I am revisiting my protocol, as DH and I are thinking about TTC again. And so I've been considering all of the options for treating HG.
Many of you know that I am a fan of an NG tube instead of a PICC line, and I thought maybe it would be helpful for others who are preparing if I posted my list of pros & cons - NG tube vs. PICC. I posted most of this a while ago on the old HuGS site...
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I am pro-NG tube. This is from both my experience as well as the advice of my regular OB and three highly respected and informed perinatologists. I have also done a lot of research on the internet about PICC vs. NG tube.
If I ever have another baby, I will definitely have an NG tube before a PICC. In fact, a PICC line will be my
very last line of defense...after steroids, NG tube, etc. My new peri said that it might be a great idea to think about an NG tube earlier in the pregnancy (before I lose so much weight and get so malnurished/dehydrated).
So, as I see it, here are the pros and cons of an NG tube:
PRO #1 -
Very good nutrition. I was given something called "Jevity" (with fiber!) in the tube. Jevity contained ALL of the nutrition that my baby and I needed (except for a very small amount of iron). Since I really couldn't eat anything, I was soooooo grateful for that nutrition. Having the tube gave me peace of mind, because I knew that my baby and I would be okay. Frankly, this peace of mind alone would have been reason enough for me to have the tube. I have heard of problems from TPN (usu relating to liver function or fatty lipids? This was never an issue for me.)
PRO #2 -
Low/No risk of infection. I think this is one of the biggest reasons to use an NG tube instead of a PICC. When PICC lines get infected, the consequences can be severe.
PRO #3 -
Easy way to take meds/liquids. If you are unable to take meds by mouth, you can crush them up, mix with water, and insert into the tube with a syringe. If you can't drink any liquids, you can insert those into the tube. When I first had the tube, I was not allowed to take anything by mouth. Not even an ice chip! So the nurses put my meds through the tube. It was a great way to take meds!
PRO #4 -
No pain. I never felt pain from the moment the tube was inserted until the moment it came out. I was uncomfortable (esp at first), but I was never in pain.
PRO #4 -
Easy to transport. The pump was very small. The pump was connected to the bag of Jevity on one end and to the tube leading to my nose on the other end. My peri has had women go to work, go to movies, etc. with the pump. Because I felt so horrible, I didn't leave the house except for doctor's appts and an occasional night on my in-laws couch, but when I did leave it was very easy to just take my bag of nutrition with me.
PRO #5 -
Easy to maintain. To keep the tube clear, 2-3 times a day my DH or my mom would flush the tube with warm water. This was absolutely painless; I didn't feel, taste, or smell anything at all.
PRO #6 -
Possible to increase speed of feedings. In the hospital, they started the feedings very slowly. They waited a day or two after the tube was placed to actually begin the feedings. When they saw that my system was tolerating the feedings, they increased the amount until I was receiving all that I needed for a 24 hour period. I received the feedings continuously, 24 hours a day. At the advice of the nutritionist, when I came home, I increased the speed of feeding so that I was able to unhook myself for 3 hours a day. I could have tried to increase more (some women are able to get all the nutrition they need in fewer hours), but I was worried about pushing too much and ending up sicker. Next time around, I hope to be more aggressive about this.
PRO #7 -
Can last for months. I had the NG tube for 6 weeks, but some women need to have the tube until delivery. As far as I can tell, the tube does not need to be replaced as long as it stays in place.
PRO #8 -
Keeps the digestive tract working. From a medical/physical standpoint, this is an important benefit of the NG tube over the PICC.
PRO #9 -
Bypasses the stomach...reduces risk of vomiting. My tube went down past my stomach, into my intestine. This was nice because it was impossible to vomit up the Jevity. So even when I vomited, I knew I would still get all the nutrients I needed.
PRO #10 -
Easy to shower/bathe. When I took a bath, I simply unhooked the tube, flushed it with water, and sealed it off with a little cap. Then I tucked it behind my ear and was able to bathe.
CON #1 -
Uncomfortable placement. In my opinion, this is the hardest part about getting an NG tube...having it put in (although the discomfort only lasted one night). My peri sent me to the radiology dept of the hospital for placement. They put some numbing gel in my nose and then the radiologist guided it down, with the help of an x-ray of some kind. The experience would have been much better if the radiologist had understood how sensitive my gag reflex was at the time. He was very harsh. The urge to vomit up the tube was very strong, but I felt that this was really the best option for me and my baby. So I mustered all the willpower I could and made it through those first few hours. After that, I really didn't even feel the tube and the urge to vomit it up was gone.
CON #2 -
Must remain at 30 degree angle while receiving feeding. While a PICC carries the risk of infection, an NG tube carries the risk of the formula coming up into the lungs. I hesitate to even write this, because the risk is so low. My peri never worried about it and one particular nurse said there is no reason to worry about it. But, Kimber wrote to me that someone receiving tube feedings ought to avoid sedating meds because of the risk. As far as I can tell, remaining on a 30 degree angle basically takes away this risk.
CON #3 -
Risk of dislodging tube. It is possible to dislodge the tube with lots of vomiting. I worried about this, but it never happened to me. I vomited many times with the tube and the placement remained perfect. I think having the tube inserted so far decreases the risk of dislodging the tube. The best scenario for tube feeding is when the amount of vomiting is reduced. Steroids in my case helped to control the amount of vomiting, so I was grateful to be given steroids at the same time as the NG tube (week 11 of my pregnancy).
CON #4 -
Hard to swallow pills. At one point I was given an enormous pill. I can't even remember what it was...something for heartburn, I think. But it was HUGE and swallowing it was very hard, esp with the tube in place. It wasn't much of an issue with smaller pills, but it did take some getting used to. Next time around, I may just crush any large pills and insert them directly into the tube.
My opinion is that an NG tube is definitely worth trying! If you are interested in reading more about it, go to
www.nvp-volumes.org and search for hyperemesis. Here is a very interesting article, which states that an NG tube should be considered before TPN:
http://www.nvp-volumes.org/p3_3.htm And here is another article, which mentions that tube feeding can be an effective, non-invasive, less expensive alternative to TPN:
http://nvp-volumes.org/p3_2.htm
There are several articles there about NG tube and PICC lines. The conclusion there seems to be that an NG tube is a better option. Also,
http://www.helpher.org/mothers/treatmen ... /index.php has good info about all the nutrition options for HGers.
I really hope everyone preparing for HG (or in the middle of HG) will carefully consider having an NG tube instead of a PICC line. There are so many HGers who have PICC lines without problems, but I would rather avoid the potential risks and infections.
I hope this will be of help to someone!
- Anna
"The little reed, bending to the force of the wind, soon stood upright again when the storm had passed over." - Aesop