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 the necessary equipment.
• Remove the tube from its packaging or container.
• Inspect the tube to ensure that it is not damaged or soiled.
• Cut the appropriate size of the protective dressing, if applied.
• Cut the appropriate size of the adhesive bandage that will secure the tube to the cheek.
• Open the lubricant packet; place a small amount of lubricant on the open tube package.

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

• Ask your child to blow his or her nose, if possible.
• If he or she is unable to do so, remove secretions from your child’s nose with a tissue or suction nasal secretions, as instructed by your healthcare team.
• Choose which side the tube will be inserted.
• Make sure the skin on the cheek on the same side as that nostril is clean and dry.
• If the tube will be left in place for a long period of time, attach the protective dressing to the cheek where the adhesive bandage will be placed.

Clean nostrils make it easier to insert the tube.

The protective dressing minimizes irritation to the cheek.

• Place your child in a lying down position.
• Swaddle the baby in a blanket if necessary, depending on the baby’s age and degree of collaboration.
• If your child is older, position your child in a seated or semi-seated position and tilt your child’s head slightly forward.

This position facilitates swallowing as well as the progression of the tube through the nose into the stomach and reduces the risk of aspiration into the lungs.

Swaddling the baby increases the safety of the procedure.

• Take the end of the tube and put it on the tip of your child’s nose.
• Holding the end of the tube in place, measure the distance from the tip of the nose (1) ⇒ to the base of the earlobe (2) ⇒ to the base of the sternum breastbone) (3) ⇒ to halfway between the base of the sternum and the navel (belly button) (4).
• Make a mark at this point on the tube with a permanent marker pen or note the number on the tube if it is graduated (numbers pre-marked).

Measuring the insertion length of the tube helps ensure that, once fully inserted, the tube will be correctly positioned for use.

If you use a water-soluble lubricant:

• Spread the lubricant (size of a pea) on the first 3 cm of the tube.
• Roll the end of the tube on in the lubricant. 

If you use water:

• Dip the end of the tube into the glass or water container.
• Shake slightly to remove excess water drops.

Lubrication of the tube makes it easier to insert and more comfortable for your child.

• Give your baby a pacifier to suck on or if your child is older, ask your child to swallow or sip water from a glass with a straw.
• Hold the pre-measured, lubricated tube like a pencil about 3-4 cm from the tip.
• Slowly insert the tube into one nostril while your child swallows; gently but quickly push the tube backwards and down. Do not force.
• Continue to insert the tube until the mark reaches the edge of the nostril.

This method of insertion follows the natural curves inside the nose and the back of the throat and avoids injury.

Swallowing, drinking or sucking while inserting the tube helps advance it into the back of the throat.

Inserting the tube quickly will minimize gagging and discomfort.

Inserting the tube up to the mark allows placement in the stomach.

• If the tube is going to be removed after the feeding session: attach the tube to your child’s cheek with the adhesive bandage.
• If the tube will be left in place for a longer period of time: place the tube over the protective dressing already stuck on the cheek and secure it by placing the adhesive dressing over it.
• Make sure that the pen mark on the tube is clearly visible on the edge of the nostril.
• Make sure that the position of the tube does not compress the edge of the nostril.

This step reduces the risk of accidental removal of the tube.

Do not put too much pressure on the nostril to avoid injury from the tube.

• With one hand, bend the tube near the outside end of it.
• With your other hand, remove the cap from the end of the tube, if in place.
• Connect the syringe.
• Stop bending the tube.
• Gently pull on the plunger to withdraw some gastric secretions (liquid from the stomach, usually clear or light yellow in colour) into the syringe.
• Bend the tube again.
• Disconnect the syringe.
• Replace the cap at the end of the tube.

• Stop bending the tube.
• Check the pH of the gastric secretions: soak the pH indicator paper with a few drops of the liquid collected in the syringe.
  • If the result is 5.5 or less, the tube is in the correct position.
  • If the result is 6 or higher, the tube may not be in the correct place; remove the tube and reinsert it.
• Discard any gastric fluid remaining in the syringe.

