An NG tube, or nasogastric tube is a thin, flexible tube that is inserted into the nose and to be placed in the stomach. It allows for the administration of food and medication to people who are unable to swallow or eat, normally due to some type of oral or throat surgery or due to degenerative diseases.
Feeding through the tube is a relatively simple process. However, it is important to ensure adequate care to prevent the tube from moving out of place, as incorrect placement can lead to food entering the lungs and pneumonia.
Ideally, feeding through an NG tube should always be carried out by a trained caregiver or medical professional. People who are independent and mentally capable can feed and administer medication themselves.
Common uses
An NG tube is indicated for people who are unable to eat or take medications orally, usually due to health conditions, like:
- Poor nutrition
- Difficulty swallowing
- Head injuries
- Surgery in the mouth and throat region
- Gastrointestinal tract diseases such as inflammatory bowel disease, short bowel syndrome, or narrowing of the esophagus
- Degenerative diseases such as cystic fibrosis, multiple sclerosis or motor neurone disease
- Post-stroke
- Liver diseases, especially in cases of ascites
- Kidney diseases
- Head and neck cancer
- Mechanical ventilation
- Psychiatric illnesses, such as severe depression or anorexia nervosa
- Post-intestinal surgery
In these cases, the NG tube is recommended for use within 6 weeks of treatment. The patient must have their stomach and intestines functioning normally, so that the nutrients or medications administered through the tube can be absorbed.
In addition, an NG tube can be used to decompress the stomach or intestine in cases of obstructions or paralytic ileus. It can also be used to empty gastric contents in intubated patients, treat bleeding or obstructions in the stomach, or collect a sample of stomach fluid for laboratory analysis.
Although it is rarer, NG tubes can also be used in hospitals for gastric lavage, in which stomach contents are aspirated, and then activated charcoal is administered. This can be done for accidental ingestion or poisoning from medications, drugs or poisoning.
NG tube insertion
The insertion of an NG tube should be carried out by a nurse or doctor. It is normally done with the person sitting, but it can also be placed with the patient lying on the left side of their body.
The nurse must put on personal protective equipment, such as gloves, a gown, a cap and face shield. All the materials should be available and within reach, and can include the tube, topical anesthetic, a stethoscope, a syringe and tape.
An NG tube is inserted after the nurse applies an anesthetic to the person's nostril and lubricates the tube with gel. Then the NG tube is firmly inserted down to the stomach. Placement can be confirmed by placing the stethoscope in the stomach area, and inserting 20 to 30 mL of air is injected through the tube. This should make a muffled pop noise, heard through the stethoscope.
To further confirm placement, fluid from the stomach is also aspirated. In some cases, an X-ray can be done to ensure the NG tube is properly placed.
After confirming the correct positioning of the NG tube, a small piece of adhesive tape is placed on the tube and nose so that the tube does not move or come out of place.
How to feed with an NG tube
Before starting a feed through an NG tube, it is important to sit the person and raise their back with a pillow to prevent food from being aspirated into the lungs:
- Place a cloth under the NG tube to protect the bed or person from spillage from the syringe;
- Bend the tip of the NG tube, pressing it tightly so that no air enters the tube. Then remove the cap and set aside.
- Fit the tip of the 100 mL syringe into the probe opening, unfold the tube and pull the plunger to aspirate the liquid inside the stomach. If you can aspirate more than half the amount of liquid from the previous meal (around 100 mL), it is recommended to feed the person later, when the content is less than 50 mL. The aspirated contents must always be placed back into the stomach,
- Bend the tip of the NG tube again and tighten it firmly so that no air enters the tube when removing the syringe. Replace the cap before unfolding the tube.
- Fill the syringe with the crushed and strained food.
- Then bend the NG tube again and remove the cap.
- Push the contents of the syringe into the NG tube slowly. Administer 100 mL over about 3 minute
After feeding the person, it is important to wash the tube and ensure adequate hydration by adding about 70 mL following the food.
In addition to food, it is very important to administer 4 to 6 glasses of water per day through the tube, or whenever the person is thirsty.
