How the tube is placed will depend on if it is a nasal tube or a gastrostomy. We will discuss the placement procedure for both types of tubes.

Nasal tube Placement

Most parents are taught how to place and replace a nasal feeding tube the following procedure is taking for granted that it is a parent placing the tube.

• Have your child sit on the side of the bed or on a chair. If your child is unable to sit, have him/her lie down on his/her back with arms raised above the head.

• Measure the tube from the tip of the nose to the ear lobe, then down to the breast bone which is located in the middle of the chest. Mark this point on the tube with a piece of tape. This length will allow the tube to go into the stomach.

• Lubricate the tube by dipping it in water or by applying water-soluble lubricant to the tube. Do not use gels or petroleum jelly (such as Vaseline®) because of the danger of the material getting into the lungs and/or clogging the feeding tube.

• Insert the tube through the nostril until you reach the marked point. Small sips of water may be given to your child while passing the tube to help him/her swallow.

• Withdraw the tube immediately if your child's color becomes blue or he/she develops breathing problems. These are signs that the tube may be in the lungs and not the stomach.

• When the tube is properly placed, tape the tube to your child's nose and face, being careful not to block the nostril.

• Always confirm the proper location of the tube before starting the feeding.

• To check the location of the feeding tube, place a stethoscope over the stomach.

• With a syringe, quickly insert 3-5 cc's of air into the tube while listening with the stethoscope for a "pop." The "pop" represents air rushing into the stomach.

• The feeding should not be started if a "pop" is not heard and the tube is not in the stomach. If the tube is not in the stomach, remove it and try to place it again.

• Once you verify that the tube is in the stomach, the tube is ready to be used for feeding.

• The tube should be checked again before feeding is started to make sure that it is still in the stomach.

  

Gastrostomy Tube Placement

There are two main ways a gastrostomy can be inserted.

• One method involves creating a gastrostomy during fundoplication surgery to help control severe reflux. Following this, your child will usually have a temporary device for approximately six weeks.

• Alternatively, a percutaneous (meaning ‘through the skin’) gastrostomy is inserted using an endoscope (a tube with a small camera on the end). This is passed down your child’s throat and into his or her stomach. The end of the gastrostomy tube is brought out through a small incision in the abdomen to allow access for feeding.