This step is used to check if the tube is in the stomach. If so, the pH indicator paper will confirm the acidity of the gastric liquid.

Bending the tube prevents the gastric secretions from leaking out if there is no cap at the end of the tube.

• Put the tip of the syringe into the water container.
• Withdraw the plunger and fill the syringe with the amount of water recommended by your healthcare team to irrigate the tube.
• With one hand, bend the tube.
• With the other hand, remove the cap in place from the end of the tube.
• Connect the syringe.
• Stop bending the tube.
• Slowly depress the plunger of the syringe to push the water into the tube.
• Bend the tube again.
• Disconnect the syringe.
• Replace the cap at the end of the tube.

• Stop bending the tube.

This step clears the tube and prevents blockage.

• Put the tube behind your child’s ear, if this is what your healthcare team recommends.
• The tube should be positioned so that it does not put pressure on your child’s nostril and allows your child to move his or her head.
• Attach the tube according to your healthcare team’s instructions: slide it under clothing or roll it up and tape it to your child’s back with adhesive tape.

This step prevents unintentional removal of the tube, minimizes the risk of strangulation and promotes your child’s comfort.

Go to the next step if you want to give your child medication instead.

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

Proceed with the administration of the medication as planned for your child.

• Wash your hands again.
• Make sure the cap is securely in place at the end of the tube.
• Carefully peel off the adhesive dressing that holds the tube in place on the cheek.
• Place your child’s head slightly tilted back.
• Firmly pinch the tube a few inches near the nose.

• Pull on the tube with a quick and continuous movement, without forcing.
• Peel off the protective bandage if present on the cheek.

Pinching the tube prevents fluid (contained in the tube) from entering the lungs when removing it.

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 the necessary equipment.
• Remove the new button from its packaging.
• Remove the extension set from its packaging or container.
• Inspect the button and extension set for damage.
• Open the lubricant packet; place a small amount of lubricant on the open package of the button.
• Fill syringe #1 with the amount of water needed to inflate the new button balloon, according to the manufacturer’s recommendations or as directed by your healthcare team.
• Fill syringe #2 with the amount of water needed to irrigate the extension set as recommended by your healthcare team.

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

• Hold the sides of the button with one hand.
• With the other hand, connect the tip of syringe #1 into the balloon port until the connection is solid.
• Depress the plunger of the syringe to inject the full amount of water into the balloon.
• While leaving the syringe connected and maintaining pressure on the plunger, check that the balloon is intact and properly inflated.
• If the balloon does not leak, remove the water from the balloon by withdrawing the plunger.
• Leave the syringe filled with water connected to the balloon port.

This step is used to check if the balloon is functioning properly and has no leaks.

Holding the sides of the button will stabilize it during this step.

Screwing the tip of the syringe into the balloon port opens the balloon fill valve.

Lay your baby down or ask your child to lie on his or her back.

The lying down position makes the procedure easier because it provides better access to the stoma site.

Spread a sufficient amount of lubricant on the tip of the new button.

Lubrication makes the button insertion easier and more comfortable for your child.

If the old button is not in place, go to step 10.

• Hold the sides of the button with one hand until the end of the step.
• With the other hand, connect the tip of syringe #3 into the balloon port of the old button until securely connected.
• Remove water from the balloon by withdrawing the plunger.
• If the water does not return, there may be no water left or the syringe may not be inserted deep enough; push the syringe a little more into the balloon port and try to remove the water again.
• When all the water has been removed, disconnect the syringe.
• Set the syringe aside.

This step is necessary to avoid injuring the stoma while removing the old button.

Holding the sides of the button helps stabilize the button during the step.

Screwing the tip of the syringe into the balloon port opens the balloon fill valve.

• Put one hand on your child’s belly and then slowly remove the button pulling vertically with the other hand.
• Even if you feel a little resistance, continue gently but DO NOT FORCE.
• Use this time to observe the stoma and the skin around it.
• Wipe the skin with the towel if any gastric secretions come out of the stoma.

This step is necessary to install the new button.

There may be a small amount of resistance as the old button is removed, even if the balloon is correctly deflated.

