Nasogastric (NG) Tube: The Road To Home

Your child needs nutrients to grow, but what happens when they have trouble eating or drinking?

If your child needs a little extra help with feedings or with getting enough daily calories, their physician may recommend a nasogastric (NG) tube. An NG tube brings food and medicine to your child’s stomach through their nose so they don’t need to use their mouth.

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Phone 402-955-5700 | Fax 402-955-5720

In order for the NG tube to work, it has to be carefully cared for and placed correctly every time.

Here’s what you need to know about your child’s NG tube.

NG Road to Home: Your Roadmap

Learning about placing and checking an NG tube can seem overwhelming at first. That’s why we have a five-step process to make sure that you’re comfortable and confident caring for the tube.

Step 1: Meeting With a Case Manager

Your child’s case manager will meet with you to discuss:

• Who will care for your child during the day, at night, and on the weekend
• Who will insert the NG tube if it needs to be replaced
• Who will be available to offer your support

Step 2: Receiving Educational Materials

Your child’s nurse will provide you with educational materials, including a teaching sheet to take home. They will have NG supplies available for “hands-on” review together.

Step 3: Observing a Nurse

The nurse will demonstrate NG tube placement on a manikin. This step includes:

• Teaching NG tube measurement, placement, and securement
• Demonstrating medication and formula administration
• Time to practice with the nurse and ask questions

Step 4: Practicing With a Manikin

You will have time to practice using the manikin and complete an assessment of your comfort level with placing the NG tube. If you’re not comfortable right away, don’t worry — you can practice independently as many times as you need.

When you are ready, the nurse will complete an assessment to make sure that you’re comfortable placing the tube and that no steps are missed.

Step 5: Heading Home

At least one caregiver will place the NG tube on your child. If needed, you will receive additional training from Home Health.

Remember — just because the five steps are over doesn’t mean you’re on your own. If you ever have questions or concerns, do not hesitate to reach out to your child’s case manager.

Caring for Your Child’s NG Tube

• Placing the NG Tube

  1. Gather necessary equipment
     – NG tube of appropriate length
     – Water-soluble lubricant
     – Tape or dressing
     – Sharpie/pen
     – pH paper
     – 5 mL syringe
  2. Wash hands with soap and water. Put on gloves if desired.
  3. Position as appropriate. You may need someone else to hold your child. If your child is small, you can wrap them with a blanket. Just remember to leave their head exposed and their arms secured.
  4. Measure the distance from the tip of your child’s nose to the earlobe and then to the space between the bottom of the child’s breastbone (where the ribs meet) and the belly button.
     – Measure until you get the same length two times.
     – Mark this point with either a piece of tape or a pen.
  5. Lubricate the tip of the tube using a water-soluble lubricant to help ease insertion.
  6. Insert: Gently insert the tube into your child’s nostril following the natural curve of their nasal passage.
     – Your child may gag or cough when you insert the tube. Pause and encourage them to swallow. If your child is small, a pacifier may be helpful. If your child is older, try a cup and straw.
     – If the tube becomes coiled in the back of the throat, pull back and restart the insertion process.
     – Pass the tube until you meet the marked point. Place a temporary piece of tape or have someone hold the tube in place to check for placement.
  7. Check placement using pH paper and the NG tube verification algorithm.
  8. Secure the tube with tape or dressing.

  

• Checking Tube Placement

  Checking placement of your child’s NG tube is an important step in inserting and maintaining the tube. Always wash your hands before and after checking placement.

  Here are the steps for checking the placement of the tube using pH testing:

  Checking After Insertion or Vomiting

  1. Once the NG tube is placed, temporarily secure the tube to your child’s cheek.
  2. Attach an empty 5 mL syringe to the tube and pull back using gentle pressure.
  3. Apply a small amount of stomach contents to the pH paper provided by Home Health.
  4. Compare the color of the pH paper to the color legend provided.
  5. If the pH is 5.5 or less, secure the tube to the child’s cheek and go ahead with using the tube. Avoid taping the tube to the openings of the nose.
  6. Throw the syringe in the trash.
  7. Mark the tube at the exit site from the nose.

  Steps to Checking Nasogastric Tube Placement for NG Use

  (Before administering medication, before each bolus feeding, and once every 8 hours during continuous feeding)

  1. Visually assess the tube placement by checking that the mark on the NG at the exit site from the nose is visible and that your child is not in distress.
  2. If the tube is obviously moved or your child is in distress, remove the tube and reinsert. If your child’s NG tube is bridled (secured in place by a provider) you will need to contact your child’s physician or the Children’s Surgery Clinic, or bring your child to the emergency room for x-ray verification or replacement.
  3. If there is any question of correct placement after visual assessment:
     – Attach an empty 5 mL syringe to the tube and pull back using gentle pressure.
     – Apply a small amount of stomach contents to the pH paper provided by Home Health.
     – Compare the color of the pH paper to the color legend provided.
     – If the pH is 5.5 or less, go ahead with using the tube.
     – Throw the syringe in the trash.

