nfeeding tubesa s o g a s e s t r i c - Eurosteriel Medical · medicina nasogastric feeding tubes | 2 . 3 | medicina nasogastric feeding tubes key features radiopaque stripe Medicina

feeding tubesfeeding tubesnasogastric

1 | med ic ina nasogastr ic f eed ing tubes

medicina nasogastricfeeding tubes andaccessories

Medicina has put together the most

comprehensive range of feeding tubes

available in the UK.

All Medicinanasogastric andnasojejunal tubesare fully compliantwith both NPSAalerts

“ “

Within this range are tubes to feed all

types of patients from 400g babies to

large adults, in both long and short-term

designs. There are three types

described in this booklet and sections

on how to select the right size and

length for a particular patient.

Other sections show how to pass a

tube safely and check that it is in the

correct position to feed.

We have also put together a variety of

accessories to help with feeding,

aspiration, flushing and the delivery of

medicines. We will also cover the care

and maintenance of tubes and what to

do when anything goes wrong.

fully NPSA compliant

In March 2011 the

NPSA issued a Patient Safety

Alert which updated the NPSA

Alert from March 2005.

These alerts are very clear in the physical

characteristics needed for a tube that is

going to be used for feeding, flushing or

for medication.

All Medicina nasogastric and nasojejunal

tubes are fully compliant with both alerts.

co

mplia

nt

FULLY

NPSA

tubeselection It is important to choose the correct size

of feeding tube in relation to the size of

the patient and also in relation to the

function required.

Feeding tubes tend to have narrower

bores than aspiration tubes and smaller

patients tend to have narrower tubes.

The length of tube must also be sufficient

to reach the desired site, without leaving

too much external length on the face.

Caution: neonates can be at risk from

the use of longer tubes instead of an

extention set, as the tube can become

wrapped around the child’s neck.

diameterIn adults, on standard feed, the most

commonly used size is 8FR. If higher

density feeds or feeds with fibre are

used then a 10FR tube is normally

selected. In children the standard size is

6FR with 8FR for thicker feeds or fibre

feeds. In neonates 4-5FR is standard

and 6FR for higher densities.

lengthIt is important to take a measurement

of the approximate depth of a feeding

tube placed into the stomach. Normally

the distance from the ear to the nose and

then from the episternum to the nose are

added together.

For jejunal feeding add approximately

30cm more to the distance. It is also

important to have sufficient external

length to reach and connect to a

feeding pump or to allow sufficient

height for bolus feeding. Typical lengths

used in neonates are 50cm, in children

50-75 and in adults 75-85cm. An adult

Jejunal tube would be about 120-130cm.

Tubes should be soft and have a

smooth surface to ease their passage.

The tube connector and guide-wire

connector should have a lock such as a

Luer lock for security and to help

aspiration. The tube should be marked

every cm along the length to reference

the correct depth of the tube. The tip

of the tube should be rounded and

usually two feeding ports are better

than one in case one becomes

blocked. Bolus tips are sometimes

made but they add to the diameter and

make the tubes harder to pass. Weights

are sometimes added to help passage

through the pylorus into the small

bowel.

tube characteristics

Standard High density

Patient feeds feeds

Neonates 4-5FR 6FR

Children 6FR 8FR

Adults 8FR 10FR

med ic ina nasogastr ic f eed ing tubes | 2


key features

radiopaque stripeMedicina has made two major changes

to the radiopaque stripe. The amount of

barium sulphate in the stripe has been

doubled from the normal 20% to 40%.

The width of the radiopaque stripe has

also been doubled. This makes it much

easier to see the tubes on X-Ray even in

difficult patients.

distance marksAll Medicina nasogastric and nasojejunal

tubes have centimetre depth markings.

This makes it easy for the user to record

the amount of tube placed inside the

patient when it is first inserted. This can

then be compared to the depth before

every feed or medication to check that

no movement has taken place.

nasogastric tubepriming volumes

diameter length 50cm 80cm 120cm4FR 0.25mls 0.6mls 0.9mls5FR 0.5mls 0.8mls 1.1mls6FR 0.7mls 1.1mls 1.6mls8FR 0.9mls 1.4mls 2.1mls10FR 1.7mls 2.8mls 4.2mls

“many countrieshave now bannedthe use ofstandard I.V.Luers on allenteral feedingequipment

