate refer to resource entitled”ICU Guideline: Post-pyloric Feeding” . Do not automatically decrease the feed rate based on gastric residual volumes GRV refer to section #5 . 3 PREVENTION OF ASPIRATION: a CONCURRENT GASTRIC DECOMPRESSION: Gastric secretions account for approximately 2400 ml of the fluid handled by the gastrointestinal tract each day. If gastric stasis is a concern, place a decompression tube such as an Argyle Salem Sump NG tube Sherwood Medical, St. Louis, MO, USA. to allow for gastric decompression. Clamp the NG tube; decompress and discard GRV Q4H. Do not place the NG tube on suction as this may result in gastric mucosal irritation, fluid and electrolyte imbalance, and decompress feed from the small bowel. If hourly decompression is required place the NG on straight drainage. NG tubes can be removed once gastric decompression is n