A nasogastric (NG) tube is a flexible medical device inserted through the nostril, down the esophagus, and into the stomach. It provides nutrition and hydration to individuals unable to swallow safely or take in enough food orally. The tube also administers necessary medications or performs gastric decompression by removing air or stomach contents to relieve pressure. Maintaining the NG tube requires daily attention to ensure its function and safeguard the patient’s well-being. A structured care plan focused on hygiene, patency, and accurate placement is fundamental to preventing complications like infection or aspiration.
Essential Daily Maintenance Routines
Maintaining the tube’s patency is a daily responsibility to prevent blockages that interrupt feeding or medication schedules. The tube must be routinely flushed with water to clear residue from formula or crushed medications. A flush involves gently pushing 30 to 60 milliliters of sterile or cooled water through the tube using a 60 mL enteral syringe. This procedure should be performed before and after every administration of feed or medication, and at least every four to six hours, even if the tube is not actively being used.
The tube’s presence can cause irritation, making frequent oral and nasal care necessary for hygiene and comfort. The nasal insertion site and surrounding skin should be cleaned daily with mild soap and water to remove secretions. Clinicians must inspect the nostril for signs of skin breakdown or irritation, which may indicate a need to adjust the tube’s position or securing device.
Mouth care must be prioritized, as the NG tube prevents the natural cleansing action of saliva and can lead to oral dryness and infection. Patients should receive oral hygiene, including brushing teeth and using mouth swabs or rinses, at least every two hours. A well-secured tube prevents accidental dislodgement and minimizes movement that can cause pressure damage. The securing device must be checked regularly and changed daily or whenever it becomes soiled or loose. Ensure the tube’s external centimeter marking is noted and remains consistent.
Verification and Monitoring Protocols
Verifying the correct placement of the nasogastric tube is a safety check performed before introducing anything into the tube. Misplaced tubes that end up in the respiratory tract can lead to aspiration pneumonia. While initial placement is confirmed with a chest X-ray, subsequent checks rely on testing the pH of the gastric aspirate.
Gastric contents are acidic, and a pH reading of 5.5 or lower confirms the tube tip is situated in the stomach. Older methods, such as injecting air and listening for a “whoosh” sound, are unreliable and no longer considered safe for verifying placement. If gastric aspirate cannot be obtained for pH testing, or if the pH reading is outside the acceptable range, the tube must not be used until further confirmation, such as a radiograph, is obtained.
Continuous monitoring of the patient’s tolerance to tube feeding is a component of the care plan. This includes assessing for signs of feeding intolerance, such as nausea, vomiting, abdominal distension, or cramping. Monitoring involves checking the Gastric Residual Volume (GRV), which is the amount of fluid remaining in the stomach. This check is performed by gently aspirating the contents of the stomach using a syringe.
Excessive residual volume signals that the stomach is not emptying properly, increasing the risk of reflux and aspiration. A single GRV measurement greater than 300 milliliters may indicate a need to adjust the feeding plan or address delayed gastric emptying. Aspirated contents should be returned to the stomach to prevent the loss of nutrients and electrolytes, unless directed otherwise by policy.
Administering Feeds and Medications Safely
Safe administration requires adherence to protocols to prevent contamination and occlusion of the tube. Before starting any feed or medication, the patient should be positioned with the head of the bed elevated to at least 30 to 45 degrees. This elevation helps reduce the risk of aspiration and must be maintained for a minimum of 30 minutes after a bolus feed.
When administering formula, check the product for the correct type and expiration date, and clean the container before opening. For continuous feeding, the feeding bag and tubing should be changed every 24 hours to prevent bacterial growth. Feeds can be delivered via gravity drip, syringe bolus, or electronic pump, with the method dictated by the patient’s nutritional plan.
Medication delivery demands meticulous care, starting with using liquid forms whenever possible. Solid medications must only be administered if they can be safely crushed and dissolved completely in water. Preparations such as enteric-coated or sustained-release tablets must never be crushed. Each medication must be prepared and given separately to prevent chemical interactions or clumping that could clog the tube.
A flush of 15 to 30 milliliters of water is administered before the first medication. A smaller flush of 10 to 30 milliliters is used between each individual medication dose to clear the tube. After the final medication, a final flush of 30 to 60 milliliters of water is performed to clear the tube completely and maintain patency.
Recognizing and Responding to Common Issues
Tube clogging is a frequent challenge that interrupts the delivery of nutrition and medication. To resolve a blockage, attempt to flush the tube with a syringe filled with warm water. A gentle, back-and-forth motion on the plunger can sometimes dislodge the obstruction, but excessive force must never be applied, as this risks rupturing the tube. If the blockage persists, specialized declogging solutions or pancreatic enzymes may be used in consultation with a healthcare provider.
Accidental tube displacement is a concern, as the tube can migrate out of the stomach into the esophagus or lungs. Signs include a noticeable change in the external length of the tube at the nostril, making the original centimeter marking important to track. The patient may also experience new onset coughing, gagging, or difficulty breathing. If displacement is suspected, the tube is unsafe for use, and no substances should be administered until correct placement is re-verified.
Aspiration is the most serious complication, occurring when stomach contents or feed enter the lungs, potentially leading to respiratory distress or pneumonia. Signs are sudden and include coughing, choking, or a change in respiratory status, such as a faster breathing rate or gurgling sounds. If these signs appear, stop the feed immediately, position the patient upright, and seek emergency medical assistance.