Administration of nutritional formula: Nasal tube

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

• Create the right moment: integrate the care in a routine.
• Alert your child to the needed care and communicate together.
• Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

See the full description here

Summary:

• Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
• Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
• Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

See the full description here

Summary 3 key concepts:

• Safety: Carefully follow the care practice steps as you have been taught.
• Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
• Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

• Set up on a flat surface or a well-cleaned table.
• Gather and inspect all equipment to ensure that it is not damaged.
• Fill the irrigation syringe with the amount of water recommended by your healthcare team.

This step ensures that the required materials are on hand in order to start the procedure.

Place your child in a seated or semi-seated position according to your child’s comfort and capacity.

This position facilitates digestion and avoids aspiration of the formula into the lungs.

• Make a visual inspection of your child’s tube; check to see if it is intact.
• Check to see if there are any changes in the outer portion of the tube, if the mark is still in the same place and if the adhesive bandage is securely in place.
• Aspirate some gastric secretions, if recommended by your healthcare team: first inject air to empty the tube and then aspirate to get a sample directly from the stomach.
• Afterwards, check the pH of this gastric fluid, if recommended by your healthcare team.

This step ensures the safe use of the tube.

• Bend the tube and remove its cap.
• Connect the syringe to the end of the tube.
• Release the tube.
• Slowly depress the plunger of the syringe to push the water into the tube.
• When the syringe is empty, bend the tube.
• Disconnect the syringe.
• Replace the cap at the end of the tube.
• Release the tube.

This step clears the tube and prevents blockage.

• Remove the protective cap from the feeding syringe.
• Dip the end of the syringe into the container and withdraw up the formula by pulling the plunger.
• Fill the syringe with the required amount of formula.
• Hold the syringe with the pointed end upwards and remove the air from the syringe by pushing gently on the plunger until a drop of formula comes out of the tip of the syringe.

This step fills the syringe with the amount of formula to be administered and removes the air from the syringe.

• Bend the tube and remove its cap.
• Connect the syringe to the end of the tube.
• Release the tube.

Connecting the filled syringe allows for administration of the formula by push.

• Slowly depress the plunger of the feeding syringe and push a small amount of formula at a time, at the speed recommended by your healthcare team.
• Every time the syringe is empty:
  • bend the tube,
  • disconnect the syringe,
  • put the cap at the end of the tube,
  • release the tube,
  • fill the syringe with formula,
  • bend the tube again,
  • remove the cap from the tube,
  • reconnect the syringe to the end of the tube,
  • continue the administration.
• Administer the formula for 20-30 minutes until your child has received the required amount or for the length of time agreed upon with your healthcare team.
• Observe your child for any signs of discomfort when the feeding session is started (eg, nausea, vomiting, difficulty breathing, abdominal pain, sweating, etc.).

This ensures that the formula reaches the stomach safely.

The length of the feeding session depends on the amount of formula required and your child’s tolerance.

When the feeding session is over:

• Bend the tube.
• Disconnect the feeding syringe from the tube.
• Replace the cap at the end of the tube.
• Release the tube.

This step prepares the tube for irrigation.

• Bend the tube and remove its cap.
• Connect the syringe to the end of the tube.
• Release the tube.
• Slowly depress the plunger of the syringe to push the water into the tube.
• When the syringe is empty, bend the tube.
• Disconnect the syringe.
• Replace the cap at the end of the tube.
• Release the tube.

Irrigation ensures that your child has received all of the formula and prevents debris from sticking to the tube and blocking it.

• Leave your child in a seated or semi-seated position for at least 30 minutes after formula administration, if possible.
• Burp your baby after feeding, as needed.

This position facilitates digestion and reduces regurgitation.

Burping your baby avoids abdominal pain (bloating and swelling).

Clean, maintain and store equipment as recommended.

This step is necessary to ensure cleanliness and proper functioning of the equipment for the next use.

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

• Listen to what your child says about the parts of the procedure that were difficult or painful.
• Comfort your child and recognize your child’s collaboration with positive feedback.
• Highlight your child’s  specific strengths that helped make the procedure positive.
• Discuss with your child what might be done the same or differently the next time the care is needed.
• Keep your promises if you have promised a reward, follow through.
• Reward yourself too.

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

• Create the right moment: integrate the care in a routine.
• Alert your child to the needed care and communicate together.
• Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

See the full description here

Summary:

• Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
• Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
• Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

See the full description here

Summary 3 key concepts:

• Safety: Carefully follow the care practice steps as you have been taught.
• Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
• Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

• Set up on a flat surface or a well-cleaned table.
• Gather and inspect all equipment to ensure that it is not damaged.
• Fill the irrigation syringe with the amount of water recommended by your healthcare team.
• Check that the roller clamp on the bag tubing is securely closed.

