Nasogastric (NG) tube: How to insert your child's NG tube

 

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 enough food by mouth or they are not safely able to take food by mouth. Liquid feeds pass through the tube into the stomach.

How do you insert the tube?

Preparing the tube for insertion

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

  1. Gather the following equipment:
    • silastic NG tube with guide wire, size _____
    • cut pieces of a non-allergenic tape, such as Hypafix
    • straw in a glass​ of water (for drinking) for a child or a soother for an infant
    • sterile water or water-soluble lubricant (for lubricating the tube)
    • permanent writing marker
    • 10 mL syringe
    • pH test strip
    1. Place all supplies within close reach.
    2. Wash your hands.
    3. Measure the NG tube to find the correct length.
      • Have your child sit up straight. For babies, lay your baby face up with their 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 about half way between the base of the chest bone and the umbilicus, or "belly button".
    Measuring the NG tube for correct length
     
    1. Mark these measurements on the tube with the permanent marker.​
    Marking measurements on NG tube
     
    1. Loosen the guide wire from the tube but do not remove it yet.

    Inserting the tube

    Each time you insert the tube, try to go from one nostril to the other with each change. A soft silastic NG tube can remain in place for one month, remember to change it 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 your child is a baby or very young, lay them down and bundle them in a blanket to help hold their 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. Do not use petroleum jelly (e.g. Vaseline) for lubrication.
    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, they may sip the water through a straw. You can also give your infant a soother to help them swallow. If your child is not allowed to drink, tell them 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 they feel 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.

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

    Check the placement of the tube

    Check your child’s tube placement:

    • before using the tube for feeds or medications
    • 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

    Check the tube placement inside your child using the following method:

    1.  
      Attach the empty 10 mL syringe to the adapter and gently flush with air to clear the tube. Then pull back on the plunger to withdraw about 2 mL of stomach contents.
    1.  
      ​Wet pH testing paper with the stomach fluid and compare the color with the label on the container. For the majority of children, the colour on the strip should be less than 4. For children who are on stomach acid suppressing medications or who have just fed, the colour on the strip should be less than 6. Ask your health care provider what colour to expect. The colour on the strip should match a number no higher than ____ .
    1. If you believe the NG tube is not correctly placed, remove it and try again.

      If you have trouble pulling back some stomach fluid to do the pH test, try the following:

      • Use a larger syringe and draw back more gently to prevent collapsing the tube.
      • Push in 1 to 2 mL of water or air through the NG tube into the stomach and gently draw back on the syringe.
      • Change your child’s position by having them lie on their right or left side for a few minutes to move the position of the tube in the stomach.

    Removing the guide wire

    1. Once you are satisfied that the tube is in the stomach, place tape across the tube to secure it to the cheek.
    2. To remove the guide wire, start by flushing 1 to 2 mL of water through the tube. This lubricates the guide wire and makes it easier to remove. Hold the NG tube at your child’s nostril and pull gently, but firmly, on the guide wire to remove it. Close the end of the tube. Do not throw away the guide wire. Save it in a safe place for future use.

    For more information, please see Nasogastric (NG) tube: Feeding your child and Nasogastric (NG) tube feeding: Common problems.


    Key points

    • A soft silastic 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.
    • You must check the placement of the NG tube each time it is inserted, used for feeds or to give medications.
    • 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.
    ​​​​​​​​​​​​​​​​​​​​​

Celine Menezes, RN, MSN, Interprofessional Education Specialist

Karen Breen-Reid, RN, MN, Manager, Interprofessional Education

6/8/2017
Notes: