A nasogastric (NG) tube is a flexible tube inserted through the nose, down the throat, and into the stomach. It is commonly used for short-term purposes, such as delivering nutrition and medication or decompressing the stomach by removing contents. Securing the tube correctly is paramount, as poor fixation can lead to displacement, risking aspiration (inhaling stomach contents) and tissue damage. Proper securement maintains correct positioning and minimizes nasal irritation. This guidance is for home care support but must not replace instructions provided by a certified healthcare professional.
Preparing the Patient and Materials
Before beginning the securement process, gather all necessary supplies. You will need medical-grade tape (such as paper or cloth tape like Durapore), specialized skin prep products (barrier wipes or creams), small scissors, and a mild cleaning solution (saline or water). Position the patient comfortably, often in a semi-sitting or upright position, to easily access the nose and face.
The skin where the tape will be applied must be cleaned and fully dried to ensure a strong adhesive bond. Use the cleaning solution to gently wipe the bridge of the nose and the adjacent cheek area, removing oil or moisture. Applying a liquid skin barrier to the clean, dry skin provides a protective film that helps prevent skin stripping when the tape is removed.
Step-by-Step Securement Techniques
The integrity of NG tube securement relies on selecting an appropriate method and executing it with precision. One widely used approach is the split-tape technique, sometimes called the “trouser leg” method. Start with a strip of tape four to six inches long and split it lengthwise down the middle, stopping about an inch from one end to create a solid base and two thin tails. The solid, unsplit end is placed flatly on the bridge of the nose, ensuring the tube rests comfortably against the septum without pulling the nostril.
The two split “legs” are then wrapped around the tube just as it exits the nostril, one clockwise and the other counter-clockwise, creating a spiral cross-hatch pattern. This wrapping action locks the tube securely to the tape base, preventing it from sliding. After application, check the tube’s external measurement marking at the nostril to confirm the insertion depth has not changed.
An alternative method, often preferred for sensitive skin, uses a hydrocolloid dressing as a stabilizing base. A piece of hydrocolloid (such as DuoDERM) is cut to fit the cheek or side of the nose and placed directly on the prepared skin. The NG tube is laid over this patch, and a separate, smaller piece of standard medical tape secures the tube directly to the hydrocolloid base. This two-layer approach minimizes direct contact between aggressive adhesive tape and the skin, reducing the risk of epidermal stripping.
Monitoring Skin Integrity and Tape Maintenance
Maintaining skin health requires diligent and frequent assessment, ideally checked daily. Focus on the skin surrounding the nostril, the bridge of the nose, and the area beneath the adhesive tape for signs of pressure or friction. Look for localized redness, swelling, or breaks in the skin, which can indicate a pressure ulcer or severe adhesive reaction. The tape should be changed routinely, typically every 48 to 72 hours, or immediately if it becomes soiled or lifts.
When changing the securement, rotate the placement of the tape slightly to avoid repeated stress on the same area of skin. This rotation may involve alternating sides of the nose or shifting the application site a few millimeters. Before reapplying the new tape, gently clean any remaining residue using an adhesive remover, followed by reapplication of the skin barrier product.
Recognizing Complications and Seeking Medical Assistance
While proper taping minimizes risks, caregivers must know the signs indicating a complication requiring professional attention. The most significant concern is tube displacement, signaled by the external measurement mark being notably different from the recorded length. Other immediate warning signs include the patient experiencing sudden coughing, gagging, difficulty breathing, or vomiting during or after a feed, suggesting the tube has migrated.
If displacement is suspected, immediately stop all feeding or medication administration, as administering substances into the lungs is a life-threatening risk. Do not attempt to reinsert a tube that has been completely dislodged; contact the healthcare provider immediately for guidance. Seek medical help for severe skin reactions, such as blistering, deep ulceration, or signs of a localized infection, including increased pain, drainage, or a fever.