“

short term tubes

long term tubes

clear tubing

clear stripe

radiopaque stripe

radiopaque tubing


labelDocumentation of the Tube placement is

one of the key features of the NPSA

guidelines. The label included in the

packaging of Medicina Long-term

nasogastric tubes makes recording all

the important details easier. These labels

are also available as a separate item.

colour codingAll Medicina tubes have a colour coded

strap which allows Clinical staff to see the

diameter of the tube at a glance. The

Tubes also have the French Gauge and

length printed at the top of the tube next

to the male connector.

pH paperAll Medicina long term tubes come

supplied with a strip of Medicina pH

Indicator paper for immediate testing of

the tube position. The Medicina pH paper

is CE marked for testing human gastric

aspirate. Under the NPSA guidelines pH

testing is the first line test for tube

position. The Medicina pH Indicator strip

acts as its own colour chart, doing away

with the need to have access to the box.

The pH strips are also available

separately in boxes of 200.

4FR red

5FR grey

6FR light green

7FR pink

8FR light blue

9FR dark blue

10FR black

12FR white

14FR dark green

16FR orange

18FR red

20FR yellow


SG4/40 4FR x 40cm length



















weighted tubesSG6/50W 6FR x 50cm length

SG6/80W 6FR x 80cm length




This range of tubes is

designed to feed patients

for short periods of up to

twenty eight days.

They are generally used in neonates and

children but can be used in adults who

require short-term enteral support.

The tubes are used to feed, deliver

medicines and aspirate stomach

contents.

The tubes have a male Luer lock

connector which fits oral/enteral

syringes and the female Luer ends of

pump administration sets. The tubing

itself is smooth and carries distance

marks to reference tube position.

All tubes have a radiopaque stripe to

confirm position with X-ray.

The popular sizes are also

available in tungsten

weighted form which can be

useful for feeding into the small

bowel or where X-ray confirmation is

difficult.

These tubes offer a comfortable safe

solution to the nutritional support of

infants and children.

Caution

In small babies who are ventilated the

tubes should be changed every 7 days

to avoid chest infections.

28 days · 4-14FR · Polyurethane

short terminfantnasogastric tubes

long termfinebore feedingtubes These tubes are used to feed adults and

children for up to 60 days. They are available

from 6FR - 10FR diameters with a variety of

lengths from 55cm - 130cm. Some popular

sizes in 8 & 10FR are also available weighted.

nasogastric tubesNGP6/55 6FR x 55cm length

NGP6/75 6FR x 75cm length








weighted tubesNGP8/85W 8FR x 85cm length

NGP10/85W 10FR x 85cm length

nasojejunal tubesNGP6/120 6FR x 120cm length




Typical users would be critical care areas,

medical and care of the eldery units,

paediatric units and also community

patients.




pump administration sets. They also

have a male-Luer guidewire holder

allowing aspiration to confirm

correct position using oral/enteral

syringes.

The tubing itself is smooth and

carries distance marks to

reference tube position.

All tubes are fully radio-opaque

(40% barium sulphate compounded

into the polyurethane), to confirm

position with X-ray or a pH strip is

included in each pouch.

The new 40% barium Sulphate tubes

have a clear stripe so that any change in

aspirate colour or feed interaction with

medicine can be detected without the

need for tube removal.

The Nasojejunal tubes have a single open

end feeding port that allows them to be

passed over an endoscopically or

radiologically placed guidewire should

this be needed.



short termRylesfeeding tubes

This range of tubes is designed to aspirate

stomach contents in adults and children.

However they can be used for short-term feeding.

They are available from 6FR-20FR with lengths of

80-100 cm. Typical users would be critical care

areas, theatres and surgical wards. They can also

be used on an emergency crash trolley.




pump administration sets. In addition

they have a funnel or bladder type

connector to fit suction equipment.

The tubing itself is smooth and carries

distance marks to reference tube

position. All tubes have a radio-opaque

stripe to confirm position with X-ray or

a pH strip is included in each pouch.

These tubes are softer and smoother

than normal PVC Ryles Type tubes

and are easier to pass and more

comfortable for the patients.


RT6/80 6FR x 80cm length










This range of silicone tubes are soft and

comfortable and are used for long term

feeding in neonates and children.

Because of the softness and long-term nature

of the material they can stay in place for up to

90 days, providing a safe comfortable solution

for long-term enteral support.

The tubes are all 100cm long and the

diameters range from 6FR for the

smaller babies to 12 FR for the larger

children. They are made of medical

grade silicone and the tubes are

distance marked every cm to check

correct placement.

The tubes have a smooth tip to aid

insertion and a tungsten weight to

maintain correct position.This weight

is radio-opaque and the tubes also

have a radio-opaque stripe along

their whole length.

The Purple connectors on the tube

allow the delivery of feeds, medicines

aspiration and flushing using the

Medicina range of oral/enteral syringes.

This range offers a tube for all sizes of

patient who need long term

nasogastric and nasojejunal enteral

support.

long term siliconenasogastric/jejunal tubes

SG6/85WSIL 6FR x 85cm length



90 days · 6-10FR · Silicone


EF2 Endoscopic Placement

EF2 Surgical Placement

1. Pass the tube via the nose into the

stomach.

2. Pass the endoscope into the stomach and

catch the suture with the forceps.

3. Using the endoscope place the tube into

the small bowel.

4. To keep the tube in position,carefully and

slowly remove the endoscope with a

twisting motion having extended scope

forceps

1. Pass the tube via the nose into the

stomach before intubation.

2. When the procedure has taken place

locate the bolus tip through the

stomach wall.

3. The feeding lumen can then be

manually advanced into the jejumum.

4. Confirm the position of the tube by X Ray

and remove guide-wire.

double lumentubes

These tubes are used to feed into the

small bowel and simultaneously

aspirate the stomach.

There are two versions of the tubes

depending on the method of

placement.

The aspiration lumen of these tubes

may be used to feed the patient as

they recover. Care must be taken

changing the labels on the tubes.

The first, EF2 has its guide-wire inside

for surgical or endoscopic placement as

in the diagrams.

The second EF2E, has an external

guide-wire and an open tip for an

“Over the Wire” placement technique

either radiologically or by using the

guide-wire down the centre of the

endoscope. See diagrams.


EF2E Endoscopic Placement

EF2E Radiological Placement

1. Introduce Endoscope into small Bowel and

insert guide-wire down the centre.

2. Place guide-wire into Jejunum and

remove Endoscope.

3. Insert tube into nostril and thread over

guidewire. Draw back tube and wire

taking care not to dislodge wire

4. Thread tube down into Jejunum. Remove

guide-wire and check position by X-Ray

1. Place the guide-wire into the jejunum

under radiological control.

2. Insert tube into nostril and thread over

guidewire. Draw back tube and wire

taking care not to dislodge wire.

3. Thread tube down into Jejunum.

Remove guide-wire and check position

X-Ray.

EF2 Standard Nasojejunal

Feed/Aspiration Tube

8/10FR x 130cm

EF2E Endoscopic Nasojejunal

Feed/Aspiration Tube

8/10FR x 130cm

14 days · 8/10FR · Polyurethane


1. Wash hands 2. Prepare equipment and

explain procedure

3. Clear nostrils 4. Measure depth A

5. Measure depth B

and then add A + Band note the total depth

6. Stretch tube 7. Lubricate tip & pass tube 8. Drink or swallow

1 2 3 4 5 6 7 8 9 10 11 12

WET THISAREA ONLY

9. Hold tube & aspirate 10. Confirm position 11. Remove guidewire

12. Fix tube onto face 13. Flush tube and check

function

A

B

passingNG tubes

pH1

pH9

pH8

pH7

pH6

pH5

pH4

pH3

pH2

FEED

FEED

CAUTION

DO NOTFEED

pH1 - 4Normal Gastric

activity

pH4 - 5Higher pH dueto medication

pH7 - 8Normal value for

Small Bowel

DO NOTFEED

pH7 - 9Tracheobronchial

Tree Normal

CAUTION

pH6pH6 is not a reliableindicator of gastric

position but may beused to confirm correct

position in neonatesfollowing a risk

assessment considering:correct measurement

of tube depth, any evidenceof displacement, previoussuccessful feed at pH6 or

above with X-rayconfirmation, medications

and amniotic fluids.

!

position confirmation

Caution: These position guidelines are

not meant to replace the healthcare

professionals’ clinical judgement and

should be used in conjunction with

other clinical signs, such as coughing,

retching and increased respiratory

distress.



aspirationand drainage

tube accessoriesMedicina long term tubes come packed

with a pH indictor strip, a patient label

and a fixation plaster.

The pH strips are available separately

in a box of 200 and the plasters in two

sizes are available separately. The

plasters are hypoallergenic and can be

used in neonates children and adults.

Enteral drainage bags are available which

connect to the tubes and allow collection

of drained fluids. These bags have an

antibacterial filter so that drained fluids

can also be returned safely to the patient

when required. Four sizes are available

depending on the size of the patient.

When aspirating to confirm position follow

the guidelines on page 12 for pH confirmation.


delivering medicinesTubes can be accessed directly

with the Medicina range of

oral/ enteral syringes.

Liquid medicines should be used

where possible. Soluble tablets can be

used if they are thoroughly dissolved.

Never crush enteric coated medicines.

Medicines can be drawn up using the

medicine straw and remember not to

prime the syringe connector just the

syringe. If glass ampoules are used

then a medicine filter straw is also

available. Several bottle adaptors are

available to fit medicine bottles.

A universal bottle adaptor fits most

bottles and for children there are six

bottle adaptors, which allow the

tamper proof capping of the bottle

in between doses.

delivering small volume medicines

When very small volumes of medicine (less than 0.5mls) are delivered

into male Luer locks on Medicina tubes, it is advisable to use the

medicines straw when drawing up the drug as this will occupy the

dead space of the syringe in the samway as the Male Luer lock of

the tube. In this way the medicine can be accurately delivered

without considering the dead space of the syringe. It is important to

flush tubes before and after medicines. Flushing before medicines

prevents reactions with feeds. Flushing after medicines clears the

priming volume of the tube and prevents reactions with feeds.

0.1

0.2

0.3

0.4

0.5

filters

Medicines can be

drawn up using the

filter straw. These filters are

recommended when any

medicines are supplied in glass

ampoules.

multiple vial medicines

A new medicines needle is available

to access multiple use vials. It has a

male Luer connector for the

Medicina oral enteral syringes.

bottle adapters

A universal bottle adaptor fits most

bottles. In the case of medicines for

children there are six press-in

tamper-proof bottle adapters for the

most common suspension bottles.

These allow the bottle adapter to

stay in the bottle and the tamper-proof

cap can be used to close the bottle in

between doses.

The smallest fits bottles from 10-11mm

and the largest first bottles from

24-26mm in diameter.


care andmaintenance

Medicina Nasogastric tubes can be used for

the maximum period stated on the packaging

but they should always be carefully

maintained.

external care

The external portion of the tube

should be cleaned daily with mild soap

and water and dried. Particular

attention should be paid to the internal

threads of the purple Luer connector.

This should be flushed thoroughly with

enough water to remove any debris.

Dressings or any fixation materials

should be changed daily.

internal care

The tube should be flushed every 4-6

hours when feeding and every 8 hours

if the tube is not in use. In addition the

tube should be flushed before and after

medicines and before and after feeds,

or inline with local hospital

policies.

Sterile water should be used in infants

less than six months and any patients

who may be imuno-compromised or

jejunally fed. All others may use tap

water. Typical volumes would be 20-

30mls in adults, 10-20mls in children

and 5-10mls in neonates. Care should

be taken with fluid restricted patients.

Larger syringes produce lower

pressure so adults and children would

normally use a 60ml and neonates a

20ml syringe or in line with local

policies. This flushing does not

represent re-processing.

0.1

0.2

0.3

0.4

0.5

tube blockage

Tubes will only block if they are not

well maintained by flushing or by

delivering inappropriate forms of

medications. Liquid medicines or

soluble tablets should be used where

possible. Any other tablets or forms of

medicines should be dissolved and

thoroughly diluted in line with

pharmacy advice or manufacturers

instructions.

If a tube becomes blocked, make sure

the external portion is not kinked.

Using warm water attempt to flush the

tube. If this fails, then fizzy water or

pancreatic enzmes may be used in line

with local policies. If tubes are flushed

normally in line with recommended

guidelines the tubes should not

become blocked.

tube dislocationIf a new tube becomes dislodged by

more than a few centimetres, then it

should be removed and re-passed.

Older tubes pose a risk of infection

and should be replaced. Local practice

and policies may vary from this. It is

important never to re-introduce a

guide wire into a tube which is still in

the patient. The tube must be

removed from the patient, the guide

wire inserted into the tube then the

tube can be re-passed.

double lumenneonatalsuction tubesThese specialist “Replogle” type tubes are typically used to

aspirate or irrigate fluids in conditions such as oesophageal

atresia. They have also been used for colonic lavage, in the

preparation of obstructed bowel procedures.

Overall the tube is 10FR in diameter

and 60cm long and it is made of

polyurethane. It has two aspiration

ports and two lumens allowing

simultaneous irrigation and aspiration.

