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

A guide on how to insert your child's nasogastric tube and how to check to make sure the placement inside your child is correct.

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.

Introduction

Treatment

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.

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

Place all supplies within close reach.
Wash your hands.
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".

Measurements on an infant and on an older child and location of base of chest bone and belly button on both

Mark these measurements on the tube with the permanent marker.

Markings on a NG tube with two ports and removable guarded wire at starting point and point on the tube below the chest bone

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:

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.
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.
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.
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.
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.
Gently remove the guidewire from the tube. Secure the tube to your child’s face with a small piece of tape. Do not throw away the guidewire. Save it in a safe place for future use.

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.
Check the correct tube placement 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:

Two millilitres of liquid in a syringe attached to an NG tube

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.

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.

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 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.

Resources

Last updated: January 26th 2024