This morning the enteral feeding system alarmed, indicating that Olivia’s ND (nasoduodenal) tube was occluded (blocked). We had seen this before, just a few days ago. At the time, the team believed the tube had moved and was up against the lining of her intestine. Moving Olivia into a new position fixed things.
Upon hearing the alarm this morning, we tried moving Olivia into mom’s arms to see if the movement and new position fixed the block. That didn’t do it. Next, the nurse switched the feeding system to a Kangaroo ePump, but that didn’t do the trick either. They tried to flush the line next, but it was backed up, and there was a minor spill of breastmilk all over Olivia’s sheets. Suspecting that it was either tube positioning or the tube itself, an x-ray was ordered to examine the position. The position was OK.
Since other options were exhausted, the team believed the occlusion must be a result of the tube itself being blocked by the feeds. Olivia was taken off TPN yesterday so her dosage of ursodiol is now being mixed into her milk, along with multivitamins and pregestimil. This new mixture is thicker and can be a bit sticky, so it is not uncommon for it to back up feeding tubes.
The typical course of action would be to replace the tube, but Dr. P made an executive decision to use this opportunity to try feeding through her stomach again. This meant removing the blocked ND tube and inserting an NG tube. Using an NG tube had failed previously (Olivia was not digesting the feeds in her stomach), but we had planned to give it a try again shortly after she reached full feeds. We were supposed to start a trial run with the NG tube later this week, but instead, we’re now going full force. 100% of her feeds are going into her stomach via the NG tube, and 0% directly to her intestine. If it fails like last time, they will insert another ND tube and give her more time receiving feeds directly to the intestine.
We’re excited. We hope she can tolerate this. They are checking residuals at 8 PM. At 18 MLs/hr, the current feeding rate, less than a 30 MLs residual in her stomach will be considered OK to continue feeding via NG.
In other news, the PICC line was removed at 4:00 PM.