• Gently insert the button vertically through the stoma until it is flush with the stomach wall.
• Try inserting the button as your child takes in a breath, when your child is usually more relaxed.
• Slight pressure may be needed to insert the button, especially if your child cries during the procedure, but NEVER FORCE TO INSERT THE BUTTON. Try to calm your child down before continuing.

This prevents injury to the gastrostomy during insertion of the button.

There may be a small amount of resistance as the new button is inserted, even if the balloon is correctly deflated.

It may be a little difficult to insert the button if your child is crying because this causes the abdominal muscles to contract.

• When the button is properly inserted, hold the sides with one hand until the end of the step.
• Depress the plunger of syringe #1 (already connected to the balloon port) with the other hand to inject the full amount of water into the balloon.
• Disconnect the syringe from the balloon port by holding the plunger.
• Set the syringe aside.
• Make sure there is a distance of about a dime between the button and the belly.
• Turn the button at skin level; you should be able to do this without any problem.

Inflating the balloon properly ensures that the button remains in place in the gastrostomy.

Holding the sides of the button helps to stabilize it during the step.

Holding the plunger when disconnecting the syringe prevents water from coming out of the balloon.

The ability to rotate the button confirms that it is not too deeply inserted into the gastrostomy.

• Remove the cover from the extension set feeding port, if in place.
• If the extension set has two ports, make sure the medication port is closed.
• Connect the syringe #2 to the end of the extension set.
• Make sure the extension set clamp is open.
• Depress the plunger of the syringe to inject water all the way to the end of the extension set.
• Close the clamp on the extension set.
• Leave the syringe connected to the extension set.

This step ensures that the extension set tubing is filled with water and ready to flush into the button feeding port.

• Remove the cover from the button feeding port, if closed.
• Hold the sides of the button and insert the extension set into the feeding port.
• Lock the extension set into the button, according to the manufacturer’s instructions or those of your healthcare team.

This step prepares for verification of the button location and irrigation.

Holding the sides of the button helps to stabilize it during the installation of the extension set.

• Open the clamp of the extension set.
• Gently withdraw the plunger of the syringe #2 (already connected to the extension set) to draw some gastric secretions into the syringe.

This step confirms that the button is installed correctly in the stomach.

• Slowly depress the plunger of syringe #2 to push back the gastric secretions and flush water from the extension set into the button.
• When the syringe is empty, close the clamp of the extension set.
• Disconnect the syringe.

This step ensures that the button is patent, ready to use and reduces the risk of the button being blocked with debris.

Go to the next step if you want to give your child medication instead.

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

Go to the next step if the button is not used immediately. 

• Proceed with the administration of the medication as planned for your child.

If you do not use the button immediately:

• Hold the sides of the button.
• Unlock the button extension set, as directed by the manufacturer or your healthcare team.
• Remove the extension set from the button feeding port.
• Put the cover on the button feeding port.

Removing the extension set prevents your child from accidentally pulling on it, moving the button and causing irritation at the insertion site. In addition, an unused extension set is cumbersome.

Holding the sides of the button helps stabilize the button while the extension set is being removed.

Closing the cover prevents leakage of the stomach contents through the button in between feeding sessions.

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 the necessary equipment.
• Open the package of the urinary Foley™ catheter and inspect it to make sure it is not damaged or soiled.
• Put the plug on the end of the catheter.
• Cut out the appropriate size of adhesive bandage that will secure the catheter to the belly.
• Open the bag of lubricant and pour a small amount onto the opened catheter package.
• Fill syringe with the amount of water needed to inflate the catheter balloon, according to the manufacturer’s recommendations or as directed by your healthcare team.

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

• Grasp the balloon port of the catheter with one hand.
• With the other hand, connect the tip of syringe into this port until securely connected.
• Depress the plunger of the syringe to inject the full amount of water into the balloon.
• While leaving the syringe connected and maintaining pressure on the plunger, check that the balloon is intact and properly inflated.
• If the balloon does not leak, remove the water from the balloon by withdrawing the plunger.
• Leave the syringe, filled with water, connected to the catheter.

