In this section
A Replogle tube is used in the management of neonates and infants with long-gap 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). An infant with OA and distal TOF may also have a large gap between the ends of the oesophagus. See diagrams below:
Figure 2: Long gap OA
Diagrams Royal Children's Hospital, Melbourne
Traction suture techniques: involves the placement of sutures under tension in the upper and lower ends of the oesophagus. The infant will return to theatre after approximately 4-8 weeks for a delayed repair of the oesophageal atresia if the oesophageal ends are close enough.
The indications for a Replogle tube are to prevent aspiration and aspiration pneumonia in infants with long-gap OA.
The RN prior to caring for a neonate/infant with
unrepaired OA must have successfully completed competencies on:
Consent must first be obtained from the infant's Surgeon and Neonatal Consultant prior to using a Replogle tube.
A medical order is required to:
These must be documented in the EMR Orders.
Prior to insertion
or changing of a Replogle tube:
Figure 4: Replogle tube inserted orally & secured with
photograph with permission
**If at any time the NEO-fitTM is deemed to be ineffective for securing the Replogle tube or if using a Replogle tube Fg8 please revert to standard oral or nasal ETT strapping**
• Change the Replogle tube and “Atrium” UWSD unit weekly, or earlier if necessary. • Continuous low pressure suction of -20 to -35 cmH20 on the Atrium drain is equal to a suction pressure of -15 to -25 mmHg• The suction at the wall must be set on -80mmHg for the Atrium Oasis UWSD drain to function correctlyPhoto (below) of the holes in the tip of the Replogle tube:
Photo series (below) of gently aspirating &
flushing the suction lumen of the Replogle tube:
• Hourly checks required:• Check Replogle tube position hourly and prn to ensure the Replogle tube remains in-situ at the correct distance at nares / mouth • Check level of sterile water in suction control chamber on Atrium UWSD unit hourly and top up to maintain sterile water level at 2cm.• Ensure saliva continuously draining along Replogle tube• Check suction pressure hourly to ensure it is set correctly as per Replogle Tube Care Order• Ensure Replogle tube remains patent, assessing tube patency every 15 minutes and as required.
Signs of Replogle tube blockage:
If fluid (sodium chloride 0.9%) runs out into the air vent syringe barrel this may indicate the Replogle tube is obstructed
If there is no drainage from the Replogle tube or the infant is requiring intermittent oral oesophageal pouch suction:
Do not flush the Replogle tube if there are immediate concerns about the infant’s deteriorating condition, position of the Replogle tube, or secretions. Perform intermittent oesophageal pouch suction until any issues with the Replogle tube position and patency have been fixed. This is to prevent aspiration with flushing a non-functioning or malpositioned Replogle tube in this situation.
**If the infant has had traction sutures placed in the upper oesophageal pouch the surgeon may order flushing of the Replogle with air instead of sodium chloride 0.9% (Check Replogle Tube Care Order)**
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
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Retrieved June 22, 2020, https://www.cardinalhealth.com.au/en_au/medical-products/patient-care/obstetric-and-neonatal/neonatal-care/argyle-replogle-suction-catheters.html
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Nursing Perspective. Journal of Child Health Care. 5 (1). Pp.19-25.
& Harrison D. (2003). ‘Suctioning Practices for the upper oesophageal pouch
in infants with unrepaired oesophageal atresia in Australia and New Zealand.’
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atresia and trachea-oesophageal fistula: Current management strategies and
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(2010). Management of the upper
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tubes in United Kingdom (Poster). Pediatric Research, 68, 476. Doi:
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Teaching Hospitals NHS Trust.
(2018). Oesophageal atresia and
trache-oesophageal fistula requiring a Replogle tube – Management of Infants
with. Leeds Teaching Hospitals NHS
Trust, Leeds, UK. Retrieved June 22,
2020 from http://lhp.leedsth.nhs.uk/detail.aspx?id=4008
T.S.M., & Bayston, R., & Spitz, L.
