How to look after my nasogastric tube (NGT)

This information leaflet is for patients being discharged home with a nasogastric tube for the purpose of enteral feeding in community. This can be inserted during your inpatient stay or can be done as an outpatient in clinic and in most cases does not require an admission. Your healthcare team will explain what is involved and answer any questions you may have.

About the nasogastric tube

A nasogastric tube is a soft tube which goes down your nose into your stomach, allowing food and water to enter your stomach directly. The term ‘nasogastric’ describes the way it is placed: 'naso' means 'via the nose', and 'gastric' means 'into the stomach'.

Why do I need an NGT?

Your medical condition may mean that you are unable to take in enough food and/or drinks by mouth to meet your nutritional requirements. This may be due to:

• Difficulty swallowing (dysphagia) that arises from changes to the function of muscles involved in swallowing. These changes can increase the risk of food and/or drinks to your lungs, which can result in a chest infection called aspiration pneumonia.
• Changes to your appetite and/or ability to take food orally due to reduced physical function or treatment
• You are unable to eat and drink due to illness, surgery or trauma.

Benefits

A nasogastric tube provides an effective way of providing nutrition, hydration and administer medication if:

• you are unable to eat and drink due to illness, surgery or trauma
• you are unable to eat and drink sufficiently to meet your daily nutritional requirements
• you have been assessed by a speech and language therapist (SLT) as unsafe to consume food and/or fluid via the oral route

How does it stay in place?

The NGT is secured with small dressings to your nose, cheek and neck. It is important to use a dressing to prevent the tube from moving or being accidently pulled out. If the dressing on your nose becomes loose, there are measurements (numbers) along the tube which you will need to check to tell if it has moved.

How long will I need to have my NGT?

How long you will need the tube will depend upon the reason why you have it. You will be regularly reviewed by a hospital or community dietitian who will advise you about this.

Nasogastric tube related problems

• Displacement: The NGT can become displaced and enter your lungs or mouth.
• Blockage: This can usually occur after giving some medications or not flushing the tube at the end of a feed. You are encouraged to prevent this by flushing before and immediately after feed.
• Falling out: This will occur if the dressing or tape on your nose and cheek becomes loose. It is important to check your dressing is fixed before each episode of tube use.

How do I check the tube is in the right place?

It is important to check that the tube is in your stomach before you use it each time. This is because it is possible for the tube to move and go into your lungs which can be very dangerous.

To do this you need to check the acidity of what you can get out of the tube, by following these instructions:

1. Remove one strip and close pot.
2. Do not touch the test zone (coloured end) with fingers as this may affect the reading.
3. Attach a 60ml purple enteral syringe to your tube.
4. Draw back on the syringe to obtain some stomach contents (‘aspirate’) – you only require a few drops of liquid.
5. Place two or three drops of aspirate on all areas along the test zone.
6. Read after 10 seconds of applying aspirate. Compare the change in colour on the test zone to the colour scale on the tube.
7. If a colour change occurs after 60 seconds, it must not be considered as safe to use the NGT.
8. A pH of 1 to 5.5 is the recommended safe range to confirm the correct placement of a NGT.

What if the pH is more than 5.5?

If you get a pH reading of more than pH5.5, you should not put any water, feed or medication down the tube. Try these different methods to help:

• Check the measurements on your tube to see if it has moved out of place.
• Wait about 30 minutes, then try again.
• If you can safely swallow, drink some easily identifiable liquid, such as blackcurrant squash, and try and draw it back into the syringe.
• Be aware that certain medications may raise the pH of your stomach contents. Training will be provided.

What if I can’t get any aspirate?

It can sometimes be difficult to obtain any liquid from your stomach. If you can safely swallow, drink some easily identifiable liquid, such as blackcurrant squash, and try again after a few minutes. Avoid drinking too much water, as this may give pH readings higher than 5.5.

If you are still unable to get an aspirate or a gastric pH between 1 and 5.5, please contact your community nutrition nurse or the nutrition nurse specialists on: 01223 216037, Monday to Friday 08:30 (8:30am) to 16:00 (4pm) (excluding bank holidays).

Can I still eat and drink?

If you are experiencing dysphagia, your SLT will assess your swallowing and provide advice if you would like to continue eating and drinking with a nasogastric tube.

How long does my tube last for and what arrangements are in place for it to be changed?

How long your NGT will last will depend on the type used. Some can be used for up to three months, at which point it will need to be changed. As patients may have a NGT for different reasons, your replacement plan will provide individualised information specific to you. Your plan will include explanations of what you need to do should the tube become blocked or fall out in working hours, out of working (and overnight), weekends and bank holidays.

Alternatives

If you require enteral feeding for a longer period, you can ask your dietitian about a gastrostomy tube.

What if I decide not to have a feeding tube?

We will check that you fully understand the risks of not having a tube but will support your decision. If you are finding it difficult to eat and drink due to lack of appetite or difficulty swallowing but decide not to have a feeding tube, we will again support your decision. Your SLT and dietitian will continue to work with you to help you make the most of eating and drinking, and to make it as easy as possible, for as long as you find this helpful.

Who to contact about what?

You will be trained in all the necessary techniques to look after the feeding tube and what to do if you do have problems. However, your community nurses, GP, dietitian and nutrition nurse will be available to help and support you. Your dietitian will provide regular follow up. The company delivering your feed also has a nurse helpline.

For concerns about your feed delivery or plastics order (including syringes and dressings)

• Nutricia Homeward 0800 093 3674
• Abbott Hospital to Home 0800 0183799
• Fresenius Kabi 0808 100 1990

For concerns about your feeding tube or feeding pump

• your community nutrition nurse
• Nutricia: 03457 623672
• Abbott: 0800 0183799
• Fresenius Kabi: 0808 100 1990

Please contact your local dietitian if you have any concerns about:

• any symptoms that suggest you are not tolerating your feed, such as bloating or nausea.
• your weight
• the amount or type of feed you take
• if you want to discuss tube removal

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device.

Privacy and dignity

Same-sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one-to-one care is required.