Your child requires a nasogastric (NG) tube

Introduction

A nasogastric tube may be used when a child or young person cannot eat or drink enough to maintain their nutritional requirements. The nasogastric tube delivers feed, fluid and medication (where required) into the stomach.

What is a nasogastric tube?

A nasogastric tube is a tube that passes through the nostril, down the throat and into the stomach. It can be used to give feed and medication. Sometimes after abdominal surgery it can be used to allow the stomach to rest.

Advantages

• Provides your child with adequate nutrition.
• Enables your child to have medication if unable to take it by mouth.
• Alleviates anxiety of having to ensure that your child takes a certain amount of calories, fluids and medication.

Disadvantages

• Not cosmetically pleasing.
• May become dislodged through coughing, sneezing or vomiting.

How long can a nasogastric tube stay in place before it requires changing?

This will depend upon the type of tube. This will be confirmed prior to discharge. If it is anticipated that the nasogastric tube will be required for several weeks then a long term tube will either be passed before discharge or arrangements made that a long term tube is passed either in the community by the Paediatric Community Nurses or at the next appointment.

My nasogastric tube

. . . . . . . . . . . . . . . . . . . . . . . . . (name) had a size 8Fr or 6Fr nasogastric tube inserted into the left or right nostril on date: . . . . . . . . . . . . . . . . . . . . . . . . . (DD / MM / YYYY)

This tube is:

• A short term tube and may remain in situ for four weeks (28 days)

Or

• A long term tube and may remain in situ for eight weeks (60 days)

Frequently asked questions

Will your child be able to go swimming?

Swimming is possible. However, the nasogastric tube should be coiled and secured to prevent it being pulled. Ensure that the cap is securely fixed to prevent water from entering the tube. Please contact individual swimming pools to ensure this is ok.

Can I learn to pass the tube myself?

Some parents and older children are taught how to pass the nasogastric tube. Please discuss with your Community Nurses.

Are there any risks associated with having a nasogastric tube inserted?

Children with certain conditions may require a blood test to check their platelets before a nasogastric tube can be passed.

There is a risk that when the tube is first inserted it may pass into the lungs or pass the stomach through into the small bowel. Therefore it is important to ensure that the tube is in the stomach and not the lungs or small bowel before a feed is given.

How long will my child need a nasogastric tube for?

Your Dietician will provide a plan. Follow-up will be arranged. This appointment may be with one of the Dieticians at Addenbrooke's or at your local hospital.

How often should the nasogastric tube be flushed if I do not need to give a feed one day?

The nasogastric tube must be flushed with water at least once a day if not using the tube for feed.

Can my child go to school with a nasogastric tube?

There is no reason why a child cannot go to school with a nasogastric tube in place.

Testing the nasogastric tube

It is important to check the position of the nasogastric tube before administering any feed, medication or water flush and after vomiting, sneezing or coughing.

Equipment

• 20ml purple syringe.
• pH indicator strips.
• Feed (if giving).
• Water to flush.
• Medication drawn up into syringes (if giving).

Instructions

1. Wash your hands.
2. Check the tube at the nostril and ensure that the number at the nose has not changed and the tube remains secure to their face.
3. Remove cap from nasogastric tube.
4. Attach a 20ml syringe to the nasogastric tube and draw back to obtain stomach contents (this is called aspirating). Draw back enough fluid (0.5ml minimum) to be able to test the aspirate on the pH paper so that a colour change can be seen. The initial fluid obtained may be the water left in the tube from the last flush.
5. Place two to three drops of the stomach contents on to a pH strip. Wait 10 seconds and no longer than 60 seconds.
6. Match the colour of the strip with the colour code on the pack to identify the pH of the stomach contents. A pH value of 1 to 5.5 indicates an acid reaction. This means the tube is in the stomach.
7. Do not feed if the pH is 6 or higher. Seek advice from the ward nurses.

Proceed to give feed

pH below 5.5

<

Seek advice

pH above 6.0

>

What to do if you cannot aspirate any fluid

1. Check the tube position at the nostril to see if it has moved since it was placed.
2. Change your child’s position if possible, for example, rolling onto one side or sitting up.
3. Try again to draw back on the syringe to obtain stomach contents.
4. If your child is allowed to drink let them have an identifiable drink, for example, blackcurrant juice.
5. Wait for 20 minutes. Try again to draw back on the syringe and test the pH.
6. If you are still unable to obtain aspirate, contact your Children’s Community Nurse or the Children’s ward.

Do not use the nasogastric tube without seeking further advice.

Medication

• If your child is already on any medications, the pharmacist will have checked that it is ok to administer these down a NG tube.
• Thereafter if your child is prescribed medications it is important to remind your Doctor and Pharmacist that your child uses a NG tube and that the medication needs to be the right preparation for this route.
• To avoid blocking feeding tubes, thick liquids should be diluted with equal amounts of water before administering.
• Please check that if you are dispersing tablets that these can be crushed or dissolved in water before administering and that the medication is completely dissolved to prevent blocking of the tube. Tablets that are enteric coated or state that they are sustained, prolonged or modified release must not be crushed.
• Do not mix medications together.

General care

• It is important to know the markings / number of the nasogastric tube at the nostril to detect for any movement.
• Ensure that the nostril and the tube are kept clean. Carefully wash the area with soap and water. Observe the nostril for any signs of skin breakdown or redness. The tube may need to be changed to the other nostril if this occurs.
• Ensure that the nasogastric tube is always securely fixed with tape. Apply a hydrocolloid dressing, such as duoderm underneath the tube to protect the skin. Apply a tape (mefix or tegaderm) over the tube to secure it. Your community nurse may be able to assist with the changing of tapes as help is usually required with this. Observe the skin around the tapes for any signs of irritation / reaction to the tape.
• Observe the nasogastric tube for any signs of deterioration, for example cracks.
• Requires changing between four to eight weeks depending on the type of tube. You will be advised about this by your ward Nurse or Paediatric Nutrition Nursing Team.

Hand hygiene

Hand hygiene is important before and after checking the nasogastric tube. Please follow the six stage hand washing technique below.