What is a Nasogastric Tube?
A nasogastric (NG) tube is a thin, flexible tube inserted through the nose, down the throat and esophagus, and into the stomach. It is made of soft plastic and comes in various sizes to fit different patients.
The NG tube serves as a conduit to deliver nutrition, medication, or fluids directly into the stomach. It can also be used to remove stomach contents, such as in cases of intestinal obstruction or severe nausea and vomiting.
Types of NG Tubes
There are two main types of NG tubes, each for a specific purpose:
Feeding Tubes: These NG tubes are used to feed patients who cannot eat or swallow safely. They deliver a liquid diet directly into the stomach.
Decompression Tubes: Also known as drainage tubes, these are used to remove air, fluid, or other contents from the stomach. They are also used to relieve pressure in cases of intestinal obstruction, paralytic ileus, or after certain surgical procedures.
Typically, your healthcare provider will determine the appropriate type and size of the tube for you or your loved one.
Indications for NG Tube Placement
NG tubes are used in medical situations where the gastrointestinal tract requires support or intervention. Here are some indications for NG tube placement:
Gastric Decompression
An NG tube can help relieve pressure and prevent complications when the stomach or small intestine is obstructed. Conditions that may require gastric decompression include:
Small bowel obstruction
Ileus (temporary paralysis of the intestines)
Obstructing neoplasms (tumors)
Volvulus (twisting of the intestine)
Intussusception (telescoping of the intestine into itself)
In these situations, the tube removes air and fluid from the stomach, allowing the intestines to decompress and potentially resolve the obstruction.
Nutritional Support
Some patients have difficulty swallowing or cannot eat by mouth due to medical conditions like stroke, neurological disorders, or severe illness. In these cases, an NG tube can deliver nutrition directly to the stomach.
Medication Administration
For patients who cannot tolerate oral medications, an NG tube offers an alternative route of administration.
Liquid medications can be given through the tube, bypassing the mouth and esophagus. This method is beneficial for patients with swallowing difficulties or those who are unconscious or critically ill.
NG Tube Insertion Procedure
The NG tube insertion procedure involves several steps to ensure proper placement and patient comfort. Here's the process:
1. Preparation
Before the insertion, a healthcare provider will explain the procedure to you and obtain your informed consent. They will likely sit you up to facilitate the insertion process. A protective sheet may be placed on your chest in case of any discomfort or emesis during the procedure.
2. Insertion Technique
The healthcare provider will lubricate the tip of the NG tube to ease its passage through the nasal cavity and throat. They will direct the tip parallel to the floor, aiming toward the back of your throat. You may be asked to sip water through a straw to help the tube pass more easily.
You may experience some discomfort, such as gagging or coughing, during the insertion. This is normal and usually subsides once the tube is in place. If you feel significant resistance or pain, inform your healthcare provider immediately.
3. Confirming Placement
After insertion to the estimated length, the healthcare provider must confirm its correct placement. They may aspirate gastric contents using a syringe to check for the presence of stomach acid. An abdominal x-ray may sometimes be necessary to verify the tube's location.
Proper placement is crucial to prevent complications (e.g., the tube entering the lungs or injuring the stomach or intestines). Once correct placement is confirmed, the tube is securely taped to the nose and cheek to prevent dislodgement.
NG Tube Maintenance and Care
Proper maintenance and care of your NG tube are essential to avoid complications. Here are some key aspects of NG tube care:
Daily Care
Measure the external length of the tube and compare it to the initial measurement. Ensure the tube is not coiled in the throat.
Use warm water and a clean cloth to remove crusts or secretions from the nose and tube.
To prevent clogging, flush the NG tube with warm water at least once daily. If you're not receiving continuous feedings, flush the tube before and after each use.
Preventing Complications
Watch for coughing, gagging, or difficulty breathing, which may indicate tube displacement. Notify your healthcare provider if you experience persistent discomfort.
To prevent accidental removal, the NG tube should be securely taped to your nose and cheek and pinned to your clothing.
Brush your teeth and rinse your mouth regularly to prevent dryness and irritation caused by the tube's presence.
Feeding and Medication Administration
Sit up or elevate your head at least 30 degrees during feedings and for 30-60 minutes afterward to prevent aspiration.
Always confirm the NG tube's placement before administering feedings or medications.
Flush the NG tube with water before and after each feeding or medication administration to keep it clear and prevent interactions between different substances.