This step ensures that the required materials are on hand in order to start the procedure.

Place your child in a seated or semi-seated position according to your child’s comfort and capacity.

This position facilitates digestion and avoids aspiration of the formula into the lungs.

• Make a visual inspection of your child’s tube; check to see if it is intact.
• Check to see if there are any changes in the outer portion of the tube, if the mark is still in the same place and if the adhesive bandage is securely in place.
• Aspirate some gastric secretions, if recommended by your healthcare team: first inject air to empty the tube and then aspirate to get a sample directly from the stomach.
• Afterwards, check the pH of this gastric fluid, if recommended by your healthcare team.

This step ensures the safe use of the tube.

• Fold the tube and remove its cap.
• Connect the syringe to the end of the tube.
• Release the tube.
• Slowly depress the plunger of the syringe to push the water into the tube.
• When the syringe is empty, fold the tube.
• Disconnect the syringe.
• Replace the cap at the end of the tube.
• Release the tube.

This step clears the tube and prevents blockage.

• Open the cap of the feeding bag.
• Pour the formula into the bag, adding about 30 ml more than the amount to be given to get rid of the the air in the tubing.
• Close the cap of the bag.

This step allows you to fill the bag with the formula.

• Hang the bag at a height of 45 to 90 cm above your child’s head.
• Hang it from a coat rack, a wall hook, or place it on the IV pole.

The correct positioning of the bag promotes the safe administration of the formula.

• Compress the drip chamber to fill it with formula to 1/3 or 1/2 of its capacity.
• Remove the cap from the end of the tubing.
• Then open the roller clamp to allow the formula to flow down through the tubing and get rid of air from the rest of the tubing.
• Direct the end of the tubing into a container to catch the few drops of formula that will drip out of the tubing.

• When the tubing is filled with formula, close the roller clamp.

This step avoids the entry of air into the stomach and prevents swelling of the belly from excess air.

• Bend the tube and remove its cap.
• Connect the tubing to the end of the tube.
• Release the tube.

Once the feeding bag tubing is connected to the nasal tube, the feeding can begin.

• Open the roller clamp and slowly roll the roller up or down until you get the flow rate agreed upon with your healthcare team.

• Observe your child for any signs of discomfort when the feeding session is started (eg, nausea, vomiting, difficulty breathing, abdominal pain, sweating, etc.).

If the formula is administered over a long period of time or continuously:

• Every 4 hours: Irrigate the tube.
• Every 4 hours and after adding formula to the bag: Shake the bag for 10 seconds.

This sets a rate for the formula to be fed into the stomach.

Irrigation of the tube prevents blockage.

When the feeding session is over, close the roller clamp on the bag tubing.

This step ends the feeding session.

• Bend the tube.
• Disconnect the tubing from the tube.
• Replace the cap at the end of the tube.
• Release the tube.

This step clears the tube for irrigation.

• Bend the tube and remove its cap.
• Connect the syringe to the end of the tube.
• Release the tube.
• Slowly depress the plunger of the syringe to push the water into the tube.
• When the syringe is empty, bend the tube.
• Disconnect the syringe.
• Replace the cap at the end of the tube.
• Release the tube.

Irrigation ensures that your child has received all of the formula and prevents debris from sticking to the tube and blocking it.

• Leave your child in a seated or semi-seated position for at least 30 minutes after formula administration, if possible
• Burp your baby after feeding, as needed.

This position facilitates digestion and reduces regurgitation.

Burping your baby avoids abdominal pain (bloating and swelling).

Clean, maintain and store equipment as recommended.

This step is necessary to ensure cleanliness and proper functioning of the equipment for the next use.

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

• Listen to what your child says about the parts of the procedure that were difficult or painful.
• Comfort your child and recognize your child’s collaboration with positive feedback.
• Highlight your child’s  specific strengths that helped make the procedure positive.
• Discuss with your child what might be done the same or differently the next time the care is needed.
• Keep your promises if you have promised a reward, follow through.
• Reward yourself too.

