A nasogastric (NG) tube is a flexible, narrow tube inserted through a person’s nostril, guided down the throat and esophagus, and into the stomach. This medical device serves as a temporary conduit, allowing for the delivery of substances directly into the stomach or the removal of gastric contents. Healthcare providers utilize these tubes for various short-term medical purposes, often when oral intake is not feasible or when stomach contents need to be managed.
Purposes of Nasogastric Tubes
NG tubes are employed for several medical reasons, primarily when individuals cannot meet their nutritional needs orally or require specific gastric management. One common use is for temporary feeding, known as enteral nutrition, delivering liquid nutrients directly into the stomach for those unable to eat or swallow sufficiently. This can be necessary for individuals with difficulty swallowing (dysphagia), certain cancers, altered mental status, or malnutrition.
Beyond nutrition, NG tubes facilitate the administration of medications to patients who cannot take them by mouth. They are also used for gastric decompression, removing excess air or fluid from the stomach to relieve pressure, often due to conditions like bowel obstruction or ileus. In emergency situations, NG tubes can be used for gastric lavage, a procedure to wash out the stomach, such as in cases of poisoning or overdose. These tubes typically serve as a temporary measure, with usage often limited to a few weeks or months.
Daily Management and Monitoring
Effective daily management ensures proper NG tube function and minimizes complications. Securing the tube properly is essential to prevent accidental dislodgement, involving taping it to the nose and cheek, and pinning it to clothing. Regularly inspect the skin around the nostril for irritation, redness, or tenderness.
Maintaining tube patency, keeping it clear from blockages, requires routine flushing. Flush the NG tube with at least 30 mL of water before and after medication administration or feedings, and every 4-6 hours for continuous feedings. This practice helps prevent residue or formula from obstructing the tube. Proper oral and nasal hygiene, including regular cleaning of the mouth and nostril area, prevents irritation and infection.
Confirming tube placement before each use ensures nutrients or medications reach the stomach, not the lungs. This involves checking the external length at the nostril against a marked measurement, and aspirating stomach fluid to test its pH. Gastric fluid has a pH of 5.5 or lower, confirming placement. If placement is uncertain, contact a healthcare professional.
Delivering Nutrition and Medication
Administering nutrition through an NG tube, known as enteral feeding, involves delivering liquid formula directly into the stomach. Feeding schedules vary, including bolus feedings (larger amounts over a shorter period) or continuous feedings (steadily delivered over several hours using a pump). During feeding, keep the individual in an upright or semi-upright position, typically at a 30 to 45-degree angle, to prevent reflux and aspiration.
Medications can also be given through an NG tube, requiring careful preparation. Liquid forms are preferred; solid medications not sustained-release can be crushed and dissolved in water. Administer each medication separately, flushing with 15-30 mL of water before and after each dose, and waiting 5-10 minutes between different medications to prevent interactions and tube occlusion. Flushing the tube with water after all medications ensures the full dose reaches the stomach.
Recognizing and Managing Issues
Several issues can arise with NG tubes, requiring prompt recognition and management. Tube blockage is common, indicated by resistance during flushing or inability to administer feeds or medications. Gently flush with warm water using a push-pull technique to address blockages. If blockage persists, specific declogging solutions or carbonated beverages might be used, but avoid excessive force to prevent tube damage.
Accidental dislodgement can occur, with signs including a change in external tube length, coughing, gagging, or difficulty breathing. If dislodgement is suspected, do not use the tube until placement is re-confirmed by a healthcare professional. Skin irritation around the nostril can be managed by regularly cleaning the area, lubricating the skin, and changing the tape or securement device.
Gastrointestinal issues like nausea, vomiting, or diarrhea can relate to tube feedings. Manage these by adjusting the feeding rate, changing the formula, or venting the tube to relieve bloating. Aspiration, where stomach contents enter the lungs, is a serious complication if the tube is misplaced or reflux occurs. Elevating the head of the bed during and after feedings helps reduce this risk. For any issues, breathing difficulties, or blood in the tube or stool, contact a healthcare provider immediately.