The NICU Enteral Feeding Tube Checklist

Those darn OG and NG feeding tubes.

Remember the last time one of your NICU babies managed to pull his loose? I figured you would.

That may have been the last time you looked at a feeding tube and really considered it at length (no pun intended).

Enteral feeding tubes may not stand out too much during your day-to-day (except when nimble fingers manage to move them). Instead they are a routine function, always there, just another checkmark on your list. Day in. Day out.

Precisely because they are so common, it’s easy to forget they have many options to choose from. Understanding these options can better prepare your unit for change and solutions down the road.

Keep these 4 considerations in mind to address your specific unit and best practices requirements when it comes to neonatal feeding tubes:

1. Feeding tube material

You’re already familiar with the three enteral feeding tube materials: PVC, polyurethane, and silicone. But did you also know their recommended insertion duration? How about the material flexibility? Here’s a quick cheat sheet:

Material is definitely a factor in your unit’s feeding tube decisions. No matter what material you currently use, it is important to be aware of the differences that may be needed for ideal use later.

2. Feeding tube size (French size)

French size comes into play depending on your unit level needs. Smaller, more critical babies will require smaller tubes, while larger infants will need larger tubes for higher feeding volume.

Use of fortifiers will also influence your French size choices. Small size 5 French tubes will deliver a very slow feed indeed when fortifier is used.

These are the most common French sizes for neonatal or infant feeding tubes and their use in NICU or PICU:

 

3. Feeding tube length

Selecting a feeding tube length is easy. Or is it?

Every NICU has differing needs based on their unit layout, equipment, available space, and more.

Your unit will make decisions on feeding tube length with those variables in mind, along with feeding methods: Syringe pump feeds will typically require a longer feeding tube, while gravity feeds often use shorter tubes.

And just to make things more exciting, PVC and polyurethane feeding tubes are typically measured in inches, with silicone often measured in centimeters.

These are the common NICU feeding tube lengths:

4. Feeding tube connectors

You’ve no doubt felt the winds of change stirring up feeding tube controversy in your hospital these past few years.

Back in the day just about everyone used slip tip connectors on their enteral feeding components. Unfortunately, slip tip connectors had their inherent issues: (1) Common disconnections, (2) stretched out hubs, and (3) the ability to connect with IV connectors (a very big safety concern).

Locking connectors were then designed to improve both clinician and patient experience. These were non-luer connectors that would not connect to an IV connector. They continue to perform admirably today in healthcare.

Recent years have seen yet another improvement: the ENFit connector. These connectors were not only locking, non-luer connectors, but also incorporated reversed male/female orientation to ensure inability to connect to any other application connector.

In summation, the following connectors are either recommended or not recommended: