In April 2024, Children’s began offering training for families on how to replace nasogastric tubes at home. (File photo)
More than 100 children and adolescents are sent home from the inpatient setting at Children’s of Alabama every year with a nasogastric (NG) tube. Often, it’s a way to postpone or avoid surgically implanted tubes. The problem is that the tube can get out of place or the child pulls it out—sometimes multiple times a day. When that happens, caregivers have to return to Children’s—which can be an hours-long drive—or go a closer emergency room that may not be able to replace the tube.
To reduce the strain on caregivers, Children’s began a one-hour training program in April 2024 to teach caregivers how to replace NG tubes at home.
The curriculum is based on the NOVEL (New Opportunities for Verification of Enteral Tube Location) project, which established best practices for pediatric NG tube placement. The program primarily serves children of all ages.
Since it launched, nurses have trained more than 20 families through the gastrointestinal service alone, with more caregivers taught via other hospital departments. Caregivers practice on mannequins but must then demonstrate they can safely place the tube in the child before they are discharged on home NG care. “There’s no emotion involved in the model,” said pediatric gastroenterologist Rachel Kassel, M.D., Ph.D., who championed the program for years, “but there is on one’s own child.”
“They’re nervous about it, obviously,” said Kelli Anderson, RN, the GI care coordinator at Children’s, who trains nurses and other clinicians to provide the education. “But after we go through the steps on the mannequin and they do it and then they do it on their own child, they’re like, ‘Oh, that wasn’t as hard as I thought it was going to be.'”
“This offers us the ability to decrease the use of surgical tubes, and it reduces the number of trips a family has to take outside of their home,” Kassel said. “While there’s always some risk, it can be made safest by having nurses teach best practices.” Risks include putting the tube in the lungs, high in the esophagus, or in the small bowel. To date, however, there have been no complications with the families trained.
Caregivers learn techniques to keep squirming babies still during insertion, usually by swaddling or having another person gently hold the child’s arms. They’re also taught to verify proper tube placement via pH testing of stomach contents. To date, there are 13 nurses and nurse practitioners, as well as Kassel, providing training.
For many parents, the hardest part is psychological. “Just kind of getting the tube to go initially, to get it past the nasal cavity, that’s biggest thing that they have problems with,” Anderson said. “They’re afraid they’re going to hurt the child.”
Some families ultimately decide the home care option isn’t right for them. “We’ve had the experience of bringing the model in for some families and going through the training where they said, ‘I’m not comfortable doing this,'” Kassel said. “We totally respect that. We’ve also had cases where one parent is comfortable but the other is not, or grandma is comfortable but the parents are not. That’s also fine.” The team also assesses patients and their caregivers to determine if they qualify for NG tubes and/or home replacement, with strict guidelines for selecting the appropriate families.
The program provides bilingual training in Spanish and English and can accommodate non-literate caregivers.
Early results suggest the program is achieving its goal of reducing emergency room visits and long trips for medical facilities.
“It’s letting us provide much more family-centered care,” Kassel said.
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