Focus on Pediatrics

Practice makes perfect with NG tube insertion

Hands-on learning essential for success at home

When health care providers refer parents or caregivers of pediatric patients to the learning center at The Children’s Hospital of Philadelphia to be taught nasogastric (NG) tube insertion, they can be sure that the education is thorough.

The class where participants are taught how to insert an NG tube through the nose into the stomach for feedings is about one and a half hours. If a pump is used to administer the feedings, the additional teaching requires another hour and a half.

The lesson plan has proven successful. Eighty-five percent of families taught NG tube insertion and care at the learning center were independent in inserting the tube and providing enteral feeds, and 88% of families were confident and prepared to care for their child at home. The initial visit time for a home care nurse was reduced by 62% for families taught in the learning center, says Linda S. Kocent, RN, MSN, coordinator of patient-family education at The Children’s Hospital of Philadelphia.

Education begins with a handout that is distributed to families prior to their appointment at the learning center to help prepare them for the lesson. Kocent says the most difficult part of the lesson for parents is conceptualizing doing an invasive procedure on their child.

"The inpatient parents are more prepared for they have watched the nurse insert an NG tube, seen their child’s reaction, and have accepted that they will have to perform the procedure on their child," says Kocent.

On the other hand, outpatient families only have the information their physician has provided along with the educational handouts, so they aren’t totally prepared for how their child might react. The emotional aspect is the hardest part for parents, says Kocent.

Toddlers are especially challenging because they cannot understand what is happening to them. Parents must hold them still while inserting the NG tube. Also, they frequently pull the tube out so that it has to be inserted time and again during the time that NG feeding is required.

When an outpatient family arrives at the learning center for teaching, the child is included if he or she is at an appropriate age to either insert the tube or help. However, if the child is young and not able to sit still for three hours of teaching, a child-life specialist works with him or her in preparation for the procedure.

With the aid of a model, the nurse begins the lesson by giving families basic information on how the GI system works. Tube placement is critical because the esophagus is close to the trachea and therefore the tube can be placed down the wrong passage entering the lung rather than the stomach, says Kocent.

The next step is to familiarize parents with the equipment such as the tube, the wire inside it that helps with insertion, along with lubricants that are used. The nurse then demonstrates on a mannequin how to insert the tube, secure it with tape, and check for correct placement. Placement can be monitored with pH paper that turns a certain color if the tube is inserted into the lungs and another color if the tube is in the stomach.

"Parents have an opportunity to practice everything the nurse did and ask questions. When they feel comfortable and the nurse thinks they are ready, they transfer their newly learned skills to their child," says Kocent.

Those parents who have children in the hospital practice the technique at bedside under the supervision of a nurse. The skills are reinforced by the home care nurse at the families’ homes for both outpatient and inpatient teaching scenarios.

Children vary widely in their cooperation with the NG tube insertion. "It’s very individual. Every year older is a year developmentally stronger, so the potential for cooperation is higher. It also depends on a child’s history," says Kocent.

Nurses at the learning center have taught a 6-year-old to insert the tube while teens sometimes must rely on their parents to complete the procedure. Children with ongoing medical problems who have spent time in the hospital are often more used to invasive procedures. Techniques to help the child concentrate on swallowing, such as drinking through a straw, are frequently taught.

"If all goes well, it takes a couple of minutes for an NG insertion. If a child is tensed up and not cooperating, it can take a half hour," says Kocent.

When parents are not educated properly, they may not understand the importance of using the NG tube and it may impact the child’s ability to grow and thrive normally, or it could impact the healing process if used following a surgery. The pump may not be programmed correctly and the child could be overfed or underfed. Also, the tube could be inserted incorrectly into the lung rather than the stomach.

The success of the education program at The Children’s Hospital of Philadelphia is reflected in the number of sessions taught. NG tube insertions are one of the most frequent teachings at the learning center, comprising 15% of all classes. The learning center averages 200 classes per month.

Source

For more information about NG tube insertion classes at the learning center at The Children’s Hospital of Philadelphia, contact:

Linda S. Kocent, RN, MSN, Coordinator of Patient-Family Education, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104. Telephone: (215) 590-3661. E-mail: kocent@email.chop.edu.