  NOTE: At the end of each feeding, flush with water as directed by your child’s provider. Flush
  with 3-5 mLs of air to clear the tube of any formula or medication.

Tube Troubleshooting

Everything doesn’t always go quite as planned, and it’s helpful to be prepared for some of the more common problems.

• Problems While Inserting the NG Tube

  Problem	Possible Cause(s)	Solution
  Nausea/Vomiting/Diarrhea	Rapid administration of feeding Air in stomach NG tube changed position or moved	Increase bolus feeding time Allow short breaks during the bolus Offer smaller, more frequent feedings Discuss rate changes on continuous feedings with your child’s provider Burp your child during feeding or allow breaks Pull back extra air from the stomach with a syringe before feeding Feed your child in an upright position Keep your child upright for 30 minutes after the feeding Re-measure the tube to assure correct placement
  Clogged NG Tube	Formula or medication build-up	Using gentle pressure, flush the tube with 5-10 mL of warm tap water Use 5 mL of a carbonated beverage to flush the tube Change the tube if you’re unable to unclog it
  NG Tube is Pulled Out	Your child pulled the tube out	Once you reinsert, prevent this from happening in the future by taping the tube as close to the nose as possible. If your child is an infant, cover their hands with mittens or socks.

• Problems While Checking NG Tube Placement

  Problem	Possible Cause(s)	Solution
  You are unable to draw back stomach contents	Your child’s stomach is empty The tube is sitting too high on your child’s stomach	Use the NG tube verification algorithm to determine whether or not to continue using the tube, or if your child needs emergency care
  You are drawing back formula	The tube may be clogged	Flush with 5 mLs of air to clear the tube and wait for 10 to15 mins before drawing back any stomach contents
  The pH is reading higher than 5.5 (stomach fluid is usually measured at a pH level of 5.5 or less)	The tube is not positioned correctly	Use the NG tube verification algorithm to determine whether or not to continue using the tube, or if your child needs emergency care.

Does My Child Need Medical Attention?

A little gagging or coughing when the tube is inserted is normal. However, call your child’s physician right away if they have these symptoms:

• Fever of 100.4 F or higher
• Vomiting, diarrhea, or constipation
• Increased periods of fussiness or are inconsolable
• Pain
• Bloated/distended stomach
• Redness, swelling, leaking, or sores develop in the skin around the tube

Get emergency care immediately if your child experiences these symptoms:

• Difficulty breathing
• Blood around the tube, in their stool, or in their stomach contents
• Coughing, choking, or vomiting while feeding
• Stomach that feels hard

Caring for Yourself: The Truth About Caregiver Burnout

You love your child and you’re happy to do anything you can to keep them healthy. But that doesn’t mean that it’s always easy. Acting as a medical caregiver — not just a parent or guardian — can take a toll on your physical and mental health. This is called caregiver burnout.

Burnout is common and completely normal — there’s nothing to be ashamed of. However, it’s important to recognize and address it, or prevent it from happening in the first place, in order to keep yourself healthy.

• Signs and Symptoms of Caregiver Burnout

  • Withdrawal from friends, family, and other loved ones
  • Loss of interest in activities previously enjoyed
  • Feeling blue, irritable, hopeless, and helpless
  • Changes in appetite, weight, or both
  • Changes in sleep patterns
  • Getting sick more often
  • Feelings of wanting to hurt yourself or the person for whom you are caring
  • Emotional and physical exhaustion
  • Irritability

  If you do not recognize the signs of burnout, the symptoms can eventually get to the point where it’s difficult to function in your everyday life.

  Look for these signs in any of your child’s other caregivers, since burnout might not be on their radar.

• Causes of Caregiver Burnout

  • Role confusion: It can become difficult to separate the roles of parent and caregiver.
    Unrealistic expectations: You may expect that your involvement will automatically improve your child’s health, but that’s not always the case.
  • Lack of control: Lack of money, resources, and skills to effectively plan, manage, and organize your child’s hair can be frustrating.
  • Unreasonable demands: You may place an unreasonable burden upon yourself, partly because you see caregiving as your personal, exclusive responsibility.

• Caregiver Burnout Prevention

  If you haven’t reached the point of burnout, take steps to make sure you don’t get there:

  • Find someone you can talk to about your feelings and frustrations.
  • Set realistic goals and accept that you may need help with caregiving.
  • Develop new tools for coping and remember to accentuate the positive. A mental health professional, such as a therapist or social worker, can help you develop these tools.
  • Accept your feelings. Having negative feelings, such as frustration or anger about your responsibilities, is normal.
  • Join a caregiver support group.
  • Take care of yourself. Don’t let your own health fall on the backburner — stay healthy by eating right and getting plenty of exercise and sleep.

Do not hesitate to talk to a mental health professional. Most of these professionals are trained to counsel people who are dealing with a wide range of emotional issues, such as the stress that causes caregiver burnout. Many clergy members are trained to provide this type of counseling, too.

At Children’s, our Child Life Specialists and Pastoral & Spiritual Care team can help you find the resources you need to cope with burnout.