What Are the Steps of Nasogastric Tube Feeding?

Nasogastric (NG) tubes are an effective way for people to get the fluids and nutrients they need when they are unable to chew, swallow, or drink the way they normally would. However, to make use of an NG tube the correct way, it is important to understand how NG tube placement should take place. As such, we decided to detail the steps of NG tube feeding in this article so that you can have a clear understanding of how the process should play out.

Determining that an NG Tube is Necessary

The first step in NG tube feeding is determining whether an NG tube is necessary at all. In cases in which people are unable to ingest foods, liquids, or medications orally, an NG tube can be an excellent short-term solution.

Becoming unable to intake nutrients orally can occur for a wide range of reasons. Likewise, people of all ages, from newborns to the elderly, may find themselves in need of an NG tube for one reason or another.

Ultimately, the decision to use an NG tube is one that your healthcare provider will suggest in response to a condition or acute injury. But while NG tubes are a convenient and effective feeding method in those instances, proper NG tube placement is crucial to success.

Placing the NG Tube

There’s no doubt that NG tubes are one of the few viable options for delivering nutrients to those who can’t intake them orally. Unfortunately, NG tube placement can go wrong more often than you might expect. When NG tube misplacement occurs, the person receiving the NG tube can experience one of several complications, some of which are more severe than others. Since the best way to resolve NG tube misplacement issues is to avoid them entirely from the start, we’ve detailed the correct process for placing an NG tube in the sections below.

NG Tube Placement Preparation

NG tube placement should take place in a sterile manner. Whoever performs the placement should begin by washing their hands, wearing gloves, and ensuring the tube and all associated placement equipment are as sterile as possible.

Speaking of equipment, the preparation phase is the time to gather all of the tools you will need to conduct proper placement. Below is a list that gives you an idea of what a complete NG tube placement toolkit could look like:

NG tube placement can be especially difficult for those with limited medical experience who attempt the process at home. Having the right tools in place before making such an attempt will increase your likelihood of successful placement.

However, in most cases, the initial placement of an NG tube should be done by a medical professional. Also, if you are uncomfortable with performing the process yourself, you should always seek medical assistance to avoid preventable complications.

NG Tube Measurements

The person placing the NG tube is responsible for taking proper measurements before inserting it. Taking the correct measurement ensures that the NG tube will reach the area of the stomach where it is more effective and least likely to cause complications.

There are multiple methods for determining how much of the NG tube you’ll need to insert, but all of the best methods take into account the distance from the mouth to the back of the throat and the distance from the back of the throat to the stomach.

Adding those two numbers together should give you a general idea of the length of the NG tube you’ll need to insert. Use your tape measure and marker to mark the measurement on the tube before you attempt to place it. This mark will serve as a guide to tell you when the tube has been fully inserted.

Inserting the NG Tube

Before inserting the end of the NG tube, apply lubricant to the end to allow for easier insertion. Then, insert the end into one of the person’s nostrils. While you should be gentile while inserting the tube, you may need to overcome some slight resistance as the tube passes through the nasal cavity.

If possible, it is helpful to have the person receiving the NG tube placement sip water through a straw as the tube moves past the nasal cavity and toward the epiglottis. The act of sipping will allow the person to essentially swallow the tube rather than having it pass into the trachea.  

Again, proceed gently and patiently as the tube continues to insert into the esophagus and eventually into the stomach. Keep note of the mark you made earlier on the NG tube. When that mark is just outside of the person’s nostril, it is likely at the correct depth, meaning that you can stop inserting the tube.

After inserting the NG tube to the proper depth, secure it in place using the tape. Throughout the entire process of inserting the tube, you should remain vigilant of the person’s response to the placement to ensure their safety at all times.

Testing Placement

Following the insertion stage, it is important to test placement before using the tube. First, you’ll want to notice any obvious signs of misplacement, including choking, vomiting, gagging, changes to face color, changes in respiration or heart rate, pain, difficulty speaking, or any other concerning responses.

If those signs are not present, it is likely that your NG tube placement was a success. However, it is important to test the placement of the tube by using a PH test. Before using the tube for feeding, it is vital to perform a PH test. Only proceed to feeding if the PH test returns results within an acceptable range. If not, the tube will need to be adjusted or replaced before feeding can begin.

NG Tube for Feeding Period

Technically speaking, NG tubes are intended for relatively short feeding periods. The use of NG tubes typically lasts for about four to six weeks. After that period, you will either need to remove the NG tube, replace it with another NG tube, or replace it with a more long-term feeding solution.

During the feeding period, you can use the NG tube to administer food, liquids, and any medications that the person using the tube needs. However, it is important to continually test the tube to ensure that it remains properly placed.

The best approach is to repeatedly perform PH tests. PH tests are often the most accurate way to tell if an NG tube’s placement is correct or needs to be changed. During the feeding period, you should also continue to monitor the tube user for any other symptoms of complications that we mentioned in the previous section.

If you place the tube and perform feedings properly, the NG tube will be a reliable way for the person using it to receive the nutrients they need during the weeks that they must rely on the tube.

NG Tube Removal or Replacement

At the end of the feeding period, you’ll reach the final step of using an NG tube. This last step is the stage at which you will either remove or replace the NG tube. If the cause of your need to use an NG tube has subsided, you may be able to return to eating, drinking, and taking medications normally.

However, in other cases, it may be necessary to replace your NG tube with either another NG tube or a feeding method that is meant for longer-term use. Either way, it is important to have your NG tube evaluated for removal or replacement after a few weeks of use.

Alternatives to NG Tubes

While NG tubes are a common way to give a person food, water, and nutrients, they are far from the only way to perform that task. In fact, there are several other NG tube alternatives that can perform the same job.

One of the most common alternatives to an NG tube is an orogastric, or OG, tube. The primary difference between an NG and an OG tube is that while an NG tube enters the person’s body through the nostril, an OG tube enters through the person’s mouth. Both NG and OG tubes serve the same function of providing a short-term feeding method.

Using an intravenous feeding method is another alternative to NG tubes for short-term feeding. Intravenous feeding is especially necessary when the stomach or other parts of the digestive system are not functional.

In some cases, it is necessary to find a feeding method that is ideal for longer-term use than NG tubes. In those instances, a Gastric tube or a Jejunostomy tube are some of the most common methods to use. However, unlike NG and OG tubes, these long-term options require an incision to access the stomach.

With that said, regardless of the feeding method you use, correct placement is paramount. If you are ever in need of an NG tube, referring to the information in this article is a great way to ensure that you are using your tube safely and correctly.

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