TEF management

Management

Immediate Treatment

1. Propping infant at 30-degree angle, supine, or side lying to prevent reflux of gastric content.
2. Nasogastric (NG) tube remains in the esophagus and is aspirated frequently to prevent aspiration until continuous low suction is applied.
3. Pouch is washed out wit normal saline to prevent thick mucus from blocking the tube.
4. Gastrotomy to decompress stomach and prevent aspiration; later used for feedings.
5. Nothing by mouth (NPO); I.V. fluids.
6. Supportive therapy includes meeting nutritional requirements, I.V. fluids, antibiotics, respiratory support, and maintaining thermally neutral environment.

Complications

• Death from asphyxia
• Pneumonitis/pneumonia secondary to:
• Salivary aspiration
• Gastric acid reflux
• Dehydration and electrolyte imbalance

Nursing Assessment

Assessment begins immediately after birth

1. Be alert for risk factors of polyhydramnios and prematurity
2. Suspect infant with the following:
1. Excessive amount of mucus
2. Difficulty with secretions
3. Cyanotic episodes (unexplained)
3. Report suspicion to health care provider immediatel

Nursing Diagnosis

• Risk for aspiraton related to structural abnormality
• Risk for deficient fluid volume related to inability to take oral fluids
• Anxiety of parents related to critical situation of neonates

Nursing Interventions

Preventing Aspiration

1. Position the infant supine with head and chest elevated to 20 to 30 degrees to prevent or decrease reflux of gastric juices into the tracheobronchial tree.
2. Perform intermittent nasopharyngeal suctioning or maintain indwelling sump tube with constant suction to remove secretions from esophageal blind pouch.
3. Place the infant in an Isolette or under a radiant warmer with high humidity to aid in liquifying secretions and thick mucus. Maintain the infant's temperature in thermoneutral zone, and ensure environmental isolation to prevent infection by using isolette.
4. Administer oxygen as needed.
5. Suction mouth to keep it clear of secretions and prevent aspiration. Provide mouth care.
6. Be alert for indications of respiratory distress.
7. Maintain NPO status.
8. Administer antibiotics as ordered to prevent or treat associated pneumonitis.
9. Observe infant carefully for any change in condition;
10. Be available, and recognize need for emergency care or resuscitation.
11. Monitor for signs or symptoms that may indicate additional congenital anomalies or complications.
12. Gastrotomy tube (GT) may be placed before definitive surgery to aid in gastric decompression and prevention of reflux.

Preventing Dehydration

1. Administer parenteral fluids and electrolytes as prescribed.
2. Monitor vital signs frequently for changes in blood pressure (BP) and pulse, which may indicate dehydration or fluid volume overload.
3. Record intake and output, including gastric drainage (if GT or decompression is present) and weight of diapers.

Reducing Parental Anxiety

1. Explain procedures and necessary events to parents as soon as possible.
2. Orient parents to hospital and intensive care nursery environment.
3. Allow family to hold and assist in caring for infant.
4. Offer reassurance and encouragement to family frequently. Provide for additional support by social worker, clergy, and counselors as needed.

Note:Since I am practicing in level 2 nicu, management listed above does not include surgical management since our unit is not capable in handling such case. 

1. Sandra M. Nettina, MSN, ANP-BC.2010. Lippincott manual of nrusing practice 9th edition. Wolters Kluwer Health|Lippincott Williams & Wilkins