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

• Create the right moment: integrate the care in a routine.
• Alert your child to the needed care and communicate together.
• Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

See the full description here

Summary:

• Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
• Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
• Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

See the full description here

Summary 3 key concepts:

• Safety: Carefully follow the care practice steps as you have been taught.
• Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
• Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

• Set up on a flat surface or a well-cleaned table.
• Gather and inspect all equipment to ensure that it is not damaged.
• Fill the irrigation syringe with the amount of water recommended by your healthcare team.
• Make sure the pump is properly charged or plugged into a wall outlet.
• Place the pump on a solid surface (eg, chest of drawers, bedside table or kitchen table), on an IV pole or in a backpack.

This step ensures that the required materials are on hand in order to start the procedure.

Place your child in a seated or semi-seated position according to your child’s comfort and capacity.

This position facilitates digestion and avoids aspiration of the formula into the lungs.

• Make a visual inspection of your child’s tube; check to see if it is intact.
• Check to see if there are any changes in the outer portion of the tube, if the mark is still in the same place and if the adhesive bandage is securely in place.
• Aspirate some gastric secretions, if recommended by your healthcare team: first inject air to empty the tube and then aspirate to get a sample directly from the stomach.
• Afterwards, check the pH of this gastric fluid, if recommended by your healthcare team.

This step ensures the safe use of the tube.

• Bend the tube and remove its cap.
• Connect the syringe to the end of the tube.
• Release the tube.
• Slowly depress the plunger of the syringe to push the water into the tube.
• When the syringe is empty, bend the tube.
• Disconnect the syringe.
• Replace the cap at the end of the tube.
• Release the tube.

This step clears the tube and prevents blockage.

• Open the cap of the feeding bag.
• Pour the formula into the bag, adding about 30 ml more than the amount to be given to get rid of the the air in the tubing.
• Close the cap of the bag.

This step allows you to fill the bag with the formula.

• Install the bag so that the highest level of the formula is about 15 cm above the pump.
• Hang it from a coat rack, a wall hook, or place it on the IV pole.
• If the bag is put in a backpack, keep the bag upright.

The correct positioning of the bag promotes the safe administration of the formula.

As directed by the manufacturer or your healthcare team:

• Turn on the pump.
• Verify that the prescribed delivery parameters (eg, volume, flow rate) are set.
• Insert the bag tubing onto the pump.

This step ensures secure administration of the formula.

• Remove the cap from the end of the tubing.
• Get rid of the air from the bag tubing, as instructed by the manufacturer or your healthcare team.

This step avoids the entry of air into the stomach and prevents swelling of the belly from excess air.

• Bend the tube and remove its cap.
• Connect the tubing to the end of the tube.
• Release the tube.

Once the bag tubing is connected to the nasal tube, the feeding can begin.

Start the pump as directed by the manufacturer or your healthcare team.

This step starts the delivery of the formula.

• Observe your child for any signs of discomfort when the feeding session is started (eg, nausea, vomiting, difficulty breathing, abdominal pain, sweating, etc.).

If the formula is administered over a long period of time:

• Every 4 hours: Irrigate the tube.
• Every 4 hours and after adding formula to the bag: Shake the bag for 10 seconds.

This allows delivery of formula at a set rate into the stomach.

When the feeding session is over, turn off the pump as instructed by the manufacturer or your healthcare team.

This step ends the administration of the formula.

• Bend the tube.
• Disconnect the tubing from the tube.
• Replace the cap at the end of the tube.
• Release the tube.

This step clears the tube for irrigation.

• Bend the tube and remove its cap.
• Connect the syringe to the end of the tube.
• Release the tube.
• Slowly depress the plunger of the syringe to push the water into the tube.
• When the syringe is empty, bend the tube.
• Disconnect the syringe.
• Replace the cap at the end of the tube.
• Release the tube.

Irrigation ensures that your child has received all of the formula and prevents debris from sticking to the tube and blocking it.

• Leave your child in a seated or semi-seated position for at least 30 minutes after formula administration, if possible.
• Burp your baby after feeding, as needed.

This position facilitates digestion and reduces regurgitation.

Burping your baby avoids abdominal pain (bloating and swelling).

• Leave the tubing in place in the pump and follow your healthcare team’s or manufacturer’s instructions for cleaning.
• Clean all other materials and equipment and store as recommended.

This step is necessary to ensure cleanliness and proper functioning of the equipment for the next use.

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

• Listen to what your child says about the parts of the procedure that were difficult or painful.
• Comfort your child and recognize your child’s collaboration with positive feedback.
• Highlight your child’s  specific strengths that helped make the procedure positive.
• Discuss with your child what might be done the same or differently the next time the care is needed.
• Keep your promises if you have promised a reward, follow through.
• Reward yourself too.