Nasogastric (NG) tubes can be easily displaced. If you are concerned the tube is not in the stomach and/or the pH strip indicates a reading of more than 5.5, do not put anything down the tube. In this situation, please read the troubleshooting section of this information or seek advice from your healthcare professional.
Before discharge from hospital
Before you are discharged with an NG tube, you should have discussed the topics outlined in this leaflet with your healthcare professional.
Confirming the correct position of your NG tube
It is important to check your NG tube is in the correct position to reduce the risk of feed or water from entering your lungs. This is because it may cause a chest infection or serious harm. You always need to check the position of your NG tube before you do any of the below:
Additionally, the position of the NG tube should be checked any time you feel the position of the tube may have moved, for example after a coughing spasm, vomiting, retching, difficulty in breathing or reflux. If the tube has moved it may appear longer, have fallen out of the nose or be coiled in the throat.
How to check the tube’s position
Before you begin, think about whether there is a reason to suspect the tube has moved out of the stomach.
If you cannot pull back aspirate from your NG tube
Try one or more of the following:
Flushing your NG tube
If you are not using your NG tube for feeding, make sure you flush the tube at least once a day with fresh tap water to reduce the risk of the tube blocking. Please contact your dietitian to advise you on the amount of water required.
Method for flushing your NG tube
Please only do this after you have confirmed the tube is in the correct position.
There are then two options to flush the tube.
When flushing your tube, you may wish to try to avoid emptying the tube completely by kinking the end of the tube before removing the syringe or as the last drops of water are entering the tube. This can reduce the risk of air entering your stomach which can make you feel uncomfortable and bloated.
Try to remain upright for at least 30 minutes after a feed or flush to help prevent reflux and regurgitation.
The syringes can be washed according to instructions or, when time to do so, can be disposed in your normal household waste.
Feeding via an NG tube
When feeding, please sit or lay in an upright or semi-upright position – at a 30 to 45-degree angle. Always flush the tube with water before and after giving any feed or medication. This reduces the risk of the tube blocking. Your dietitian will tell you how much water and feed to use as part of your feeding plan.
Caring for your tube and skin
If your skin becomes sore or irritated, contact your community nurse or GP for advice.
If you have learned how to pass the NG tube yourself you might want to refer back to your proficiency documents.
What if my tube becomes blocked?
The most common causes for feeding tubes to become blocked are feed or medications.
The following tips can help clear a feeding tube which has become blocked with feed or medications:
Milking the tube
Push and pull technique
If you think the tube is blocked by medication, check your technique and process for administering medications or ask your nurse to check with you. If it’s a persistent problem and you are following the correct procedures for administering medicines, your GP might be able to review your medication if an alternative is available.
What if I still can’t get any aspirate to check the position of my tube before feeding?
It remains vital that you obtain aspirate from the nasogastric tube and you test it using pH paper and you obtain a pH of 5.5 or below before you commence feeding via the tube. If you still cannot get any aspirate from the tube you might be able to:
If you are still unable to obtain aspirate, contact your nurse or the contact given when you first came home with your tube, to discuss a way forward.
What if I can get aspirate from the tube but the pH is six or above?
It is possible for the pH of your stomach to be higher than 5.5. This can be caused by some medications, or the presence of feed or food. It can feel very frustrating when you want to feed but the aspirate pH is six or above.
However, it remains vital that you obtain aspirate from the nasogastric tube, you test it using pH paper and you obtain a pH of 5.5 or below before you commence feeding via the tube. If you have just placed the tube and you want to use it for water, feeding or medication for the first time follow the procedure for replacing a nasogastric tube.
In some circumstances, with a tube that has been confirmed as being in the correct position on previous occasions you may be able to follow a different process. Your dietitian or nurse may give you additional training and additional information about what to do when the pH of an existing, correctly placed tube is high.
What do I do if my nasogastric tube comes out?
If your nasogastric tube comes partially or fully out when you are not feeding through it, remove it, the securing tape, and discard as you would normally.
If you are feeding when your tube comes out it is possible that the tube has dislodged and gradually worked its way out and therefore you may have inadvertently got feed in your wind pipe or lungs. If you feel unwell or are concerned, you must obtain medical advice.
Your feeding tube will probably need replacing. If you have been taught how to do this, you may go ahead if you have passed the NG proficiency assessment. If you do not replace your own nasogastric tube you should contact the person, ward, or children’s community nurse, as agreed when you were discharged from hospital.
If the tube has come out during the night and you are not concerned you have inadvertently got feed into your windpipe, it is possible for some people to leave the tube replacement until the morning. Agree a plan with your doctor, nurse or dietitian so you are prepared if this happens. The plan will vary from person to person depending on your age, condition and/or treatment plan.
What should I do if the tape securing the tube starts to peel off?
What if I still need help?
If you still need help with your nasogastric feeding, contact the Abbott or Nutricia. Alternatively, contact your designated contact, community nurses or the Home Enteral Nutrition Service for advice.
Can you cough with an NG tube?
HINT: Sneezing and coughing are common after NG Tube removal.
What tips can you provide the patient to ease the insertion of an NG tube?
Lubricate 2-4 inches of tube with lubricant (preferably 2% Xylocaine). This procedure is very uncomfortable for many patients, so a squirt of Xylocaine jelly in the nostril, and a spray of Xylocaine to the back of the throat will help alleviate the discomfort. then the stomach.
What should the nurse do when inserting nasogastric tube?
Hand the patient a glass of water with a straw and ask him to extend his neck backward. Insert the tube and gently advance it toward his nasopharynx with the curved end pointing downward. When the end just passes the nasopharynx, have the patient flex his head forward and swallow sips of water.
What are the safety considerations in using nasogastric tubes?
These patients should never be allowed to lie completely flat. Lying flat increases the patient's risk of aspirating stomach contents. Patients with an NG tube are at risk for aspiration. The head of bed should always be raised 30 degrees or higher.