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Replogle Tube, Care of

A Replogle tube is a double lumen, radio-opaque tube, which is mainly used to give continuous suction and irrigation to a blind ending pouch.

The most common use is for babies with oesophageal atresia when the Replogle tube is passed into the blind ending upper oesophageal pouch in the pre-operative period. In the majority of cases this will be for less than 24 hours, but if there is delay in attempting a repair of the oesophagus this time may be much longer, up to six to eight weeks (Johnson, 2005).

A survey of units in the UK in 1998 has revealed that there are few babies needing long term suction (Harper and Wallis, 1998). A multidisciplinary approach to their care is essential.

The baby requiring the use of a Replogle tube demands the constant observation and vigilance of all staff members.

Inform the family

 Ensure the family are informed of the following:

  • that a Replogle tube will need to be passed
  • what a Replogle tube is
  • what it entails
  • the reasons for passing a Replogle tube
  • the likely duration of the procedure.
  • how long the tube will stay in situ (Rationale 1)

Preparation


  • The bed space should be prepared and the following equipment assembled before the baby is admitted (Rationale 2):
  • A clinical hand wash must be performed before the equipment is handled (Reference 3)
    (Rationale 8).
  • On admission the baby should be fully assessed and monitoring of the vital signs commenced.
  • The airways should be given immediate suction (Rationale 9).
  • Any necessary resuscitative measures should be taken.
  • The medical staff should be informed of the baby’s arrival (Rationale 10).
  • A Replogle tube should only be passed by, or under the supervision of, an experienced nurse or doctor (Rationale 11).

Inserting a Replogle tube

  • The preferred route for passing the Replogle tube is via the nostril (Rationale 12, Rationale 13).
  • The Replogle tube will need to be passed orally if:
    • the baby is very small
    • the baby has choanal atresia

To pass the Replogle tube:

  • Put on an apron (Rationale 14).
  • Perform a clinical hand wash (Rationale 15).
  • Put on non-sterile gloves (Rationale 16).
  • Give suction to the nasal passages and the oro-pharynx (Rationale 17).
  • The Replogle tube should then be gently passed until resistance is felt with the blind ending (atretic) upper oesophagus.
  • Pull the Replogle tube back very slightly (Rationale 18).
  • The tube is then connected to the low flow suction unit using the suction tubing (Rationale 19).
  • Set the suction on the pump between 3.5-4 Kpa (25-30 mmHg 35-42cms water) (Replogle 1963).
  • Secretions will be observed starting to drain along the Replogle tube and into the suction tubing.
  • Secure the tube firmly once the position appears satisfactory (Rationale 20).
  • Instil 0.5mls of 0.9 per cent sodium chloride into the blue lumen of the Replogle tube to facilitate the continuous drainage of secretions (Rationale 21).
  • Clear away equipment according to Waste Policy (Rationale 22).
  • Wash hands (Rationale 23).
  • Record the procedure in the child’s health care records (Rationale 24).
The tube should be changed every four days.  It may need to be changed more frequently if the secretions are excessive and/or thick secretions (Rationale 25).

Alternating nostrils should be used wherever possible (Rationale 26).

Ongoing Care

If the baby shows signs of deterioration, conventional naso-pharyngeal suction should be given & assistance sought (Rationale 27, Rationale 28).

If there is any doubt about the effectiveness of a Replogle tube help must be sought immediately (Rationale 29).

  • The baby should be nursed on an apnoea mattress and observed at all times (Rationale 30).
  • The baby should be positioned on a slight head up tilt (Rationale 31).
  • 0.5 mls of 0.9 per cent sodium chloride for injection should be instilled into the tube every 15 minutes (Rationale 32).
  • It must be recorded as follows:
  • Using CareVue®, if the baby is on an Intensive Care Unit.
  • On the baby’s replogle tube flush chart, if the baby is on a ward (Rationale 33, Rationale 34).
  • Prior to injecting the 0.9 per cent sodium chloride, the nurse must perform a clinical hand wash and put on non-sterile gloves (Rationale 35).
  • The ampoule of 0.9 per cent sodium chloride and syringe must be labelled with the date and time of preparation and changed at least two-hourly (Rationale 36, Rationale 37).
  • The pressure of the suction pump should be monitored hourly (Rationale 38).
  • If the pressure on the suction pump starts to increase this may be a sign that the Replogle tube is blocked or it is adherent to the oesophageal wall.
If the Replogle tube is not draining:

  • Check that suction pump is turned on and working (Rationale 39).
  • Instil an extra 0.5 mls of 0.9 per cent sodium chloride for injection into the blue lumen of the tube and observe what happens. Normally the sodium chloride should be observed moving down the main lumen of the tube during the installation (Rationale 40)
If this does not occur:

  • Check that the tube is positioned near the bottom of the oesophageal pouch, by pushing gently on it until resistance of the pouch is felt, then pulling back slightly (Rationale 41).
  • Inject air into the blue lumen of the Replogle tube using a 2ml or 5ml syringe (Rationale 42).
  • Move the tube gently in the nostril.
  • Briefly increase the strength of the suctionto a maximum of 7-10 pa, 50-60 mmHg, 70-84 cms of water (Rationale 43).
If none of the above are successful assistance should be sought from an experienced nurse or doctor (Rationale 44).

Change the suction tubing and Serres liner (or suction bottle) every 24 hours (Rationale 45).

Changes in colour and/or consistency of secretions should be noted (Rationale 46).

A weekly pouch secretion specimen should be sent to microbiology (Rationale 47).

