An orogastric (OG) tube is a medical device that accesses the stomach through the mouth. It temporarily delivers substances to the stomach or removes contents when the natural oral route is not feasible. Trained medical professionals always perform this common healthcare procedure. This article explains what an OG tube is, how it’s placed, its ongoing care, and when it’s removed.
What is an Orogastric Tube?
An orogastric tube is a flexible, hollow tube, typically made of materials like polyvinyl chloride, polyurethane, or silicone. These tubes come in various diameters, measured in French units, commonly ranging from 8 to 14 French.
Primary applications for an OG tube include decompressing the stomach by removing air or fluid, administering medications, providing nutritional support when a patient cannot eat or drink by mouth, or sampling stomach contents for diagnostic purposes.
OG tubes are generally used for short-term situations, often in hospital environments. A key distinction from a nasogastric (NG) tube is its insertion pathway: an OG tube goes through the mouth, while an NG tube is inserted through the nose. Healthcare providers might choose an OG tube, particularly for neonates or patients requiring respiratory support like CPAP, as it avoids nasal obstruction and potential nasal trauma. It may also be preferred in cases of facial trauma or bleeding disorders that make nasal insertion risky.
The Placement Process
The placement process begins with patient preparation, often involving positioning the individual in a semi-Fowler’s position (head of the bed elevated 30-45 degrees) to aid gravity. Essential equipment is gathered, including the OG tube, water-soluble lubricant, a syringe, tape, and a stethoscope.
The healthcare provider measures the tube’s length from the corner of the patient’s mouth to their earlobe, then down to the xiphoid process. The measured portion, typically the distal 7.5 to 10 cm, is lubricated. The tube is gently inserted into the mouth, directed backward and downward toward the pharynx. Cooperative patients may be asked to flex their neck and swallow, guiding the tube down the esophagus into the stomach. If resistance, coughing, or gagging occurs, the tube may be slightly withdrawn and re-attempted.
Confirming correct placement in the stomach, not the lungs, is important. One method involves aspirating fluid and testing its pH; gastric contents are typically acidic (pH 5.5 or less). Another technique involves injecting 10-30 mL of air into the tube while listening with a stethoscope over the upper abdomen for a gurgling sound, though this method is less reliable alone. The most definitive method for confirming initial placement, especially in high-risk patients, is an X-ray. Once confirmed, the tube is secured to the patient’s cheek or face with adhesive tape to prevent dislodgement.
Living with an Orogastric Tube
Patients with an orogastric tube may experience various sensations and require ongoing care. Immediately after placement, some discomfort, a gagging sensation, or difficulty speaking and swallowing saliva may occur. The tube can also increase saliva production, requiring frequent oral hygiene.
Maintaining the tube’s patency and correct position is essential. Healthcare providers regularly flush the tube with water before and after administering feeds or medications, and at least every 4-6 hours during continuous feedings, to prevent clogging. The tube’s external length is routinely measured and compared to the initial insertion measurement to detect migration. Oral care is also provided to keep the mouth clean and reduce irritation.
Healthcare professionals continuously monitor the patient’s tolerance and any output from the tube. This includes observing for complications such as irritation, dislodgement, or changes in respiratory status. Nutrition, fluids, and medications are administered through the tube using syringes or feeding pumps, ensuring the patient receives necessary support.
When an Orogastric Tube is Removed
An orogastric tube is removed once its medical purpose is fulfilled. A healthcare professional makes the decision, typically when the patient’s condition improves, they can safely consume adequate nutrition and fluids by mouth, or the tube is no longer needed for diagnostic or therapeutic reasons. For instance, if swallowing ability returns or stomach decompression is no longer required, the tube may be removed.
The removal process is generally quick and often causes less discomfort than insertion. The tube’s securement, such as tape, is first gently removed from the patient’s face. If the tube has securing devices like a balloon, it is deflated prior to removal. The healthcare provider then gently and steadily pulls the tube out through the mouth.
After removal, patients are monitored for any immediate discomfort or complications, such as a sore throat or minor irritation. Oral hygiene is often encouraged to promote comfort. Patients typically transition back to eating and drinking by mouth, gradually resuming their normal dietary intake as tolerated.