IV cannula video (clear explanation and clear demonstration of the technique in young child in under 6 minutes video- theory and two actual cannula insertions)
Taping and IV cannula in a child
IV fluids (PIC )
WHAT IF WE DON'T HAVE: Normal saline +5% fluids?
To make normal saline fluids+ into normal saline + 5% glucose:
To prepare a 5% solution, withdraw 120 mL from the 1 L bag of normal saline and discard.
Add 110 mL of 50% glucose.
The final solution will contain 50 grams in 1025 mL (approximately 5% glucose)
To make normal saline fluids+ 5% into normal saline + 10%:
A 1 L Baxter brand bag of 5% glucose contains an average volume of 1035 mL (51.75 grams of glucose).
To prepare a 10% solution, withdraw 120 mL from the 1 L bag of 5% glucose and discard.
Add 110 mL of 50% glucose.
The final solution will contain 100 grams in 1025 mL (approximately 10% glucose)
Video of inserting a nasogastric tube in child (theory and actual procedure shown at 14:46 on Youtube video)
TIPS
1) swaddle child and place mits (or bandages) on both hands of uncooperative child before NG inserted
2) two person job- one persons holds the head
3) measure NG carefully
4) insert NG in two phases
a) to back of throat and note coughing, wait for coughing to settle a bit then
b) insert to measured depth aiming straight back of nasal passage
c) if hitting resistance then pull back
d) consider placing sucrose in mouth and encourage swallowing during procedure
4) watch breathing , colour and voice quality carefully after putting it in
5) Aspirate NG tube and check pH < 5
6) tape carefully
7) if in doubt of correct placement, consider chest with abdominal xray if available
FULL Information on SCHN guideline NG insertion is on page 16
Taken from SCHN guideline page 16 (above)
Procedure for Insertion of tube
1. Explain procedure to parents and patient. Obtain verbal consent for NGT insertion and document in the patients’ notes Consider involvement of Child Life Therapist and age appropriate position and holding for the procedure.
2. For difficult or non-cooperative patients, consider using anti-anxiolytic measures such as Nitrous Oxide or local anaesthetic sprays when inserting tubes. Consult the medical team if this is considered. 3. Wash hands as per Hand Hygiene Policy
4. Gather and prepare equipment required for tube insertion. i. Pre-cut tapes and protective dressing. ii. Open syringe packaging and ensure pH indicator strips are ready to use
5. Measure the tube (see picture below) and document the measurement in patient notes.
Childs head should be kept in a neutral position when measuring naso/orogastric tube as this can affect length measurement
i. Nasogastric Tube Measure from the tip of the nose to the earlobe and down to midway between the end of the breastbone (xiphoid process) and the umbilicus
ii. Orogastric Tube Measure from the edge of the mouth to the earlobe and down to midway between the end of the breastbone (xiphoid process) and the umbilicus
Figure 3 6. Wash hands as per Hand Hygiene Policy and don PPE.
7. Lubricate the tube with water soluble lubricant. If using a long-term tube prime the tube with sterile water (allows guide wire to be easily removed) and dip the end of the tube in sterile water to activate the lubricant.
8. Gently insert the tube into the nare (nasogastric) or side of the mouth (orogastric tube) and arch it over and downwards into the throat. Encourage the child to swallow if possible to assist with ease of tube insertion.
9. Continue inserting the tube until the measured appropriate length is reached. 10. If resistance is felt during the insertion, do not force the tube; pull the tube out slightly and attempt to reinsert. 11. The tube should be removed if the child becomes persistently distressed, chokes, turns blue or continues to cough. Settle the child and attempt to reinsert the tube.
Guideline No: 2006-8237 v4 Guideline: Enteral Feeding Tubes and the Administration of Enteral Nutrition Date of Publishing: 30 January 2018 2:02 PM Date of Printing: Page 18 of 24 K:\CHW P&P\ePolicy\Jan 18\Enteral Feeding Tubes and the Administration of Enteral Nutrition.docx This Guideline may be varied, withdrawn or replaced at any time. 12. Using a 2.5 - 20mL syringe, obtain an aspirate to check the tube position. Disperse some aspirate on to the pH indicator strips.
If pH is less than or equal to 5, the tube position is confirmed.
DO NOT use other potentially dangerous techniques for confirming tube placement such as gas insufflation/auscultation, secretion colour and litmus paper. 13. If aspirate is unable to be obtained once the tube is placed in the stomach refer to algorithm. (See Algorithm 3)
14. Remove the guide wire and secure the tube using appropriate tapes. Do not reinsert guide wire once it has been removed.
15. Document in the clinical notes: tube type; size; measurement at the nare or mouth; confirmation of tube placement; number of attempts of insertion; and any complications during the procedure.
16. Mark the exit point on the feeding tube with permanent marker. Label tube as per NS
NG rehydration (RCH)
Clean catch urine ( Qld)
Acute pain management (RCH)