Which Feeding Tube is the Right Tube?

 

Have you ever gone to the supply room and stood there for several minutes, trying to decide what kind of feeding tube you needed for a particular baby? Or have you ever just grabbed a tube in haste – and later discovered that it was the wrong type of tube?

I’ve worked in several NICUs where there were many types of neonatal feeding tubes stocked in the supply carts and the supply room. As a bedside nurse, I knew there were short-term and long-term use tubes, but I never considered why they were short or long term, nor did I consider what they were made of.

Only in the last few years did I learn there is a big difference between the types of tubes. Let’s take a deeper dive into feeding tube materials. It just might help you choose the right tube… for the right reason.

Short-term feeding tubes

First, let’s look at polyvinylchloride (PVC) feeding tubes. These tubes tend to be the least expensive.  However, PVC is a stiff tube that continues to get stiffer when exposed stomach acid.1  These tubes should only be used for three days and then changed out. In my experience, I have seen these tubes most often used in a Newborn Nursery/ Postpartum area for finger feeds or SNS, or have seen them used in the resuscitation room to vent a baby’s stomach.

Long-term feeding tubes

The next feeding tube to look at is a polyurethane (poly) tube. I have learned a lot about poly tubes over the last year and found that poly, in my opinion, is a really great middle ground tube. It has a lot of similarities to silicone tubes (which we will talk through next), but is less expensive, and serves multiple purposes. Poly tubes are softer than PVC tubes, yet maintain a bit of stiffness to make insertion easy. Once the poly tube is in the infant, it warms to body temperature and softens.1 Additionally, as Wallace and Steward (2014) go on to discuss, the inner lumen of the tube is wider, and so allows the clinician to apply manual suction to the tube without collapsing the tube. This larger inner lumen also allows for better venting of the stomach for our babies that are on NCPAP or high flow NC, or NPO. Obviously, for these later uses, we want to use the biggest tube possible for that particular baby. I always recommend an eight French tube for to allow the best pathway for air to escape.

Lastly, there are the silicone, or silastic, feeding tubes. In my NICU lifetime, I have seen practice start at PVC and swing to silicone tubes. Silicone tubes are the softest, most pliable tube. We all thought these were the gold standard tubes because of this. However, silicone tubes are generally more expensive, may more easily coil inside the baby, and can be difficult to place because of their pliability. Additionally, if you pull back too hard on the tube, the inner lumen may collapse. Now, I’m not discounting that this material is probably the most comfortable to our babies. Yet, to the clinician, silicone can be very difficult to work with.

One last note: the poly and silicone tubes have very similar lifespans. Most manufacturers have recommended these tubes be used for 30 days. However, there is some growing evidence that indwelling tubes should be changed every seven days (but that’s a conversation for another day, so stay tuned to future blogs!).

I hope this discussion will help you decide which tube(s) are best for your unit, for your babies, and for your practice. We often get asked about a sample policy or protocol for feeding tubes. This is difficult to provide as there is wide variation in practice across units in the United States.

There are some great resources out there that can help guide you towards the most evidence-based practice that is available today. One of them is the study cited for this blog, “Gastric Tube Use and Care in the NICU.” Another is Merenstein & Gardner’s Handbook of Neonatal Intensive Care, 8th Edition. Dig in to that literature and create a standard of practice in your facility.

Tell us: Which feeding tube materials do you prefer, and why? Share your answers in the comments section below!

Learn more about Medela Neonatal Solutions feeding tubes.

Resources:

1. Wallace, T. Steward, D. (2014). Gastric Tube Use and Care in the NICU. Newborn & Infant Nursing Review. (14). 103-108.