(1985). Bacterial colonisation of the upper pouch in neonates with
oesophageal atresia. Z Kinderchirurgie, 41: 78-80.
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a Patient on a Replogle Tube. The
Yorkshire and Humber Neonatal Operational Delivery Network.
Services Clinical Guideline: Neonatal Surgery ‘Oesophageal Atresia with a
distal Tracheo-oesophageal Fistula’ (2016).
May, 2016 from http://www.adhb.govt.nz/newborn/guidelines/
Replogle RE. (1963).
‘Esophageal atresia. Plastic sump catheter for drainage of the proximal pouch.’
Surgery. 54: 296-297
for Women (2014). Procedure Guideline: Set-up and insertion of Replogle tube.
November, 2020 from
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Oesophageal atresia/tracheoesophageal fistula.
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April 20, 2020, https://kemh.health.wa.gov.au/~/media/Files/Hospitals/WNHS/For%20health%20professionals/Clinical%20guidelines/NEO/WNHS.NEO.OesophagealAtresiTracheoesophagealFistula.pdf
Example of Replogle tube documentation:
Above is a screenshot of a
current patient’s Replogle tube documentation.
The information below will
explain each row, and the calculations involved.
Replogle Tube Properties:
When the Reploge tube was inserted, to what depth, size etc.
Site Assessment: Multi
select options – clean, dry, intact, bleeding, haematoma, leaking, painful,
pink, red, oedematous – pick what is relevant to the site appearance.
Securement method and
status: Multi select option. We are mainly using the Neo-Fit now. Please
also comment on if it is secure, have you checked the length, has it been
repositioned or retaped (if applicable).
Patency of vent lumen: Only
options are Partially Blocked and Occluded, so if it is working well, leave this
Vent Lumen Intervention: Multi-select
option. You can flush with normal saline (see next comment), flush with air or
aspirate it. Document whichever ones you have performed in the previous hour.
Volume of Normal Saline
Flushed into Vent Lumen (ml): This is the 0.5ml flush every 15 minutes. If
you do an extra flush, or flush 1ml instead of 0.5ml, write this volume here.
It’s over the hour, this is the total amount you flush in. It is usually 2ml.
Patency of Drainage Lumen: Single
option select, draining freely, partially blocked, occluded.
Drainage Lumen Intervention:
Multi-select option. You can flush with normal saline (see next comment), flush
with air or aspirate it. Document whichever ones you have performed in the
Volume of Normal Saline
Flushed into Drainage Lumen (ml): This is usually 2ml, every 1-2 hours,
depending on the patient.
Volume Aspirated from
Drainage Lumen: Hopefully, this is at least the same amount that you put
in. If it is more, you will need to add that additional amount to the row below
(i.e. if you flush with 2 and get back 3, please add 1ml to the row Amount of
Saliva Drained in the previous hour). If you flush 2ml and get back 2ml, you do
not need to add anything to the next row, If you flush 2ml and only get back
1ml, you will need to minus 1ml from the next row.
Amount of Saliva Drained in
Previous Hour: You can see in the image above, that the Cumulative Output
is 84 one hour, then 94 the next. The amount of saliva drained is documented at
8, and not 10. This is because we know 2ml of that is Normal Saline and we’re
not interested in that. We are interested in the saliva output only. DO NOT
include the normal saline volume in the saliva output total. If you have
acquired extra saliva from the drainage lumen flush, add that volume here
** This row is what populates to your fluid
balance activity, where we review daily ins and outs. If you count the saline
as output, it will give a falsely large output. Only document the saliva.**
Cumulative Output (ml)/ Chamber Reading: The hourly
reading of the Atrium. It should go up by at least 2ml each hour if the
Replogle is working properly and draining the saline you are putting in.
Anything above two, is saliva and counts to the overall fluid balance
Refer to separate evidence table for this
Evidence table for
Replogle Tube Management can be accessed here.
The development of this nursing guideline was coordinated by Alisa Hawley, Oesophageal Atresia Nurse & Lactation Consultant, Koala Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated April 2021.
Please remember to read the