This step is used to check if the balloon is functioning properly and has no leaks.

Screwing the tip of the syringe into the balloon port opens the balloon fill valve.

Lay your baby down or ask your child to lie on his or her back.

The lying down position makes the procedure easier because it provides better access to the stoma site.

• Spread enough lubricant over the first 3 cm of the tip of the catheter.
• Roll the tip of the catheter in the lubricant.

Lubrication makes the catheter insertion easier and more comfortable for your child.

• With one hand, hold the catheter about 7-10 cm from its tip.
• Gently insert the tip of the catheter into the stoma; gently push the catheter all the way to the end of this length.
• Some pressure may be needed to insert the catheter, especially if your child cries during the procedure; take time to calm your child NEVER FORCE THE CATHETER IN.
• If you are unable to insert the catheter, try a smaller size catheter.
• Wipe the skin with the towel if any stomach contents come out of the stoma.
• Thoroughly clean and dry the skin around the stoma.

This prevents injury to the stoma during insertion of the catheter.

There may be a small amount of resistance as the catheter is inserted, even if the balloon is correctly deflated.

It may be a little difficult to insert the catheter if your child is crying because this causes the abdominal muscles to contract.

• Take the balloon opening with one hand.
• Depress the plunger of the syringe (already connected in the balloon port) to inject the entire amount of water into the balloon.
• While maintaining pressure on the plunger, disconnect the syringe.
• Set the syringe aside.
• Gently pull the catheter until you feel a slight resistance.

Balloon inflation ensures that the catheter remains in place in the stoma.

Pulling slightly on the catheter positions balloon against the stomach wall.

• Secure the catheter in place on the belly with tape to prevent it from moving, according to the method suggested by your healthcare team.
• You can hold it in place using the “H” technique: form an “H” with tape and attach it to the catheter and then to the skin.

Attaching the catheter securely prevents the catheter from moving and irritating the stoma.

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.

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.

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 your child’s button; check to see if it is intact.
• Check to see if the button is correctly in place and not pushed into the stoma, or too far out of the stoma.

This step ensures the safe use of the button.

• Remove the cover from the extension set feeding port.
• If the extension set has two ports, make sure that the medication port remains closed throughout the procedure.
• Connect the syringe to the end of the extension set.
• Make sure the extension set clamp is open.
• Depress the plunger of the syringe to inject water all the way to the end of the extension set.
• Close the clamp on the extension set.
• Leave the syringe connected to the extension set.

This step ensures that the extension set tubing is filled with water and ready to flush into the button feeding port.

• Remove the cover from the button feeding port, if closed.
• Make sure the port is clean.
• Hold the sides of the button and insert the extension set into the feeding port.
• Lock the extension set into the button, according to the manufacturer’s instructions or those of your healthcare team.

This step prepares for verification of the button location and irrigation.

Holding the sides of the button helps to stabilize it during the installation of the extension set.

• Open the clamp of the extension set.
• Slowly depress the plunger of the syringe (already connected to the extension set) to push the water into the button
• When the syringe is empty, close the clamp of the extension set.
• Disconnect the syringe.
• Replace the cover on the feeding port of the extension set.

This step ensures that the button is patent, ready to use and reduces the risk of the button being blocked with debris.

• 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.

• Remove the cover from the extension set feeding port.
• Connect the supply syringe into the extension port.
• Open the extension set clamp.

Connecting the feeding syringe makes it possible to administer 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:
  • close the extension set clamp,
  • disconnect the syringe,
  • put the cover on the extension feeding port,
  • fill the syringe with formula,
  • remove the cover from the feeding port,
  • reconnect the syringe from the extension port,
  • open the extension clamp,
  • 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 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:

• Close the button extension set clamp.
• Disconnect the feeding syringe from the extension set.
• Replace the cover on the extension set.

This step clears the extension for irrigation.

• Remove the cover from the extension set.
• Connect the syringe to the end of the extension set.
• Open the clamp of the extension set.
• Slowly depress the plunger of the syringe to push the water into the button.
• When the syringe is empty, close the clamp of the extension set.
• Disconnect the syringe.
• Replace the cover on the feeding port of the extension set.

