In this section
A Replogle tube is used in the management of neonates and infants with oesophageal atresia awaiting a delayed repair of their oesophagus. Infants with long-gap oesophageal atresia may wait up to 4 months until surgical repair of the oesophagus is undertaken.
A Replogle tube is used to continuously drain saliva from the upper oesophageal pouch and is positioned 0.5cm above the end of the oesophageal pouch.
Adequate drainage of the upper oesophageal pouch is essential to prevent saliva spilling over into the trachea resulting in aspiration or pneumonia.
To outline the principles of management of infants with a Replogle tube in-situ in the Butterfly Ward (Newborn Intensive Care) at The Royal Children’s Hospital.
Replogle tube: A double lumen tube, where one lumen is for drainage of saliva and the other functions as an air vent. The Replogle tube (Figure 1) is placed in the upper oesophageal pouch and connected to continuous low pressure suction of -15 to -35 cmH20 to aspirate saliva and prevent aspiration.
Figure 1: example of a Replogle tube
ARGYLETM Replogle Suction Catheter
Oesophageal atresia (OA): A congenital anomaly in which the oesophagus ends in a blind upper pouch. Most Infants with OA also have an abnormal connection between the trachea and oesophagus, which is called a tracheo-oesophageal fistula (TOF).
Long-gap oesophageal atresia: Variants of OA with a large gap (wider than 4cm between the two ends of the oesophagus). This includes pure OA (Figure 2) and OA with a proximal TOF (Figure 3). See pictures below:
Foker Procedure: Involves growth induction of the oesophagus. The Foker process uses tension-induced growth to enable primary oesophageal reconstruction in patients with long gap OA. Sutures are placed on the upper and lower ends of the oesophagus and brought out onto the infant's chest wall. Tension is applied to the sutures by placing short pieces of silastic tubing under the suture loops, with the tension usually increased each day over a 1-3 week period. When enough growth in the oesophageal ends has been achieved, the baby returns to theatre for an oesophageal atresia repair (oesophageal anastomosis). The Foker procedure may also include the placement of internal sutures on the upper and lower oesophageal segments.
Growth induction procedures: Other growth induction procedures may also be undertaken, involving internal sutures on the oesophageal ends, prior to full repair of the OA.
The indications for a Replogle tube are to prevent aspiration and aspiration pneumonia in patients with long gap OA.
Consent must first be obtained from the infant's Surgeon and Neonatal Consultant prior to using a Replogle tube.
A medical treatment order is required to:
These must be documented on the EMR Orders.
These signs indicate the need for immediate and additional oesophageal pouch suction and a problem with Replogle tube patency / suction. Provide immediate intermittent oesophageal pouch suction and ensure Replogle tube is patent and in-situ to the required length.
Prior to Insertion of Replogle tube:
It is the responsibility of the clinician caring for the infant with a Replogle tube to ensure that the parents understand the rationale for the intervention, as well as potential complications.
Parent support groups
Refer to separate evidence table for
Replogle Tube Management
The development of this nursing guideline was coordinated by Alisa Hawley, Care Manager, Butterfly Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated June 2016.
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