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Nasogastric Tube Feedings

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A nasogastric tube, or NG tube as it is often called, is a tube that is inserted through the nose and down the back of the throat.  It travels down the esophagus and into the stomach.  It is primarily used for giving medications and infant formula or breast milk to babies and children who cannot take enough formula by mouth to gain weight.

The two types of NG tubes we use:

  • A clear tube that is changed every three days

  • A yellow tube that is changed every 30 days

Putting in the Nasogastric Tube

 Gather the following supplies:

  • Tape

  • 3cc oral syringe

  • The correct size NG tube

  • A cup of water or water soluble lubricating jelly (do not use petroleum jelly because this will clog the tube)

  • A blanket for swaddling your baby

Begin by washing your hands.

Measuring the NG tube

  1. Cut 2 pieces of tape: one small piece to mark the tube so you know how far to insert it and a larger piece to hold the tube in place.

  2. Open the NG tube package and squeeze the water soluble jelly onto the inner package.  If you are using water as a lubricant have it nearby.

  3. Place your 3cc oral syringe within reach.

  4. To measure the tube, lay your child on his/her back.  Remove the metal stylet or inner wire if you are using the 30 day yellow NG tube.

  5. With the baby’s face straight and looking up, take the end of the NG tube that will be in the stomach:

    • Hold it to the middle of the ear lobe

    • Measure from the ear lobe to the tip of the nose

    • Then measure to a place halfway between the lower tip of the breast bone and the belly button (umbilicus).  Mark this spot with the small piece of tape.  This is how much of the tube that must be inserted in order for it to reach the stomach.  Check your measurement more than once to ensure correct length for placement.

 

Inserting the NG tube

  1. Swaddle your baby with a blanket; this will help prevent your child from grabbing at the tube while you are inserting it.   Giving your child a pacifier or having an older child swallow will help guide the tube down.

  2. Dip the end of the tube that will be in the stomach into the water or jelly to lubricate it.

  3. Gently insert the tube through the nostril and if you meet resistance, try curving the tube downward.  If the tube won’t move easily, if you see the tube coming out of the mouth or if there is excessive coughing, stop, remove the tube and try it again.

  4. Stop inserting the tube when you reach the spot marked with tape.

  5. Tape the tube close to the nose and cheek.

 

Confirming NG tube placement

  1. Put 2cc of air into your 3cc syringe and attach it to the NG tube.  Place your ear up against your child’s stomach and quickly push in the 2cc of air while listening for a pop or swoosh to confirm that the end of the tube is in the stomach.  Draw back the 2cc of air to help prevent discomfort from gas pain.  If you continue to pull back on the syringe you may see a little liquid come into the syringe.  This is from the stomach and is a second way of checking for tube placement.   However, if the stomach is empty you may not get any liquid back.

  2. Give the stomach contents back to your child because these contain acids and electrolytes your child needs.  Do not give any extra air.

  3. When proper placement is confirmed, make sure the tube is secured well to your child’s face.

  4. Always check for placement before putting anything down the NG tube.

 

Feeding your child

Gather your supplies

    • Formula or breast milk that is warmed to room temperature

    • 60cc oral syringe or feeding bag and kangaroo pump

    • 3cc oral syringe

    • cup

Gravity Feeding/Pump Feeding

  • Confirm correct tube placement (described previously).

  • Remove the plunger from the 60cc oral syringe

  • If you are using the bag and pump, close the roll clamp and pour no more then four hours worth of formula into a feeding bag.

  • Remove any air by opening the clamp on the feeding bag and letting the formula fill the tubing.  Any formula flowing out of the end of the tubing may be caught in a cup or bottle and placed back in the syringe or feeding bag.  Place your feeding bag on a hanger and place it in the pump.

  • If you are using the 60 cc oral syringe, connect it to the NG tube and then add the appropirate amount of feeding.
  • Syringe feedings run by gravity so the higher it is placed the faster it will run.  Normally a feeding should take 20 to 30 minutes.  Lower the syringe if the feeding is running too fast.  If the feeding is not going in, take the plunger and gently push down in the syringe slightly (you may feel a little resistance) and then remove the plunger.   With the kangaroo pump feedings, set the pump rate as instructed by your health care provider.
  • Feeding time is a social time.  Hold, talk, and look at your child.  Your baby may also like a pacifier during the feeding.  If you are unable to hold your child lay him/her on their side to help prevent choking or vomiting.
  • When the feeding is completed, flush the NG tube with 3cc of water to clear the NG tube of formula and prevent it from clogging.  Rinse the 60cc syringe or feeding bag with water and it is ready for the next feeding.  
  • Medications may be given through the NG tube and followed with a 3cc flush to ensure all the medication is in the stomach.  However, there are some medications that should not be given through a NG tube such as aspirin or cyclosporine.  Check with your nurse to see which medications can be safely given through the NG tube.

Removing the Nasogastric Tube

  1. Gently remove the tape from your child’s face.

  2. Pinch the NG tube with your thumb and forefinger to prevent any liquid from flowing out while the tube is being removed.  Remove the tube in one gentle motion.

  3. If you are using the clear tube, rinse it with warm tap water while looking for leaks.   You may reuse this NG tube 2 or 3 times as long as it is flexible, has no leaks, and is not clogged.  The yellow 30 day tube should be discarded after it is removed and a new one inserted.

  4. Remember to switch nostrils with each tubing change.

Call your doctor/clinic if:

    • Your child has breathing problems or a fever after choking

    • Your child vomits more then one feeding

Reviewed by Denise Roberts, RN, MSN, October 2008

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University of Michigan Health System Cardiovascular Center
1500 E. Medical Center Dr.
Ann Arbor, MI 48109
734-764-5177
http://www.med.umich.edu/
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