A nasogastric (NG) tube is a flexible tube inserted through the nose and down into the stomach to deliver nutrition, fluids, and medications. Flushing the NG tube is a standard maintenance practice involving gently pushing a small amount of fluid through the tube. This action is performed to maintain tube patency, keeping the tube open and free from obstruction. Regularly flushing ensures the safe delivery of necessary formulas and medicines, preventing blockages.
Gathering Supplies and Preparation
Before starting the procedure, gather all necessary supplies. The required materials include the prescribed flushing solution, typically sterile water, cooled boiled water, or a specific solution directed by a healthcare provider. The volume of flush fluid usually ranges from 15 to 30 milliliters (mL) for an adult. A 60 mL enteral syringe with a specialized ENFit connector is needed for drawing up and injecting the fluid.
Hand hygiene is the first step in preparation, requiring a thorough wash or the use of an alcohol-based sanitizer. Draw the prescribed amount of flush water into the syringe. Eliminate any air bubbles by gently tapping the syringe and pushing the plunger until a small drop of water appears at the tip. This preparation minimizes the risk of infection and prevents the introduction of air into the stomach.
Step-by-Step NG Tube Flushing Procedure
Ensure the patient is in a safe, upright position (30 to 45-degree angle) to prevent reflux. If required, verify the tube’s placement before introducing anything, often by checking the pH of aspirated stomach contents. Remove the end cap or plug from the NG tube port, and securely connect the syringe containing the flush solution.
Administer the fluid using slow, steady, and gentle pressure on the syringe plunger. A recommended method is the “push-pause” technique, where the fluid is injected in small increments, followed by a brief pause. Never apply excessive force, as this can damage the tube or cause discomfort for the patient. After the full volume of flush solution has been delivered, ensure the tube is completely clear.
Once the tube is fully flushed, momentarily pinch or kink the NG tube to prevent fluid from leaking out when the syringe is disconnected. Carefully remove the syringe from the port, and immediately cap or plug the end of the NG tube back into place. Keeping the tube capped when not in use maintains cleanliness and prevents air from entering the stomach.
Establishing a Flushing Schedule
Maintaining a regular flushing schedule prevents the buildup of formula or medication residue that leads to clogs. For patients receiving bolus feedings, the tube must be flushed both immediately before and after the administration of each feed. Similarly, a flush is required before and after every medication is delivered through the tube.
If multiple medications are being given, a small flush of water, typically 5 to 15 mL, should be used between each separate medication dose to prevent drug-drug interactions within the tube. For individuals receiving continuous feeding, the tube needs to be flushed at least every four to six hours. The exact volume and frequency of these routine flushes should always follow the specific instructions provided by the patient’s healthcare team.
Addressing Clogs and Troubleshooting
Despite consistent flushing, a tube may occasionally become blocked, indicated by resistance when attempting to push fluid or the inability to instill any solution. When a clog is suspected, first ensure there are no kinks or bends in the external part of the tube causing the obstruction. One gentle technique involves lightly squeezing and “milking” the tube between the fingers along its length to help dislodge any material.
To attempt to clear the internal blockage, draw up a small amount of warm water (5 to 10 mL) into a syringe and connect it to the tube. Use a very gentle push-pull motion on the plunger, applying a slight vacuum and then a slight pressure, similar to a pumping action, to try to move the blockage. Never use forceful pressure, as this can rupture the tube or cause serious complications. If the blockage does not clear after a few gentle attempts, or if the patient experiences pain, immediately stop the procedure and contact a healthcare professional for guidance.