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Nasogastric (NG) Tube: How to Insert Your Child's NG Tube

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What is a nasogastric tube?

A nasogastric (NG) tube is a long, thin, hollow tube which is passed through a nostril of the nose into the throat and down into the stomach. You can use the tube to feed your child if they are unable to take food by mouth. Fluids pass through the tube into the stomach.

How do you insert the tube?

A. Preparing the tube for insertion

The steps are a little different for babies and children. Please follow the directions from your nurse.

1. Gather the following equipment:

  • NG tube, size _____
  • cut pieces of a non-allergenic tape, such as Hypafix™
  • straw in glass of water (for drinking) or soother for an infant
  • sterile water or water-soluble lubricant (for lubricating the tube)
  • dry syringe and your stethoscope
  • permanent writing marker
  • pH test strip

2. Place all supplies within close reach.

3. Wash your hands.

4. Measure the NG tube to find the correct length.

  • Have your child sit up straight. For babies, lay your baby face up with the chin slightly raised.
  • Hold the end of the tube with the holes at your child’s nostril and begin measuring from the holes.
  • Measure the feeding tube from the nostril to the base of the ear lobe, then to below the chest bone (about 1 finger width for an infant or 2 finger widths for a child).
Measuring the NG Tube for Correct Length
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5. Write down these measurements on the tube with the permanent marker.

Marking Measurements on NG Tube
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6. Loosen the guide wire from the tube but do not remove it yet.

B. Inserting the tube

Each time you insert the tube, try to go from one nostril to the other with each change. Also remember to change the NG tube every month.

Every time you put an NG tube in your child, you must do the following steps:

  1. Have your child sit upright. If he is a baby or very young, lay him down and bundle him in a blanket to help hold his arms and legs.
  2. Dip the first 2 to 4 inches (5 to 10 cm) of the tube in the water or water-soluble lubricant (for example, KY™ or Muko™ Jelly). This will make it easier to pass the tube.
  3. Insert the end of the tube into the nostril you have chosen and advance the tube slightly down and towards the ear on that side. Do not force the tube.
  4. If your child is allowed to have water, he may sip the water through a straw. You can also give your infant a soother to help him swallow. If your child is not allowed to drink, tell him to swallow as the tube goes down.
  5. Continue to advance the tube until the marked spot reaches the nostril. If the tube comes back out of your child’s mouth, pull it back, let your child recover and start again.
  6. Secure the tube to your child’s face with a small piece of tape.
  7. Be alert for accidental placement of the NG tube in the trachea (windpipe). If the tube is in the airway, your child may choke, cough, or have trouble breathing. If this happens, REMOVE THE NG TUBE IMMEDIATELY. Let your child rest and start again once he feels better.
  8. Check the correct tube placement before removing the wire and before giving any feeds or medicines. See the instructions below for checking the tube placement.
  9. Hold the NG tube at your child’s nostril and pull gently, but firmly, on the guide wire to remove it. Do not throw away the guide-wire. Save it in a safe place for future use.
     

C. Check the placement of the tube

Check your child’s tube placement:

  • before every feeding
  • when a new tube is put in
  • when you are concerned that the tube may have come out
  • if your child is choking, vomiting, coughing or having trouble breathing

There are two ways to check the tube placement inside your child. Check using both of these methods:

Method 1:

  1. Pull back the plunger on the syringe and draw in 3 mL of air.
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  1. Attach the syringe with air to the end of the tube.
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  1. Put the ear pieces of the stethoscope comfortably in your ears. Put the round part over your child’s stomach, below the ribs and to your child’s left side.
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  1. While listening with the stethoscope, push down quickly on the syringe plunger. If you hear a whooshing, gurgling or popping sound, the tube is correctly positioned.
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  1. Repeat until you are certain that you hear the sound or until you decide that the tube is not correctly placed.
  2. If you believe the NG tube is not correctly placed, remove it and try again.

Method 2:

  1. Attach the empty syringe to the adapter and pull back on the plunger to withdraw about 2 mL of stomach contents.
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  1. Wet pH testing paper with the stomach fluid and compare the color with the label on the container.  The colour on the strip should match a number no higher than ____ .
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  1. If you believe the NG tube is not correctly placed, remove it and try again.

After inserting a new tube: Once you are satisfied that the tube is in the stomach, flush 1 mL to 2 mL of water through the tube. This lubricates the guide-wire and makes it easy to remove.

D. Once you are sure the tube is in the stomach

  1. Secure the tube. Place tape across the tube to secure it to the cheek.
  2. Remove the guide-wire while securing the tube to prevent it from being pulled out. Close the end of the tube.
  3. Save the guide wire for future use. Clean and dry it and place in a secure location.

If skin irritation occurs over time and you are not able to heal it, speak to your child’s doctor or nurse. 

For more information, please see Nasogastric (NG) Tube: Feeding Your Child and Nasogastric (NG) Tube Feeding: Common Problems.

Key points

  • A nasogastric (NG) tube is a long, thin, hollow tube which is passed through a nostril of the nose into the throat and down into the stomach.
  • Each time you insert the tube, try to go from one nostril to the other with each change.
  • If the tube is in the airway, your child may choke, cough, or have trouble breathing. If this happens, remove the NG tube right away. Let your child rest and start again once they feel better.

Amanda Lovell, RN

Celine Menezes, RN, MSN, ANP (Educator)

Julia Kelly, RN

Karen Breen-Reid, RN, MN, ANP (Educator)

Sarah Ferguson, RN

12/7/2010




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