Material needed
To correctly feed a person with an NG tube, it is important to have the following material:
- 1 100 mL syringe (feeding syringe);
- 1 glass of water;
- 1 cloth (optional).
The feeding syringe should be washed after each use and changed at least every 2 weeks with a new one, purchased from the pharmacy.
Furthermore, to prevent the tube from becoming clogged and needing to be changed, you should only use liquid foods, such as soup or smoothies, for example.
Care after tube feeding
After feeding with an NG tube, it is important to keep the patient sitting or with their back raised for at least 30 minutes, to facilitate easier digestion and prevent the risk of vomiting. However, if it is not possible for the person to remain sitting for a long time, they should be turned to the right side and prevent food reflux.
Furthermore, it is important to administer water through the tube regularly and maintain the patient's oral hygiene because, even if they are not eating through the mouth. Bacteria can continue to develop in the mouth which can cause cavities or thrush.
How to prepare NG tube food
NG tube feeding, also called enteral feeding, can be done with almost any type of food, however, it is important that the food is well cooked, crushed in a blender and then strained to remove pieces of fiber that may end up clogging the tube.
Since much of the fiber is removed from food, it is common for the doctor to prescribe supplements,, which can be added and diluted in the final preparation of the food.
There are also ready-made meals to place directly on the tube, which can be purchased in pharmacies in powder form and diluted in water.
Sample NG tube meal plan
This sample meal plan outlines day's worth of meals for a person who feeds through an NG tube:
- Breakfast – Liquid cornmeal porridge
- Morning snack - Strawberry smoothie.
- Lunch – Carrot, potato, pumpkin and turkey meat soup. Orange juice.
- Afternoon snack – Avocado smoothie.
- Dinner – Cauliflower soup, ground chicken and pasta. Cherry juice.
- Evening snack - Liquid yogurt.
It is also important to administer water through the tube, around 1.5 to 2 liters throughout the day and to not use the water just to wash the tube.
How to administer medications through an NG tube
To administer medications through an NG tube, check-out the following recommended steps:
- Wash your hands with water and neutral soap before preparing the medications. Add this medication to a medication-dedicated syringe.
- Place the person in a sitting or partially sitting position, raising the head of the bed;
- Bend the tip of the NG tube, pressing it tightly so that no air enters the tube, and remove the cap.
- Connect the syringe to the probe opening, unfold the tube and pull the plunger to aspirate the liquid inside the stomach. The aspirated contents must always be placed back into the stomach;
- Bend the tip of the NG tube again and tighten it well so that no air enters the tube when removing the syringe;
- Fill the water-dedicated syringe with about 30 mL of water for adults (10 to 15 mL for children) and add into the NG tube. After washing the NG tube, bend the tube again and disconnect the water syringe.
- Connect the medication-dedicated syringe to the NG tube. Unfold the tube and administer the medicine slowly through the probe. Bend the tip of the tube again.
- Use the water-dedicated syringe to wash the tube and “push” all the medication into the stomach.
- Bend the tip of the NG tube, pressing it tightly so that no air enters the tube, and replace the cap.
- Maintain the elevated position for at least 30 minutes after administering the medication to avoid gastric reflux.
Medications should be prepared and administered immediately. Generally, the doctor will opt to prescribe liquid forms of medications, like syrups, drops or suspensions. However, if it is necessary to use tablets or capsules, the tablet must be crushed in a glass container, or the capsule opened before use, and mixed with 10 to 15 mL of water until the medicine is completely dissolved.
If more than one medication is used, it is recommended to tube the probe with approximately 5 mL of water between administration of each medication.
The syringe used to administer medications through the NG tube must be exclusively for medicines and must not be used for feeding. Furthermore, it is important to wash the syringe after administering the medicine, as well as the glass container used to crush or mix the medicine with water.
When to change the NG tube or go to the hospital
Most NG tubes are very durable and can remain in place for around 6 weeks at a time or as recommended by your doctor.
It is important to change the NG tube and go to the hospital whenever the tube comes out of place or if it it becomes blocked.