This step ensures that all of the formula was given and reduces the risk of the button being blocked with left over traces of formula.

• Hold the sides of the button.
• Unlock the button extension set, as directed by the manufacturer or your healthcare team.
• Remove the extension set from the button feeding port.
• Put the cover on the button feeding port.

If the extension set is kept in place, your child may accidentally pull on it and move the button, in addition to it being cumbersome.

Holding the sides of the button helps stabilize the button while the extension set is being removed.

Closing the cover prevents leakage of the stomach contents through the button in between feeding sessions.

• 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 your child’s button; check to see if it is intact.
• Check to see if the button is correctly in place and not pushed into the stoma, or too far out of the stoma.

This step ensures the safe use of the button.

• Remove the cover from the extension set feeding port.
• If the extension set has two ports, make sure that the medication port remains closed throughout the procedure.
• Connect the syringe to the end of the extension set.
• Make sure the extension set clamp is open.
• Depress the plunger of the syringe to inject water all the way to the end of the extension set.
• Close the clamp on the extension set.
• Leave the syringe connected to the extension set.

This step ensures that the extension set tubing is filled with water and ready to flush into the button feeding port.

• Remove the cover from the button feeding port, if closed.
• Make sure the port is clean.
• Hold the sides of the button and insert the extension set into the feeding port.
• Lock the extension set into the button, according to the manufacturer’s instructions or those of your healthcare team.

This step prepares for verification of the button location and irrigation.

Holding the sides of the button helps to stabilize it during the installation of the extension set.

• Open the clamp of the extension set.
• Slowly depress the plunger of the syringe (already connected to the extension set) to push the water into the button
• When the syringe is empty, close the clamp of the extension set.
• Disconnect the syringe.
• Replace the cover on the feeding port of the extension set.

This step ensures that the button is patent, ready to use and reduces the risk of the button being blocked with debris.

• 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 and extension set are 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.

• Remove the cover from the extension set port.
• Connect the tubing to the end of the extension set.
• Open the extension set clamp.

Once the feeding bag tubing is connected to the button extension set, 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 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 button.
• Every 4 hours and after adding formula to the bag: Shake the bag for 10 seconds.

This ensures that the formula reaches the stomach.

Irrigation of the button extension set during continuous administration of the formula prevents blockage.

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

This step ends the feeding session.

• Close the button extension set clamp.
• Disconnect the tubing from the extension set.
• Replace the cover on the extension set.

This step clears the extension for irrigation.

• Remove the cover from the extension set.
• Connect the syringe to the end of the extension set.
• Open the clamp of the extension set.
• Slowly depress the plunger of the syringe to push the water into the button.
• When the syringe is empty, close the clamp of the extension set.
• Disconnect the syringe.
• Replace the cover on the feeding port of the extension set.

This step ensures that all of the formula was given and reduces the risk of the button being blocked with left over traces of formula.

• Hold the sides of the button.
• Unlock the button extension set, as directed by the manufacturer or your healthcare team.
• Remove the extension set from the button feeding port.
• Put the cover on the button feeding port.

If the extension set is held in place, your child may accidentally pull on it and move the button, in addition to it being cumbersome. 

Holding the sides of the button helps stabilize the button while the extension set is being removed.

Closing the cover prevents leakage of the stomach contents through the button in between feeding sessions.

• 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 its 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 your child’s button; check to see if it is intact.
• Check to see if the button is correctly in place and not pushed into the stoma, or too far out of the stoma.

This step ensures the safe use of the button.

• Remove the cover from the extension set feeding port.
• If the extension set has two ports, make sure that the medication port remains closed throughout the procedure.
• Connect the syringe to the end of the extension set.
• Make sure the extension set clamp is open.
• Depress the plunger of the syringe to inject water all the way to the end of the extension set.
• Close the clamp on the extension set.
• Leave the syringe connected to the extension set.

This step ensures that the extension set tubing is filled with water and ready to flush into the button feeding port.