Remember, your healthcare team is there to support you throughout the process. Don't hesitate to ask questions or express concerns you may have.
Complications of NG Tubes
While NG tubes serve important purposes, they can also lead to complications. Understanding these potential issues helps you recognize and address them promptly.
Discomfort and Irritation
The constant presence of the NG tube in the nasal cavity and throat can cause discomfort and irritation. Sinusitis, an inflammation of the sinuses, may occur due to the tube's prolonged presence.
Epistaxis, or nosebleeds, can also result from the tube rubbing against the delicate nasal mucosa. In some cases, the pressure from the tube can cause nasal ulcers, especially if it remains in one position for an extended period.
To minimize discomfort and irritation, ensure the tube is securely anchored to prevent excessive movement. Regularly clean the nasal area and apply lubricants as directed by your healthcare provider. If you experience persistent discomfort, inform your medical team promptly.
Aspiration Risk
NG tubes can increase the risk of aspiration, which occurs when stomach contents enter the lungs. This is particularly concerning if the tube becomes obstructed or malfunctions, as it may hinder the stomach's ability to empty properly.
Aspiration can lead to serious respiratory complications, such as pneumonia. To reduce the risk of aspiration, always confirm the tube's placement before administering food or medication.
Keep the head of the bed elevated at least 30 degrees during feeding and afterward. If you suspect blockage or malfunction, notify your healthcare provider immediately.
Misplacement
Incorrect placement of an NG tube can cause serious complications. Intrapulmonary placement, where the tube accidentally enters the lungs instead of the stomach, can cause respiratory distress, pneumothorax (collapsed lung), or death during feeding.
Intracranial placement, although rare, may occur in patients with basilar skull fractures, resulting in tube insertion into the brain.
So, proper placement is crucial to prevent misplacement complications. Your healthcare team uses various methods, such as aspirating gastric contents, checking the pH of the aspirate, or performing imaging studies, like X-rays, to confirm the tube's correct position.
When to Remove an NG Tube
An NG tube should be removed when it is no longer required. Your physician may order a trial of clamping the tube to assess your tolerance for its removal.
During this trial, the NG tube is clamped for several hours to see if you can manage without it. If you do not experience nausea, vomiting, or abdominal distension during this period, the tube can be safely removed.
The removal process is usually quick and straightforward. However, the tube should not be forcefully removed, as it can become knotted. Your healthcare provider will carefully remove the NG tube while you take a deep breath and hold it, which helps prevent aspiration.
After removing the tube, your healthcare team will clean your nose and provide mouth care. They will also monitor you closely for any signs of discomfort or complications.
Benefits of at-home care for seniors include support for transitioning off NG tubes. Home care professionals can assist with monitoring your condition, providing education on post-removal care, and helping you adapt to eating and drinking normally again.
They can also watch for any signs of complications and coordinate with your medical team to ensure a smooth recovery.
NG Tube Care
NG tubes are part of the standard of care for many routine health issues. While they may seem daunting initially, proper care and maintenance can prevent many problems.
The entire healthcare team, including physicians, nurses, and caregivers, should know the indications, contraindications, and potential complications associated with NG tubes. This knowledge allows for effective management and timely intervention if issues arise.
If you require assistance with NG tube care at home, private duty nursing vs. home health services can provide personalized support customized to your needs. These professionals help you with the daily care tasks, monitor for complications, and provide education and guidance.
Remember, you are not alone in this journey. Your healthcare team is there to support you every step of the way.
Care Indeed offers comprehensive support for nasogastric tube care, ensuring you receive expert guidance and assistance to manage daily maintenance and prevent complications. Our skilled professionals provide personalized care for a comfortable and safe experience.
Contact Care Indeed today to learn how we can assist with your nasogastric tube care needs.
Frequently Asked Questions
What Should I Do If the NG Tube is Clogged?
If the NG tube becomes clogged, try flushing it with warm water and repositioning yourself. If it remains clogged, contact your healthcare provider immediately.
How Can I Reduce the Discomfort Caused by the NG Tube?
To minimize irritation and discomfort, ensure the tube is securely anchored, clean the nasal area regularly, and apply lubricants as directed by your healthcare provider.
Where Can I Get Help With NG Tube Care At Home?
Home health services and private duty nursing can assist with NG tube care, ensuring proper maintenance, monitoring for complications, and offering personalized support.