  •  To obtain the pouch secretions specimen:
  • Attach a sputum trap (obtainable from HSDU) between the Replogle tube and suction tubing (Rationale 48).
  • The larger suction catheter (provided with the trap) fits into the lumen of the Replogle tube (Rationale 49).

  • The specimen is normally obtained in a few minutes.

The serum and urinary electrolytes should be checked regularly.

Sodium supplements may be necessary for some babies (Rationale 50).

The skin around the tape should be checked at least twice a day & the condition of the skin recorded in the child’s health care records (Rationale 51).


Provide appropriate stimulation/play therapy for the baby (Harper & Wallis 1998) (Rationale 54):

  • The baby may be handled and moved out of the bed.
  • The baby may be allowed to suck a dummy. (Rationale 55)
Ensure that the family are well supported and given regular updates of progress (Rationale 56, Rationale 57).

Rationale

Rationale 1: To increase understanding so facilitating shared care & family co-operation.
Rationale 2: To ensure that all equipment is working correctly and ready for immediate use.
Rationale 3: This is the only available size.
Rationale 4: To facilitate secretions.
Rationale 5: To cap syringe.
Rationale 6: To secure tube.
Rationale 7: To detect apnoeic attacks.
Rationale 8: To minimise the risk of infection.
Rationale 9: To clear secretions from the nostrils and naso-pharynx.
Rationale 10: To ensure that the baby is admitted without delay.
Rationale 11: To ensure the safety of the baby.
Rationale 12: It is easier to secure.
Rationale 13: It is more comfortable for the baby.
Rationale 14: To minimise the risk of infection.
Rationale 15: To minimise the risk of infection.
Rationale 16: To minimise the risk of cross infection.
Rationale 17: To clear residual secretions.
Rationale 18: To prevent trauma & adherence to the oesophageal wall.
Rationale 19: To give effective suction.
Rationale 20: To secure the Replogle tube.
Rationale 21: To facilitate the continuous drainage of secretions.
Rationale 22: To meet Hospital Policy.
Rationale 23: To minimise the risk of cross infection.
Rationale 24: To provide an accurate record.
Rationale 25: The tube function diminishes when there are excessive and/or thick secretions in the lumen (Rationale 2).
Rationale 26: To prevent damaged nostrils (Rationale 2).
Rationale 27: To prevent aspiration of secretions
Rationale 28: To facilitate emergency treatment.
Rationale 29: Delay could allow secretions to overspill into the trachea causing complications & deterioration.
Rationale 30: To monitor for apnoeic attacks
Rationale 31: To try to prevent aspiration of gastric contents via the lower pouch fistula (when present) (Rationale 3).
Rationale 32: To prevent tube blockage & subsequent aspiration of gastric secretions into the trachea.
Rationale 33: To provide an accurate record.
Rationale 34: The flush is ‘suctioned’ out so it is not part of the child’s fluid balance.
Rationale 35: To minimise the risk of infection.
Rationale 36: To provide an accurate record.
Rationale 37: To minimise the risk of infection.
Rationale 38: This could indicate that the Replogle tube may be becoming blocked.
Rationale 39: To ensure it is working.
Rationale 40: To ensure that the Replogle tube is functioning.
Rationale 41: To ensure correct placement of the Replogle tube.
Rationale 42: To assist unblocking it.
Rationale 43: The tube can get attached to the oesophageal wall & the suction is no longer effective.
Rationale 44: The Replogle tube may need to be removed and replaced.
Rationale 45: To minimise the risk of infection.
Rationale 46: Pouch secretions quickly become colonised with organisms (Leung et al 1996)
Rationale 47: To detect & initiate early treatment of infection.
Rationale 48: To facilitate the collection of the pouch secretions.
Rationale 49: It will give an effective seal to enable the specimen to be obtained with ease.
Rationale 50: Sodium levels may fall owing to the loss of saliva via the suction pump.
Rationale 51: To minimise trauma to the skin.
Rationale 52: To provide an accurate record of the skin condition.
Rationale 53: To reassess the skin care, and provide an appropriate alternative (Harper and Wallis, 1998).
Rationale 54: To encourage normal development.
Rationale 55: To encourage non nutritive sucking.
Rationale 56: To prevent misunderstandings.
Rationale 57: To promote parental involvement.

References

Reference 1:
Harper M, Wallis ML (1998) Survey of the current patterns of use & the nursing care of babies with a Replogle tube in situ. Great Ormond Street Hospital for Children, Unpublished

Reference 2:
Replogle R (1963) Esophageal Atresia: plastic sump catheter for drainage of the proximal pouch. Surgery 54: 296-297.

Reference 3:
Johnson RVP (2005) Oesophageal Atresia. Surgery 1(5): 163-167.


Further reading

Carter B (1993) Manual of Paediatric Intensive Care Nursing Carter B In: Manual of Paediatric Intensive Care Nursing. London, Chapman and Hall

Rowley S (1996) Aseptic non-touch technique. A safe and efficient handling technique for IV therapy. London, Great Ormond Street Hospital for Children NHS Trust.

Leung TSM, Bayston R, Sptiz L (1986) Bacterial colonization of the upper pouches in neonates with oesophageal atresia. Z Kinder-chirurgie 41: 78-80.

Document control information

Lead author(s)
Mary Wallis, Neonatal Nurse Advisor

Additional authors
Louise Frampton, Assistant Practice Educator, OATS & Head and Neck

Document owner
Deborah Wade, Senior Staff Nurse, OATS & Head and Neck

Approved by
Clinical Practice Committee

First introduced: 28 May 1999
Date approved: 7 September 2011
Review schedule: Two years
Next review: 6 September 2013
Document version: 2.0
Replaces version: 1.0

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