• Remove the cover from the button feeding port, if closed.
• Make sure the port is clean.
• Hold the sides of the button and insert the extension set into the feeding port.
• Lock the extension set into the button, according to the manufacturer’s instructions or those of your healthcare team.

This step prepares for verification of the button location and irrigation.

Holding the sides of the button helps to stabilize it during the installation of the extension set.

• Open the clamp of the extension set.
• Slowly depress the plunger of the syringe (already connected to the extension set) to push the water into the button.
• When the syringe is empty, close the clamp of the extension set.
• Disconnect the syringe.
• Replace the cover on the feeding port of the extension set.

This step ensures that the button is patent, ready to use and reduces the risk of the button being blocked with debris.

• 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.

• Remove the cover from the extension set port.
• Connect the tubing to the end of the extension set.
• Open the extension set clamp.

Once the bag tubing is connected to the button extension set, the feeding can begin.

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

This step starts the delivery of the formula.

• Open the extension set clamp.
• Observe your child for 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 button.
• 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.

• Close the button extension set clamp.
• Disconnect the tubing from the extension set.
• Replace the cover on the extension set.

This step clears the extension for irrigation.

• Remove the cover from the extension set.
• Connect the syringe to the end of the extension set.
• Open the clamp of the extension set.
• Slowly depress the plunger of the syringe to push the water into the button.
• When the syringe is empty, close the clamp of the extension set.
• Disconnect the syringe.
• Replace the cover on the feeding port of the extension set.

This step ensures that all of the formula was given and reduces the risk of the button being blocked with left over traces of formula.

• Hold the sides of the button.
• Unlock the button extension set, as directed by the manufacturer or your healthcare team.
• Remove the extension set from the button feeding port.
• Put the cover on the button feeding port.

If the extension set is held in place, your child may accidentally pull on it and move the button, in addition to it being cumbersome. 

Holding the sides of the button helps stabilize the button while the extension set is being removed.

Closing the cover prevents leakage of the stomach contents through the button in between feeding sessions.

• 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.

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 long tube; check to see if it is intact.
• Check to see if there are any changes in the outer portion of the tube.

This step ensures the safe use of the long tube.

• Bend the tube and remove its cover.
• Connect the syringe to 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 cover on the tube.
• Release the tube.

This step clears the long tube of any debris 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 cover.
• Connect the syringe to the tube.
• Release the tube.

The installation of the syringe makes it possible to administer 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 cover on the tube,
  • release the tube,
  • fill the syringe with formula,
  • bend the tube again,
  • remove the cover from the tube,
  • reconnect the syringe to 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 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 cover on the tube.
• Release the tube.

This step clears the long tube for irrigation.

• Bend the tube and remove its cover.
• Connect the syringe to 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 cover on the tube.
• Release the tube.

Irrigation ensures that your child has received all of the formula and prevents debris from sticking to the long 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 long tube; check to see if it is intact.
• Check to see if there are any changes in the outer portion of the tube.

This step ensures the safe use of the long tube.

• Bend the tube and remove its cover.
• Connect the syringe to 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 cover on the
• Release the tube.

This step clears the long tube of any debris 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 cover.
• Connect the tubing to the end of the tube.
• Release the tube.

Once the feeding bag tubing is connected to the long 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 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 long tube. 
• Every 4 hours and after adding formula to the bag: Shake the bag for 10 seconds.

This ensures that the formula reaches the stomach.

Irrigation of the long tube during continuous administration of the formula 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 cover at the end of the tube.
• Release the tube.

This step clears the long tube for irrigation.

• Bend the tube and remove its cover.
• Connect the syringe to 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 cover on the tube.
• Release the tube.

Irrigation ensures that your child has received all the formula and prevents debris from sticking to the long 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 its 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 long tube; check to see if it is intact.
• Check to see if there are any changes in the outer portion of the tube.

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 long tube of any debris 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 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 cover.
• Connect the tubing to the end of the tube.
• Release the tube.

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

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

This step starts the administration of the formula.

• Open the extension set clamp.
• Observe your child for 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 long tube.
• Every 4 hours and after adding formula to the bag: Shake the bag for 10 seconds.

