Your Child's Nasogastric Tube: Placing the Tube

Your child is going home with a nasogastric (NG) feeding tube in place. This is a soft thin tube inserted through your child’s nose down into the stomach. It delivers liquid food directly to the stomach. You were shown how to place the tube before your child was discharged from the hospital. This sheet can help you remember those steps when you and your child are at home. Arrangements may also be made for a home health nurse to help you.

Home Care

Your child’s NG tube needs to be replaced every 14 days. (If your child pulls the tube out before then, you’ll need to reinsert it. It’s okay to use the same tube in this case. Before you reinsert it, wash the tube with soap and water.) Change nostrils each time you need to insert the tube.

Supplies

Measure the NG tube before placing it in your child.

• NG tube

• Dark-colored marker pen

• Water-based lubricant

• Adhesive skin dressing

• Tape

• 5-10 cc/mL syringe

Steps

• Prepare the tube.

  • Wash your hands with soap and water.

  • One end of the tube is rounded and goes into the nose. The other end has two ports. One port is for feeding. The other port is for giving medications.

  • The tube may have a wire (metal stylet) inside it. The wire keeps the tube from curling. If your child’s tube has a wire, check that it can be removed easily and doesn’t get stuck.

• Measure the tube.  

  • Hold the tip of the tube at your child’s nose.

  • Extend the tube to the earlobe. Then, extend from the earlobe to a spot between the bottom of the breastbone (xyphoid process) and the belly button.

  • Keep your finger on the tube at this spot.

  • Use a dark marker pen to mark this spot on the tube. This shows how much of the tube needs to be inserted before it reaches the stomach.

• Position your child. 

  

  The NG tube is placed through your child’s nose and down into the stomach.

  • If your child is an infant, wrap him or her in a blanket to prevent movement.

  • If your child is older, he or she should sit upright. Also, if possible, have your child tuck his or her chin slightly toward the chest.

• Insert the tube.  

  • You may need someone to hold your child while you insert the tube.

  • Apply water-based lubricant to the tip of the tube so that it can slide through the nose easily.

  • Gently guide the tube into either nostril.

  • The tube is easier to advance when your child is swallowing. An infant can suck on a pacifier as you insert the tube. An older child can drink water or dry swallow. Don’t force the tube. If your child coughs, gags, or has trouble breathing, stop and wait. Allow your child to rest. Then, try again.

  • Advance the tube until the mark you made earlier reaches the child’s nose.

  • Place the adhesive skin dressing on your child’s cheek where you plan to tape the tube. This protects your child’s skin from being damaged by the tape.

  • Tape the tube to your child’s cheek over the adhesive skin dressing (as you were shown in the hospital). This secures the tube in place.

  • If your child’s tube has a wire, remove it at this time. Don’t throw the wire away. In case you need to reinsert the tube, the wire can be reused to keep the tube straight.  

• Check the placement of the tube. 

  • Check for proper tube placement:

  • • Attach the syringe to the end of the tube and make sure the other port of the tube is closed off.

    • Pull back on the plunger of the syringe to get stomach contents.

    • Check the pH using pH paper. Gastric (or stomach) pH should be 1 to 4 if your child is not on a proton pump inhibitor or H2 receptor antagonist. Please discuss what medications your child is taking with his or her doctor.

    • Observe the color of the fluid. Gastric (stomach) fluid should look clear, light yellow, or light green.

  • Disconnect the syringe from the tube.

  • When the placement of the tube is confirmed, adjust the tape on your child’s cheek to secure the tube in place, if needed.

  • Wash the syringe with soap and water and let it dry.

NOTE: If you are NOT SURE the tube is in the stomach, reinsert or advance the NG tube as you were instructed by the health care provider and REPEAT the steps to check for CORRECT placement.

Tips for Parents

• Some parents don’t like how the tube looks on the child. But it shouldn’t be uncomfortable for your child. The tube doesn’t hurt and your child will get used to it in time.

• When placing the tube, it may help to talk to your child and explain what you’re doing. Praise your child after you have placed the tube.

• You’ll need to check the skin around your child’s nose and face regularly to prevent soreness and infection. Keep the area around your child’s nose clean and dry. Also, make sure to cleanse your child’s mouth regularly. Do this even though he or she isn’t taking food by mouth.

• Always have a backup tube in case a problem occurs with your child’s tube.