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This guideline is applicable to all medical, nursing, midwifery and nursing support staff caring for neonates within the West of Scotland in both hospital and community settings. In addition, this guideline is also applicable to parents who have been trained to administer enteral feeds via a gastric tube. Staff should also be aware of guidelines for hand hygiene. Staff should also familiarise themselves with the Wospghan document entitled “Enteral tube feeding Information pack for healthcare professionals”
Gastric tube position should be checked :-
Gastric Aspirate pH 6 or above
If the pH reading is 6 or above, do not feed and consider the following:
If the answer to any of the above questions is “Yes”, discuss with medical staff /senior nursing staff prior to administering the feed.
If not, or in any doubt, seek advice from a member of medical/senior neonatal nursing staff. You may have to reposition or remove the gastric tube and reinsert. However, this should only be done as a last resort.
It is important that actions and their rationale are documented.
No aspirate obtained
If there is any difficulty obtaining an aspirate:-
Infants who consistently have an aspirate pH 6.0 or above should have their care discussed and agreed with the multidisciplinary team. Decisions made should be clearly documented in the infant’s medical, nursing and dietetic notes and communicated to all involved in the infant’s care.
N.B. None of the existing methods for testing the position of gastric feeding tubes are totally reliable. The most accurate method for confirming correct tube placement is radiography. However X-Ray for the sole purpose of confirming gastric tube position in a neonate is not recommended.
If a feeding tube is required and it is likely that the baby will need a chest x-ray, it should be passed prior to the x-ray being performed as the x-ray will confirm the position of a tube from which you may be unable to obtain an aspirate.
Please see accompanying flow chart on gastric tube position confirmation
Huband, S Trigg, E (2002) Practices in children’s nursing : guidelines for hospital and community. Edinburgh : Churchill Livingstone
Metheney, N et al (1993) Effectiveness of pH measurements in predicting feeding tube placement : an update Nursing Research 42(6) 324-331
Metheney, N et al (1998) Testing feeding tube placement: auscultation vs, pH method American Journal of Nursing 98 (5) 37-42
NHS QIS (2003) Nasogastric and Gastrostomy Tube Feeding for children being cared for in the community. Best Practice Statement. Edinburgh NHS QIS
Spence, K (2003) Nutritional management of the infant in the NICU in Boxwell, G ed. Neonatal Intensive Care Nursing 3rded. Routledge: London Ch.11
Symon, A and Cunningham, S (1994) Naso Gastric Feeding Methods In Neonates Nursing Times 90(35) 56-60
Last reviewed: 14 October 2019
Next review: 01 October 2022
Author(s): Andrena Kelly – Nurse Educator - RHC
Co-Author(s): Other professionals consulted: Anisa Patel, Clinical Pharmacist, NICU, RHC
Approved By: West of Scotland Neonatology Managed Clinical Network