This ensures that the formula reaches 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 cover at the end of the tube.
• Release the tube.

This step clears the long tube for irrigation.

• Bend the tube and remove its cover.
• Connect the syringe to 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 cover on the tube.
• Release the tube.

Irrigation ensures that your child has received all the formula and prevents debris from sticking to the long 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.

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 syringe #1 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 medication into the lungs.

If the feeding session is not in progress, go to the next step. 

• Turn off the pump.
• Bend the nasal tube.
• Disconnect the tubing from the tube.
• Replace the cap at the end of the tube.
• Release the tube.
• Put a cap on the end of the tubing or place the end of the tubing on a clean compress.
• Then proceed to step 8.

Mixing medications and formula may cause problems such as:  changing the effect of the medication or causing blockages.  Temporarily stopping the formula feeding to give medications reduces these risks.

• 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 and possible interactions between the formula remaining in the tube and the medication.

• Remove the protective cap from the feeding syringe #2.
• Dip the end of the syringe into the container and draw up the medication by pulling the plunger.
• Fill the syringe with the required amount of medication.
• Hold the syringe with the pointed end upwards and remove the air from the syringe by gently depressing the plunger until a drop of medication comes out of the tip of the syringe.

This step fills the syringe with the amount of medication to be given 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 syringe to the nasal tube allows the medication to be given by push.

• Slowly depress the plunger of the syringe #2.
• Continue until your child has received all the medication.

This ensures that the medication reaches the stomach safely.

When all the medication is administered:

• Bend the tube.
• Disconnect the syringe #2 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 #1 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 #1.
• Replace the cap at the end of the tube.
• Release the tube.

This step ensures that all of the medication was given and reduces the risk of the tube being blocked with left over traces of medication.

Taking into account the time required after the administration of the medication, as indicated by your healthcare team:

• Reconnect the tubing to the nasal tube.
• Start the pump.

This step allows you to continue the temporarily stopped feeding session.

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 syringe #1 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 medication into the lungs.

If the feeding session is not in progress, go to the next step. 

• Turn off the pump.
• Close the clamp of the extension set.
• Disconnect the tubing from the extension set.
• Put a cap on the end of the tubing or place the end of the tubing on a clean compress.
• Then proceed to step 10.

Mixing medications and formula may cause problems such as: changing the effect of the medication or causing blockages.  Temporarily stopping the formula feeding to give medications reduces these risks.

• Make a visual inspection your child’s button; check to see if it is intact.
• Check to see if the button is correctly in place and not pushed into the stoma, or too far out of the stoma.

This step ensures the safe use of the button.

• Remove the cover from the feeding port or medication port, depending on the type of extension set.
• If the extension set has two ports, ensure that the feeding port remains closed throughout the procedure.
• Connect the #1 syringe to the end of the extension set.
• Make sure the extension set clamp is open.
• Depress the plunger of the syringe to inject water all the way to the end of the extension set.
• Close the clamp on the extension set.
• Leave the syringe connected to the extension set.

This step ensures that the extension set tubing is filled with water and ready to flush into the button feeding port.

• Remove the cover from the button feeding port, if closed.
• Make sure the port is clean.
• Hold the sides of the button and insert the extension set into the feeding port.
• Lock the extension set into the button, according to the manufacturer’s instructions or those of your healthcare team.

This step prepares for verification of the button location and irrigation.

Holding the sides of the button helps to stabilize it during the installation of the extension set.

• Open the clamp of the extension set.
• Slowly depress the plunger of the syringe #1 (already connected to the extension set) to push the water into the button.
• When the syringe is empty, close the clamp of the extension set.
• Disconnect the syringe #1.
• Replace the cover on the feeding port of the extension set.

This step clears the button and prevents blockage and possible interactions between the formula remaining in the button and the medication.

• Remove the protective cap from the feeding syringe #2.
• Dip the end of the syringe into the container and draw up the medication by pulling the plunger.
• Fill the syringe with the required amount of medication.
• Hold the syringe with the pointed end upwards and remove the air from the syringe by gently depressing the plunger until a drop of medication comes out of the tip of the syringe.

