What is the management plan for an infant with trauma due to a feeding tube?

Management of Infant Feeding Tube Trauma

The management of an infant with trauma due to a feeding tube requires immediate assessment of tube patency, appropriate tube replacement if necessary, and careful monitoring for complications. 1

Initial Assessment and Management

• Assess the type and severity of trauma, which may include nasal erosions, pharyngeal/esophageal damage, or displacement into the airway 1
• Evaluate for signs of respiratory distress, which may indicate tube displacement into the airway or aspiration 1
• Check tube patency by attempting to pass a soft suction catheter through the tube - avoid using rigid devices like bougies which may create false passages 1
• If the tube is blocked or displaced, consider it a foreign body that must be removed 1
• Provide supplemental oxygen if the infant shows signs of respiratory distress 1

Tube Replacement Protocol

• For nasogastric/orogastric feeding tubes:

  • Use well-lubricated tubes and have experienced staff perform insertion to reduce risk of esophageal damage 1
  • Prefer nasogastric tubes over orogastric tubes as they have less movement against oral mucosal lining 1
  • Secure tubes with low-adherent film contact layer, then full-adherent tape to the film (avoid direct tape contact with skin) 1

• For displaced tubes:

  • Replace with the same size tube for first attempt 1
  • If first attempt fails, use a tube one half-size smaller 1
  • For third attempt, consider using a soft suction catheter as a guide for placement 1
  • Verify proper placement before resuming feeds 1

Preventing Complications

• Monitor for common complications including:

  • Nasal erosions, abscess formation, sinusitis, and otitis media 1
  • Esophagitis and ulceration from local abrasion 1
  • Fistulation to the trachea, especially when an endotracheal tube is present 1
  • Aspiration from reflux 1

• Preventive measures:

  • Rotate feeding tubes between nostrils when replacement is needed (every 4-6 weeks) 1
  • Use smaller diameter tubes to reduce pressure effects 1
  • Provide appropriate mouth care with mouthwashes, ice cubes, or artificial saliva to manage discomfort 1
  • Ensure proper tube fixation to prevent movement and additional trauma 1

Nutritional Considerations

• Calculate nutritional requirements considering wound losses and feeding capacity 1
• Consider continuous feeding rather than bolus to lower resting energy expenditure in young infants 1
• Monitor for signs of feeding intolerance such as vomiting, bloating, or diarrhea 1
• Coordinate feeding with the infant's natural sleep cycle to establish proper feeding patterns 1
• Provide oral-motor stimulation for tube-fed infants to prepare them for eventual oral feeding 1

Special Considerations

• For infants with chronic lung disease, monitor closely for aspiration risk during tube feeding 1
• For infants with epidermolysis bullosa or other skin fragility conditions, use extra caution with tube securement 1
• Consider early gastrostomy placement if long-term nutritional support is anticipated and nasogastric tubes are problematic 1
• For trauma patients requiring long-term enteral access, percutaneous endoscopic gastrostomy (PEG) has fewer complications than surgical gastrostomy 2

Follow-up Care

• Regular assessment of continued need for tube feeding 1
• Monitoring of growth parameters and nutritional status 1
• Evaluation of oral-motor skills development 1
• Parent education on tube care, feeding protocols, and recognition of complications 1

Common Pitfalls to Avoid

• Attempting to use rigid devices to check tube patency, which may create false passages 1
• Continuing to use a tube that shows signs of blockage or displacement 1
• Failing to verify proper tube placement before administering feeds or medications 3
• Neglecting oral care and oral-motor stimulation in tube-fed infants 1
• Inadequate parent education on tube care and emergency management 1