Nasogastric Tube Feeding ( Home ) - Discharge of Babies Requiring Short Term

Publication: 20/05/2008  --
Last review: 06/02/2018  
Next review: 23/03/2021  
Clinical Guideline
CURRENT 
ID: 1255 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2018  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Guideline For the Discharge of Babies Requiring Short Term Home Naso-Gastric Tube Feeding

Aim

To identify infants who require short term nasogastric tube feeding and to plan and implement a package of care tailored to the needs of the individual infant and family to promote a smooth transition from hospital to home.

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Goals

  1. To initiate and implement a discharge plan following discussion with the parents/carers and the multidisciplinary team.
  2. Identify specific education needs for parents/carers to manage their baby’s nutritional needs.
  3. Identify and organise the provision of required equipment and resources.
  4. Foster a partnership in care ensuring safe discharge to a supported home environment.
  5. To provide ongoing support and care within the home environment.

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Criteria for Discharge Home

To qualify for early discharge for short term home tube feeding the following criteria must be fulfilled:

  • Infant must be > 34 weeks corrected gestation
  • Infant is able to maintain axilla temperature >36.5C in an open cot
  • Infant is able to demonstrate stability in blood sugar levels in case there is a delay in receiving a nasogastric feed, e.g. when the nasogastric tube is displaced
  • There must be no concerns about weight gain (actual weight is unimportant)
  • If the infant is on treatment for gastro-oesophageal reflux, symptom control must be achieved. Any revision to the accepted aspirate pH range should be discussed with the medical team and documented
  • Infant is medically fit for discharge and it is anticipated that nasogastric tube feeding at home is short term
  • If parents do not wish to learn how to pass a nasogastric tube but are confident in checking tube placement and giving bolus feeds then discharge will be considered when the baby is feeding effectively/completing at least 50% of their feeds orally in 24 hours, (either breast or bottle), without requiring nasogastric ‘top-ups’.
  • If parents are confident in inserting a nasogastric tube, discharge will be considered once the infant is feeding effectively/completing 2-3 feeds orally in 24 hours (either breast or bottle)  without requiring   nasogastric ‘top-ups’
  • Parents/carers must have completed a nasogastric tube feeding teaching package, including all competencies and documentation completed. They must feel confident in all aspects of care.
  • An individualised risk assessment has been undertaken with the parents/carers which will be completed at home.
  • The Neonatal Outreach Team is able to provide a good quality safe service,with appropriate staffing levels and equipment available (Casiro et al 1993, Langley et al 2002).

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Staged Approach to Discharge

  1. The infant should be assessed by the nursing staff. If any major feeding difficulties are identified they should not be considered for short term nasogastric tube feeding.
  2. Following discussion with a Consultant Neonatologist, ward nursing staff and the Neonatal Outreach team, a decision is made that short term nasogastric tube feeding is viable (Spinner et al 1998). This outcome must be documented on the tube feeding care plan.
  3. There should be a discussion with parents/carers concerning the need for short term nasogastric tube feeding that may need to continue following discharge home. They must understand the principles and consent to taking the infant home with a nasogastric tube in-situ.
  4.  Once the decision for home tube feeding has been reached and agreed by all parties concerned, the parents/carers must be supported to complete the relevant parts of the education package. Parents /carers may choose to learn to check the tube is correctly positioned and give bolus feeds or they may progress and learn how to safely pass a nasogastric tube and then check it is correctly positioned.
  5. Parents should be encouraged to participate in this aspect of the baby’s care as soon as possible as the earlier they are involved in their baby’s cares the more confident they will be at discharge. This is known to significantly reduce pasrent/carers levels of anxiety following discharge. (Lee et al 2013)

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General Points

  1. Naso-gastric tube feeding discharge planning is supplemental to ongoing discharge preparation within the Neonatal unit (NNU).
  2. The discharge of infants requiring short term nasogastric tube feeding is beneficial for family-infant integration/bonding and the promotion of optimal infant development. (Wakefield and Ford 1994, Cruz et al 1997, Spinner et al 1998, UNICEF 2013)
  3. The hospital Neonatal Consultant will continue to be responsible for the care of the infant until full oral feeds are established.

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Guideline Procedure

  1. It is important to discuss with the parents/carers about the infant’s need for short term nasogastric tube feeding. Ensure the parents/carers receive the written nasogastric tube feeding education package to read before they make a decision. Parents/carers should not be coerced into taking their infant home short term nasogastric tube feeding. (Charles-Edwards and Casey 1992, Wakefield and Ford 1994).
  2. The Neonatal Outreach team will complete an individualised risk assessment.
  3. Ensure the parents/carers have the opportunity to discuss the education package and to practice all the components. Routine discharge planning should take place alongside the nasogastric tube feeding education pack (Rose et al 2008).
  4. Ensure that all components of the nasogastric tube feeding pack are completed and the parents/carers are both happy and competent in all aspects of nasogastric tube feeding. As well as parents being ‘signed off’ by staff to confirm parents/carers competency, parents must also sign to confirm that they feel confident and competent with this. A  record of competency must  be kept in the patient medical notes.
  5. Ensure the parents/carers are given all the necessary equipment to take home in order to enable them to naso-gastric tube feed safely.
  6. Encourage the parents/carers to spend at least one night on the unit to care for their infant prior to discharge home. (Please note this may be done before the education package is fully completed).
  7. The routine discharge planning (including basic life support) and the nasogastric tube feeding package must be completed prior to discharge. Discharge can only take place when all those involved are happy with the decision.
  8. The medical discharge summary must be available for the day of discharge of the infant and must state that the infant is going home on short term tube feeding. The baby cannot be discharged without a discharge summary for the parents to take with them.
  9. On discharge a discussion should take place with the parents/carers on an individualised basis regarding ‘trouble shooting’ This will advise them on action to take and who to ring if they need assistance during the day or night.

Provenance

Record: 1255
Objective:

To identify infants who require short term naso-gastric tube feeding and to plan and implement a package of care tailored to the needs of the individual infant and family to promote a smooth transition from hospital to home.

Clinical condition:
Target patient group: Infants who require short term naso-gastric tube feeding
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

Casiro O.G et al  Earlier Discharge with Community-Based Intervention for Low Birth Weight Infants: A Randomized Controlled Trial. Pediatrics 1993; 92:128-134
Charles-Edwards I, Casey A. Parental involvement and voluntary consent. Journal of Paediatric Nursing1992;February: 16-18.
Cruz. H et al.  Early hospital discharge of preterm, very low birth weight infants. Journal of Perinatol 1997 Jan-Feb 17 (1):29-32
Langley. D et al  Impact of community neonatal services: a multicultural survey. Archives of Disease in Childhood, Fetal, Neonatal Ed 2002;87:3 F204-F210
Rose. C et al  Strategies for getting preterm infants home earlier. Archives of Disease in Childhood 2008;93:4 271-273
Lee S.K et al  A pilot cohort analytical study of Family Integrated Care in a Canadian Neonatal Intensive Care Unit. BMC Pregnancy and Childbirth 2013 13 (supp11):S12
Spinner. S  et al  Earlier discharge of infants from neonatal intensive care units: A pilot program of specialised case management and home care. Journal of Clinical Paediatrics 1998 June;37:6 353 -357.
UNICEF  The Evidence and Rationale for the UNICEF UK Baby Friendly Initiative Standards 2013 London UNICEF UK
Wakefield J, Ford L. Nasogastric Tube Feeding and Early Discharge. Journal of Paediatric Nursing 1994;6:9 18-19

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

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