A nasogastric (NG) tube is inserted through the nose and down into the stomach. This temporary measure delivers liquid nutrition and medication or removes gastric contents for decompression, often in cases of bowel obstruction. Removal of the NG tube is an important step in recovery, and the decision rests with the medical team who determine when the patient can safely transition back to normal function.
Clinical Criteria for Discontinuation
The decision to remove an NG tube is guided by the resolution of the medical problem that required its placement. For decompression tubes, this means the return of normal gastrointestinal function, evidenced by the patient passing gas or having a bowel movement. Additionally, the volume of residual stomach fluid drained by the tube must significantly decrease, often dropping below 100 to 200 milliliters over 24 hours.
For patients receiving nutrition, discontinuation depends on achieving a safe and adequate level of oral intake. The ability to swallow safely is a major consideration, as premature removal carries a risk of aspiration, where food or liquid enters the lungs. The medical team must confirm that the patient can consistently meet their hydration and caloric needs by mouth or through an alternative, less-invasive method.
The assessment involves the patient’s overall stability and the absence of complications warranting continued tube placement. Factors such as the patient’s state of consciousness and ability to cooperate with swallowing exercises are also taken into account. The healthcare provider balances the risks of continued tube placement, such as discomfort and potential mucosal damage, against the patient’s readiness to manage without the tube.
The Weaning and Readiness Process
Before physical removal, a structured weaning process is implemented to ensure the patient can sustain the transition. This phase begins with a comprehensive assessment of the patient’s ability to swallow, often performed by a speech-language pathologist (SLP). SLPs use tools like bedside swallow tests or modified barium swallow studies to evaluate the safety and efficiency of the swallow reflex.
For feeding patients, weaning involves a gradual reduction of tube-delivered volume or calories. This reduction encourages the patient’s appetite and motivates them to increase oral intake to compensate. The goal is to gradually shift the primary source of nutrition from the tube to oral feeding while monitoring the patient’s weight and hydration status.
The medical team closely monitors the patient for signs of intolerance, such as increased nausea, vomiting, or abdominal discomfort. If the NG tube was used for decompression, a “clamping trial” may be ordered. The tube is temporarily closed for several hours to see if the patient develops symptoms before removal. The patient’s active participation and tolerance during this preparatory phase indicate readiness for the final removal step.
The Removal Procedure and Immediate Follow-Up
The physical removal of the NG tube is performed by a healthcare professional. The patient is positioned in a high Fowler’s position, sitting upright, with a protective pad placed over the chest. The tube is disconnected from any suction or feeding equipment, and the tape securing it to the nose is removed.
Before withdrawal, the patient is instructed to take a deep breath and hold it; this action closes the epiglottis and helps prevent residual gastric contents from being inhaled. The healthcare provider then pinches the tube near the nostril and pulls it out with one quick, steady motion, wrapping it as it emerges. This rapid technique minimizes the uncomfortable sensation as the tube passes through the nasal and throat passages.
Patients may experience reactions immediately after removal, such as watering eyes, a cough, or mild irritation in the nose and throat. Once the tube is out, the healthcare team provides oral hygiene and cleans the nose to remove secretions or adhesive residue. The patient is then monitored to ensure successful oral intake and to watch for persistent symptoms of gastrointestinal distress, such as nausea or difficulty swallowing. If concerning symptoms, like persistent vomiting or difficulty breathing, develop, the patient should promptly notify the medical team.