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
3 | med ic ina nasogastr ic f eed ing tubes
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
med ic ina nasogastr ic f eed ing tubes | 4
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
5 | med ic ina nasogastr ic f eed ing tubes
SG4/40 4FR x 40cm length
SG4/50 4FR x 50cm length
SG4/80 4FR x 80cm length
SG5/40 5FR x 40cm length
SG5/50 5FR x 50cm length
SG5/80 5FR x 80cm length
SG6/40 6FR x 40cm length
SG6/50 6FR x 50cm length
SG6/80 6FR x 80cm length
SG6/100 6FR x 100cm length
SG6/120 6FR x 120cm length
SG8/40 8FR x 40cm length
SG8/50 8FR x 50cm length
SG8/80 8FR x 80cm length
SG8/120 8FR x 120cm length
SG10/80 10FR x 80cm length
SG10/120 10FR x 120cm length
SG12/80 12FR x 80cm length
SG14/80 14FR x 80cm length
weighted tubesSG6/50W 6FR x 50cm length
SG6/80W 6FR x 80cm length
SG8/80W 8FR x 80cm length
SG10/80W 10FR x 80cm length
SG12/80W 12FR 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
NGP6/85 6FR x 85cm length
NGP8/55 8FR x 55cm length
NGP8/75 8FR x 75cm length
NGP8/85 8FR x 85cm length
NGP8/120 8FR x 120cm length
NGP10/85 10FR x 85cm length
NGP10/120 10FR x 120cm length
weighted tubesNGP8/85W 8FR x 85cm length
NGP10/85W 10FR x 85cm length
nasojejunal tubesNGP6/120 6FR x 120cm length
NGP8/120 8FR x 120cm length
NGP8/130 8FR x 130cm length
NGP10/130 10FR x 130cm length
Typical users would be critical care areas,
medical and care of the eldery units,
paediatric units and also community
patients.
The tubes have a male Luer lock
connector which fits oral/enteral
syringes and the female Luer ends of
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.
med ic ina nasogastr ic f eed ing tubes | 6
60 days · 6-10FR · Polyurethane
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.
The tubes have a male Luer lock
connector which fits oral/enteral
syringes and the female Luer ends of
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.
7 | med ic ina nasogastr ic f eed ing tubes
RT6/80 6FR x 80cm length
RT8/80 8FR x 80cm length
RT10/100 10FR x 100cm length
RT12/100 12FR x 100cm length
RT14/100 14FR x 100cm length
RT16/100 16FR x 100cm length
RT18/100 18FR x 100cm length
RT20/100 20FR x 100cm length
14 days · 6-20FR · Polyurethane
med ic ina nasogastr ic f eed ing tubes | 8
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
SG8/85WSIL 8FR x 85cm length
SG10/85WSIL 10FR x 85cm length
90 days · 6-10FR · Silicone
9 | med ic ina nasogastr ic f eed ing tubes
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.
med ic ina nasogastr ic f eed ing tubes | 10
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
11 | med ic ina nasogastr ic f eed ing tubes
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.
med ic ina nasogastr ic f eed ing tubes | 12
13 | med ic ina nasogastr ic f eed ing tubes
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.
med ic ina nasogastr ic f eed ing tubes | 14
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.
15 | med ic ina nasogastr ic f eed ing tubes
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
med ic ina nasogastr ic f eed ing tubes | 16
17 | med ic ina nasogastr ic f eed ing tubes
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.
med ic ina nasogastr ic f eed ing tubes | 18
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
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
BA03 18-19.5mm Bottle Adapter (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
BA06 20-21.5mm Bottle Adapter (50) 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
med ic ina nasogastr ic f eed ing tubes | 20
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
21 | med ic ina nasogastr ic f eed ing tubes
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
FB500 500ml Enteral Feeding Bag (55) NHS Code: TBA
FB250 250ml Enteral Feeding Bag (65) 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 sets
med ic ina nasogastr ic f eed ing tubes | 22
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.