Electronic Beep

Use an electric pump to extract milk from mom. Use a different electric pump to put that same milk in baby's tummy.  While effective, it is one of the least convenient or efficient ways to feed a baby.  (And so many parts to wash!)

Hannah has had an NG feeding tube for 2 months now-since she was two weeks old.  NG means "nasogastric" and goes in her nostril (naso-), down her throat, and directly into her stomach (-gastric).

Tubing goes through the pump valve and rotor

Starting at the top, we have a disposable "pouch" much like an IV bag, which gets filled periodically with fortified breast milk.  The tubing coming out of the bag passes through a Kangaroo Joey pump, being connected by a valve, going around a rotor, and then out again. Then there is about 6 feet of tubing. This bag and tubing is replaced every 24 hours. The bag is washed out and the tubing "flushed" with hot water every four hours when it gets refilled.  (This process takes at least 5 minutes and cannot be accomplished with one hand.  I have tried.  Its also much harder as a walking zombie at 2am.)

Hannah is sporting the NG tube in a soft purple,
the Kangaroo Joey pump in a black backpack,
and is accessorizing with two sizes of dosing
syringes that complement her tube and port.
She tops off the look with facial tape,
because who wouldn't?

This high-maintenance bag and tubing set is then connected to Hannah's NG tube that is taped to her face and goes into her body.  Her tube is much shorter, and extends out of her nose about 18 inches.  It has a purple push-on cap, and when uncapped, screws onto the end of the longer pump tube. This "port" has several uses. It allows us to change the bag and tubing every day, it allows us to administer medication directly into her NG tube with a matching screw-on syringe, and it allows us to cap and close off the NG tube when she is not getting fed.  We also flush her NG tube with 3 mL of warm water every 4 hours when we refill her bag to prevent her tube from getting clogged.

Unlike the feeding bag and tubing, Hannah's NG tube stays in 2-4 weeks without being removed or replaced.  It goes up into her nostril, at the back of the nasal cavity it turns downward and goes down her esophagus (past her cricopharyngeal bar), through the lower esophageal sphincter, and into her stomach.  The very last inch of this tube has a few openings similar to a soaker hose where the liquid nutrition is deposited in her tummy.

It is very uncomfortable for Hannah while we are putting the tube in, especially trying to "turn the corner" at the back of her nose to make it go downward.  But fortunately, once it's in all the way and we are done taping it to her face, she doesn't mind it at all and quickly goes back to being happy and smiley.  It usually takes me 2-3 tries, but Chris can usually get the tube in on his first try.  It is definitely a two-person job: one person to hold her down and put the tape on, and the other to put the tube in and hold it in place while it gets taped. It only takes about 10 minutes, but it sure gives me anxiety!

"NG Tube Insertion 101" is not a class we took when we became parents, so there was some learning and failing and quite a few tears before we got the hang of it.  It hurts my momma heart to pin a screaming baby down and torture her by putting things in her nose. It's disturbing when the tubing comes out her mouth instead of going down (eww!).  And its scary to realize you might accidentally get the tubing into her lungs rather than her stomach.  The tube has to be inserted the correct length, which depends on the size of the person.  It has to be taped at the right spot and in a way that the tape won't come off.

After we put the tube in and tape it, we have to check to make sure its in her stomach.  Using one of the screw-on syringes on the port end of the NG tube, we pull back slowly to see what comes out: if stomach content comes out, we're golden.  (Sorry! Kinda gross!)  Another way to check is by pushing air into the tube and listening with a stethoscope for a "whoosh" sound in her abdomen.  (Side bar: this whole process is kind of unfair. In the hospital, after an NG tube is inserted, they order an x-ray to make sure it is in the right place. I obviously don't have that luxury!  Why do they expect us to get it right when they have to use an x-ray to check their work?!)

The pump and food pouch go in a convenient little backpack which helps the baby stay portable, but it is still a pain in the neck.  Unless you bring the backpack with you, the baby can only go 6 feet. If you forget to bring the bag and you pull the tubing too far (which I do about once a day), the tubing gets dislodged and the pump beeps annoyingly at you until you turn it off and back on again.  If you pause feeding for some reason and then forget to turn it back on, it beeps at you.  If the tubing gets clogged or pinched, it beeps at you.  If the battery is low, it beeps at you.  If the bag tips over and gets an air bubble in the tubing, it beeps at you. When the bag is empty, it beeps at you.  Hannah sleeps 10 hours straight through the night, but I wake up to an electronic beep every 4 hours in order to refill her feeding bag.  Its so hard to get out of bed for an electronic beep!  I have actually fallen asleep standing up waiting for the bottle warmer...

Its easy to get tangled up her in tubing.  Its tricky to get her in her car seat, and her car seat in the car without pinching or pulling the tubing (or closing the car door on it).  Its impossible to wash and refill the bag while holding a screaming baby.  In short, the NG tube gives me anxiety, the pump is annoying, and the bag is high maintenance.  But I am so glad they exist.  They feed my baby and are helping her grow!  Without them, she would not have lived, so I am grateful for this work-around until Hannah can get her surgery and can swallow again. I would much rather feed my baby the regular way, but for now I'm glad I can even feed her at all.

Happy Feeding Tube Awareness Week!

(OK, seriously, I didn't know that there was a feeding tube awareness week, and I was already working on this post when I learned it was the second week of February.  Happy coincidence!)