The Right Tools for the Right Patients: Enteral Feeding in the NICU

 

As a NICU clinician, I am sure you have been in the unit, possibly at the start of your shift, and found that products or equipment you had been using would be changing (or had already changed) to a new manufacturer.

The product could have been as simple as a new brand of tegaderm, or as complex as a UAC transducer or pulse oximeter.

Sometimes the new product was one that was just smaller and could be used for neonates. However, it was not designed for neonates. Instead it is merely a smaller version of an adult product.

When it comes to enteral feeding, don’t settle for just a “smaller” feeding tube, a generic syringe, or a one-size-fits-all extension set.

There are neonatal/pediatric products on the market that are specifically designed for fragile infants and children. One example: neonatal feeding tubes. Neonates require enteral feeds over longer periods of time, which can often extend over months. The feeding tubes must meet the specialized needs of infant patients.

It is critical to be persistent and look for enteral feeding products and manufacturers that meet the needs of the neonatal and pediatric patient population.

When looking for enteral feeding products, there are a few key features and safeguards to consider.

Enteral Feeding Products Checklist

• Feeding tube French sizes to meet the needs of neonatal and pediatric patients
• Clearly marked French size on the hub (or do you have to search for it?)
• Easy-to-read number markings on feeding tubes (dark applique), and do they resist rubbing off
• An end hole in the distal portion of the feeding tube, and side holes
• Smooth-edged side and end holes
• Recommended dwell time for feeding tubes
• Gravity feeding syringes with lids to prevent spills
• Mini- and micro-bore extension sets should be available
• Medport options
• Syringes are clearly marked “enteral”
• Syringe volume markings that are dark and easy to read
• A complete locking system. Products must securely connect to each other (non-standard slip connectors that are not compatible with lure lock.1)
• Milk warming options for enteral feeding patients

It is also important that you do your research and find a manufacturer that offers a full portfolio of neonatal/pediatric enteral feeding products and equipment.

Here are significant points to consider, and questions to ask, when looking for a vendor.

Enteral Feeding Manufacturer Checklist

• Is the manufacturer a neonatal /pediatric enteral feeding company?
• Are they able to meet the complicated needs of the neonatal patient?
• Do they provide quality customer service and education?
• Will the field representatives be available when you need them?
• How much support will be available during a product or equipment install?
• Are clinicians or product experts available to answer questions during product implementation as well as after the installation?
• How are backorders communicated and handled? Are there alternate solutions offered, and will someone be available to walk with you through the process?
• Do they have a warming option (solution) for patients that receive enteral feeding over a period of time (longer than a bolus feed; 20 min – 4 hours)?
• Does their enteral feeding equipment include an “enteral only” feeding pump?
• Are they prepared for the ISO Standards and the changes to be made to small bore connectors as recommended by GEDSA?2

Most importantly, whenever possible, it is imperative that neonatal and pediatric clinicians participate in the decision for products that come into your unit.

Don’t just go with an adult product that is smaller for neonates and pediatric patients. Request a carve-out for your patients. Be prepared to get involved with the upcoming changes for enteral feeding connectors: to find the right products and the right manufacturer for all your enteral feeding needs, and to help ensure best practices, and meet the needs of your specialized patients.

References:

1. Enteral Nutrition Practice Recommendations. Journal of Enteral Parenteral Nutrition. 2009

2. Global Enteral Device Supplier Association (GEDSA). GEDSA.org