Nasogastric feeding tube care advice

IMPORTANT

NEVER PUT ANY WATER, MEDICATION OR FEED DOWN THE TUBE UNTIL YOU ARE CERTAIN THAT THE TUBE IS CORRECTLY LOCATED IN THE STOMACH.

Comfort and safety

Always wash your hands thoroughly before handling your feeding tube.

Check that the nasogastric (NG) tube is securely taped to your face. Replace the tape if dirty or peeling off. Clean your skin with soap and water and dry thoroughly when changing the tape being careful not to move the tube. Try to alter the position of the tape when changing it to prevent the skin becoming sore.

Tube position

Before using the NG tube for feeding, flushes or giving medicines, it is essential that you check that the end of the NG tube is still correctly located in your stomach.

To do this:

Using a measuring tape, measure the length of the tube, from your nose to the end of the tube, excluding the cap. Check that this is the same length as it was when you were shown in hospital;
Take a clean 60 ml syringe and pull back the plunger to fill it with a small amount of air (20 ml);
Attach the syringe to your NG feeding tube and flush the air down the tube;
Pull the plunger back gently and draw 1 to 2 ml of liquid (stomach acid) into the syringe;
Remove the syringe from the NG tube and add a drop of liquid onto the correct place on your pH paper;
A pH reading of 1 to 5 indicates an acid reaction. This means the tube is in the stomach and you can safely use your tube for water, feeding and medication.

You should also check the position of the NG tube if:

you have a coughing episode;
you have had an episode of vomiting or retching or;
you have any concerns that the NG tube may have moved

What should I do if I get a pH of more than 5?

If you have just had a feed, the pH of the stomach acid may have increased. Retest again after 1 hour.
If you have been told it is safe to do so, you could also try having something to drink such as squash. Avoid water or milky drinks as this may raise the pH reading.
If you are still getting a reading of more than 5, do not use the tube and contact your company nurse, dietitian or community nurse for further advice.

What should I do if the length of the tube has changed?

If the length of the tube has changed, firstly take a new external measurement and a sample of stomach acid for pH testing. Then contact your company nurse or community nurse for advice. Do not put any water, feed or medication down the tube until you have received advice.

What should I do if I cannot get any stomach acid back?

Check the external length of the NG tube is correct;
Using a 60 ml syringe, inject 20 ml of air down your tube. Then try again to withdraw some stomach acid;
Lay on your left side, wait a few minutes and test the tube position again;
If you have been told it is safe to do so, try having a drink and then try to get some stomach acid back again;
If you have been told it is not safe to swallow liquid, brush your teeth instead as this may help to produce some stomach acid.

If it is still not possible to obtain any stomach acid, do not use the tube, contact your community nurse, company nurse or dietitian.

Recording your readings

It is useful for you and your community team to have a record of your pH readings and tube measurements. Please use the attached record sheet to do this.

Positioning during feeding

When you are feeding, particularly during the night, it is very important that you are propped up with pillows. A position of 45 degrees will allow the liquid feed to move out of your stomach properly, reducing the chance of you being sick.

Disconnecting your nasogastric tube

If you are feeding for long periods of time, you may require a toilet break. If you do, you can disconnect the tube and replace the cap on the end of the giving set. Flush the NG tube as you have been shown. If there have been no episodes of coughing or vomiting and no reason to suspect the tube has moved, you may reconnect the feed on your return from your toilet break. Ensure you have washed your hands before you do this.

If you have coughed, vomited or pulled the tube accidentally during this short break, then you need to check that the tube remains in your stomach. To do this wait for at least 1 hour before testing the tube for stomach acid. If you get a pH reading of 1 – 5, you may restart your feed.