The tube is distance marked every cm

to confirm placement and has a port

on each of the lumens. The primary

port has a black connector, which fits

wall suction, mucous extractors and

bladder tip syringes for aspiration.

The purple connector fits the

Medicina range of oral/enteral

syringes for irrigation.

NF02 Double Lumen

‘Replogle Tube’ 10FR



paediatric siliconenasogastric plaster

NS01 Paediatric Silicone

Nasogastric Plaster

60mm x 16mm

The silicone gel adhesive on a breathable

polyurethane film has excellent adhesion

properties resulting in long lasting wear

time without causing pain on removal

from even the most delicate skin. No

residue is left on removal.

This strip can be used as a simple

fixation device or can be used as a skin

protector under the other strips (NS03

and NS04) to prevent skin erosion by the

naosgastric tube (see opposite).

A clear silicone strip which allows full view

of the tube depth markers.

“long lasting weartime withoutcausing pain onremoval from eventhe most delicateof skins

“

nasogastricplastersThe non-aggresive acrylic adhesive

ensurers a long life with

reduced skin damage.


NS03 Paediatric

Nasogastric Plaster

66mm x 20mm

NS04 Adult

Nasogastric Plaster

75mm x 25mm

These clear breathable polyurethane

strips allow full view of the tube depth

markers.

The 1, 2, 3 placement system makes

them easy to use on both adult and

paediatric patients. The strips come in

easy to use packs of 5

This kit contains one alcohol wipe to

clean the skin. A paediatric silicone

plaster to protect the skin under the

nasogastric tube and a paedaitric plaster

to fix the tube.

This easy to use kit will help reduce the

damage done to the skin by long-term

use of nasogastric tubes especially in

babies with delicate skin.

paediatric nasogastric fixation kit

NS05 Paediatric Nasogastric

Fixation Kit


productrange

RC150 150mm Rectal Medicine Straw (200)NHS Code: TBA

RC075 75mm Rectal Medicine Straw (200)NHS Code: TBA

BA02 15-16.5mm Bottle Adapter (50) NHS Code: TBA

BA02B Bulk pack of 15-16.5mm Bottle Adapters (50) NHS Code: TBA


BA03B Bulk pack of 18-19.5mm Bottle Adapters (50) NHS Code: TBA

BA04 25.5-27mm Bottle Adapter (50) NHS Code: TBA

BA04B Bulk pack of 25.5-27mm Bottle Adapters (50) NHS Code: TBA

BA05 18.5-20.5mm Bottle Adapter (50) (Oromorph) NHS Code: TBA


BA07 10.5-11mm Bottle Adapter (50) NHS Code: TBA

surfactant kits double lumen replogle tubes

SF01 Surfactant Kit (25) NHS Code TBA

SF02 Needle Free Surfactant Kit (25) NHS Code TBA NHS Code TBA


NS01 Paediatric Nasogastric Plaster (50) NHS Code: TBA

NS03 Paediatric Nasogastric Plaster 66mm x 20mm (50) NHS Code: TBA

NP01 Adult Nose Plaster (100) NHS Code: TBA

NP02 Paediatric Nose Plaster (100) NHS Code: TBA

NS04 Adult Nasogastric Plaster 75mm x 25mm (50) NHS Code: TBA


REF: FFS01

FB1000 1000ml Enteral Feeding Bag (45) NHS Code: TBA

EV01 250ml Gastric Decompression System (30) NHS Code: TBA

EV02 500ml Gastric Decompression System (30) NHS Code: TBA



FB01 Flexifeed Gravity Set (30) NHS Code: TBA

FB02 Pre Filled Bag Gravity Set (30) NHS Code: TBA

FFS01 Enteral Feeding Bag Stand (1) NHS Code: TBA

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feeding and drainage bags

flexifeed feeding bags

gastric decompression systems

feeding sets


Unit 2, Rivington View Business Park, Station Road, Blackrod, Bolton BL6 5BNTelephone: +44(0)1204 695050 email: [email protected]

www.medicina.co.uk

NGBK001

medicina nasogastricfeeding tubes andaccessories

Medicina has put together

the most comprehensive range

of feeding tubes available

in the UK.

Documents

nfeeding tubesa s o g a s e s t r i c - Eurosteriel Medical · medicina nasogastric feeding tubes | 2 . 3 | medicina nasogastric feeding tubes key features radiopaque stripe Medicina