This step fills the syringe with the amount of medication to be given and removes the air from the syringe.

• Remove the cover from the appropriate port of the extension set.
• Connect the #2 syringe into the extension port.
• Open the extension set clamp.

Connecting the syringe to the button extension set allows the medication to be given by push.

• Slowly depress the plunger of the syringe #2.
• Continue until your child has received all the medication.

This ensures that the medication reaches the stomach safely.

When all the medication is administered:

• Close the button extension set clamp.
• Disconnect the syringe #2 from the extension set.
• Replace the cover on the extension set

This step clears the extension for irrigation.

• Remove the cover from the extension set.
• Connect the syringe #1 to the end of the extension set.
• Open the clamp of the extension set.
• Slowly depress the plunger of the syringe #1 to push the water into the button.
• When the syringe is empty, close the clamp of the extension set.
• Disconnect the syringe #1.
• Replace the cover on the feeding port of the extension set.

This step ensures that all of the medication was given and reduces the risk of the button being blocked with left over traces of medication.

Taking into account the time required after the administration of the medication, as indicated by your healthcare team:

• Reconnect the tubing to the nasal tube.
• Start the pump.

This step allows you to continue the temporarily stopped feeding session.

• Hold the sides of the button.
• Unlock the button extension set, as directed by the manufacturer or your healthcare team.
• Remove the extension set from the button feeding port.
• Put the cover on the button feeding port.

If the extension set is held in place, your child may accidentally pull on it and move the button, in addition to being cumbersome.

Holding the sides of the button helps stabilize the button while the extension set is being removed.

Closing the cover prevents leakage of the stomach contents through the button in between feeding sessions.

Clean, maintain and store equipment as recommended.

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

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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.

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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.

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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.

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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 syringe #1 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.

If the feeding session is not in progress, go to the next step. 

• Turn off the pump.
• Bend the tube.
• Disconnect the tubing from the long tube feeding port.
• Replace the cover at the end of the feeding port.
• Release the tube.
• Put a cap on the end of the tubing or place the end of the tubing on a clean compress.
• Then proceed to step 8.

Mixing medications and formula may cause problems such as: changing the effect of the medication or causing blockages.  Temporarily stopping the formula feeding to give medications reduces these risks.

• Make a visual inspection of your child’s long tube; check to see if it is intact.
• Check to see if there are any changes in the outer portion of the tube.

This step ensures the safe use of the long tube.

• Bend the tube and remove its cover.
• Connect the syringe #1 to 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 #1.
• Replace the cover on the tube.
• Release the tube.

This step clears the tube and prevents blockage and possible interactions between the formula remaining in the long tube and the medication.

• Remove the protective cap from the feeding syringe #2.
• Dip the end of the syringe into the container and draw up the medication by pulling the plunger.
• Fill the syringe with the required amount of medication.
• Hold the syringe with the pointed end upwards and remove the air from the syringe by gently depressing the plunger until a drop of medication comes out of the tip of the syringe.

This step fills the syringe with the amount of medication to be given and removes the air from the syringe.

• Bend the tube and remove its cover.
• Connect the syringe #2 to the tube.
• Release the tube.

Connecting the syringe to the long tube allows the medication to be given by push.

• Slowly press the plunger of the syringe #2.
• Continue until your child has received all the medication.

This ensures that the medication reaches the stomach safely.

When all the medication is administered:

• Bend the tube.
• Disconnect the syringe #2 from the tube.
• Replace the cover on the tube.
• Release the tube.

This step clears the long tube for irrigation.

• Bend the tube and remove its cover.
• Connect the syringe #1 to 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 #1.
• Replace the cover on the tube.
• Release the tube.

This step ensures that all of the medication was given and reduces the risk of the long tube being blocked with left over traces of medication.

Taking into account the time required after the administration of the medication, as indicated by your healthcare team:

• Reconnect the tubing to the long tube feeding port.
• Start the pump.

This step allows you to continue the temporarily stopped feeding session.

Clean, maintain and store equipment as recommended.

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