Are we doing what they’re doing? Tube weaning at The Canberra Hospital and internationally

Kathryn  Rodda¹

¹The Canberra Hospital , Chifley, Australia

AIMS: Tube dependence can be an expensive and detrimental side effect of managing medically complex children.  Evidence from international sites shows that hunger provocation tube weaning is effective at increasing successful return to oral feeding (Hartdorff et al, 2015).  Research shows that 90% of hunger provocation tube weans are successful, with a 75% success rate on the first attempt and the majority of children weaned on the second attempt (Wilken et al, 2013).  However, there are only anecdotal reports on the use and success of hunger provocation tube weaning in hospitals in Australia (Gardiner et al, 2016).

This retrospective review examines success rates of hunger provocation tube weaning at The Canberra Hospital’s (TCH) Children’s Feeding Clinic (CFC), and a thematic review of the factors contributing to unsuccessful tube weans.

METHODS: Retrospective review of outcomes since commencing hunger provocation tube weaning at TCH (2015 – 2018 inclusive). Review of patient, carer and environmental characteristics of successful and unsuccessful tube weans

RESULTS

• 42 tube weans managed by TCH CFC 2015 – 2018.
• 30/42 (71%) successful first time, 9 of the remaining successful second attempt (total successful = 39/42 = 93%).
• 3/42 unsuccessful in first 2 attempts (7%).

Reasons for unsuccessful tube weans can be grouped into three main areas – patient specific, parent/carer expectations and stress, and environmental factors.  Parent factors are most likely to result in a second unsuccessful tube wean attempt.

CONCLUSION: Hunger provocation tube weaning managed by TCH Children’s Feeding Clinic has similar success rates to published international data.

CLINICAL SIGNIFICANCE: Hunger provocation tube weaning is generally effective and should be considered for all medically appropriate children.

REFERENCES: Gardiner, Vuillermin and Fuller (2016).  A descriptive comparison of approaches to paediatric tube weaning across five countries.  International Journal of Speech Language Pathology

Biography:

Kathryn is a speech pathologist working in the area of acute neonatal and paediatric feeding.  Her clinical work includes establishing feeding in sick and premature neonates, feeding and dysphagia support and management for children with complex feeding and medical presentations, and tracheostomy management.