NG tubes come in all sorts of lengths and thicknesses. Typically, there are two kinds of NG tubes:
Short Term Tubes
Short term tubes are made of PVC plastic, often called Portext of Vygone tubes. They need to be changed every 5-7 days.
Long Term Tubes
These are called silk tubes, and are made from very soft plastic. They’re designed to be used for 4-6 weeks.
Nasogastric tube placement
The first few times, it’ll be done by a healthcare professional, such as a nurse. Typically in hospital. It can be done while the child is either awake, or asleep, and while uncomfortable, it shouldn’t be painful.
The NG tube is inserted up through the nostrils and down through the oesophagus and into the stomach. If the child is able to take direction, it’s helpful if they can swallow while the tube is being placed. If a new NG tube is being inserted, it’s typically done through the other nostril, alternating which side of the face the tube is secured to.
Parents can and do get training in how to insert a NG tube – please don’t insert one without training as it’s possible to place the tube in the trachea and into the lungs. This is could cause breathing issues if you were to the use the tube, as the contents would be deposited into the lungs.
Because of this, it is essential to check the position of the tube after it is inserted and every single time the tube is used to give a feed or medication. Every single time, without exception.
Securing the Nasogastric Tube
Testing the Nasogastric Tube
The placement of the NG tube is checked by aspirating a small amount of liquid from the stomach – typically the gastro liquids will acidic.
- Check if the NG tube has moved, by comparing the marker number at the nostril.
- Check if the tape is secure. It can be dangerous to have the tube move while in use. If the tape is not secure, now is a good time to retape it.
- Using a 20ml syringe, attach it to the NG tube. Pull back gently on the plunger until a small amount of fluid (also called an aspirate) appears in the syringe.Note: where possible use a 20ml syringe or larger. The pressure build up through the tube is less with larger syringes. The larger the syringe, the more comfortable it will be.
- Squirt the aspirate onto a PH strip and check for colour change. It should be between PH1 and PH5.5.
Nasogastric tube care
There are three main things to remember when caring for a nasogastric tube:
1. Always wash your hands before handling the tube.
2. Flush the tube at least three times a day, but always before and after feeding or giving medications. This helps to stop the tube becoming blocked.
3. Ensure that the outer end of the tube is always securely fixed to the child’s face to prevent the tube from moving in and out of the child.
What if the tube becomes blocked?
If you cannot flush a tube, this may mean that the tube is blocked or (with short term tubes) that the end may have become flattened. Try gently putting 1 to 2ml of air down the tube from a syringe, then try to flush it again. If you still cannot flush the tube, seek medical advice. Remember that regular flushing of the tube using 5ml boiled, cooled water, will help to prevent it becoming blocked.
Is there anything else I need to know?
You should feel confident about feeding and caring for the tube before you leave hospital. Make sure that you know who to contact if you have further queries or if you encounter any problems. Having a child with a nasogastric tube will involve you some extra work and will inevitably be quite stressful at first, until you get used to the routines involved. Try not to let feeding dominate your life – accept what help you are offered from friends and family, and remember that the hospital staff are there to answer queries and offer support when you need it.
How do I feed my child using a nasogastric tube? You should only use specially prescribed feedstuffs from the hospital/dietician with the tube, and never put medications down the tube unless you have specifically been told they are safe to administer in this way. The child should be sat up for feeding so that the food runs down the tube and the stomach is encouraged to empty well, minimising gastro-oesophageal reflux. Wash your hands before handling the tube. Before feeding it is essential to check that the tube is in the correct place. This is done by withdrawing a small amount of fluid using a syringe conncted to the tube end, and testing a sample of it on blue (alkaline) litmus paper. Because the stomach contents are acidic, the paper should turn pink/red. • If you managed to withdraw fluid but the paper doesn’t turn pink, seek medical advice. • If you can’t withdraw fluid, it doesn’t necessarily mean the tube is in the wrong place; it may be that the child’s stomach is empty or the tube is lying up against the stomach wall. Give the child a drink, wait a few minutes then try again; if there is still no fluid seek medical advice. Flush the tube before feeding using 5ml boiled, cooled water from a 50ml syringe. Feeds may be administered using either a special pump or by a gravity-fed system – as instructed by the hospital staff. After giving feed and/or medications, the tube should be flushed again, as abov
How is the tube inserted? Passing the tube is not a very pleasant procedure, but it is soon over. The procedure will be explained to you, but it is important that you ask questions if you feel unsure about anything, so that you fully understand what is involved. If your child is old enough, they will normally be prepared for the insertion of Nasogastric tubes Content provided by Elaine Sexton and Chris Holden – members of the Feeding Liaison Team at Birmingham Children’s Hospital. the nasogastric tube by play therapists, so that they know where the tube is going to, why it is needed and what they may feel when it is being passed. Babies may be given a bottle to suck on when the tube is inserted; an older child can be given a glass of water with a straw to help them to swallow as the tube is passed. Adhesive tape is then used to secure the end of the tube by the child’s nose. The child may complain of a sore throat, and/ or feel self-conscious, and a baby may try to remove the tube (so it’s important that it’s securely fixed in place) but most get used to the tube after a little time. The tube stays in place until it needs replacing, the child is eating enough that it is no longer required, or an alternative means of tube feeding (gastrostomy or jejunostomy) is implemented. Some parents may be given the option to learn now to pass the tube themselves (either when it needs changing or if it is inadvertantly pulled out) but if you don’t want to do this you don’t have to (community staff or your local hospital can do it). If you do choose to undertake this yourself, you will receive intensive training in hospital so that you feel confident about the procedure. If a very much older child needs a nasogastric tube, then they may be trained to pass their own tube.