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A nasogastric tube, commonly known as an NG tube, is a slender plastic tube that extends from your nose into your throat and stomach. If you're experiencing difficulty with eating or drinking independently, this type of tube may be necessary. Although the process of having an NG tube inserted can be daunting or uncomfortable, there are strategies you and your healthcare team can employ to alleviate any discomfort or pain. Additionally, proper care of the tube post-insertion is essential to prevent irritation and minimize the risk of infection or other complications. Don't hesitate to communicate any questions or concerns with your doctor or nurse!
Procedures
Ensuring a Comfortable Insertion Process
Inform your doctor about any past nasal injuries. Occasionally, one nostril may be preferable for NG tube insertion. If you have a history of a deviated septum, nasal injury, or other conditions affecting nasal passage, informing your medical team can assist in determining the most suitable nostril for insertion.
- For instance, you might mention, “I have nasal polyps in my right nostril, so could we consider using the left nostril instead?”
- Prior to insertion, your nostrils may be individually closed while you're asked to sniff. This evaluation aids in identifying the nostril with better airway clearance.
Inquire about anesthesia or sedation for comfort. While uncomfortable, anesthesia or sedatives can ease the process. Consider asking for lidocaine to numb your nose and throat or sedation to reduce anxiety and gag reflex.
- Lidocaine may be administered through vapor or liquid form, with a waiting period for full effect.
- A local anesthetic spray can also help minimize discomfort during the procedure.
Establish a distress signal with your doctor. Agree on a gesture to indicate discomfort during tube insertion. This allows the medical team to pause and provide you with a moment to relax.
- For instance, raising your hand or tapping an armrest can serve as signals.
Discuss tube preparation with your doctor. Ensure the tube is curved and lubricated to match your nasal passages. Don't hesitate to ask questions about the process.
- Ask about lubrication procedures before insertion.
- Some doctors recommend techniques like placing the tube in an oral airway device or soaking it to aid insertion.
Pro Tip: Some patients prefer narrower, more flexible tubes for comfort. If insertion is challenging, inquire about alternative tube options.
Request water during insertion. Sipping water can aid tube insertion by facilitating swallowing and reducing gag reflex.
- If drinking water isn't allowed, try swallowing to ease the tube's passage.
Opt for an upright position if feasible to ease insertion. Sitting at an angle between 45° and 90° facilitates NG tube passage into the stomach. Ensure proper support with pillows under your head and shoulders.
- If sitting upright isn't possible, inquire about lying on your side.
NG tube insertion can be messy. Expect nasal discharge and saliva during the process. Your medical provider will provide towels, a basin, and tissues for cleanup.
Adjust your chin position to widen your throat. Tilt your head forward slightly and tuck in your chin before tube insertion to ease esophagus access.
- Breathe through your mouth simultaneously to further open your throat.
Continue swallowing during tube insertion. Although gagging and coughing are normal, swallowing water or saliva can aid tube advancement, reducing discomfort.
- If persistent coughing occurs, the procedure may pause to assess tube positioning.
NG Tube Maintenance
Regularly cleanse around the tube with warm water and a washcloth as necessary. Increased nasal discharge is common with an NG tube. Gently wipe away any fluids or crusts to prevent irritation and infections.
- Proper cleaning reduces the risk of irritation and infections.
Maintain oral hydration to prevent dryness and irritation. Mouth breathing and inability to drink fluids through the mouth are common with an NG tube. Rinse your mouth with water or mouthwash periodically to alleviate dryness and irritation.
- You may also suck on ice chips if permitted.
Remember: Oral hygiene is crucial for infection prevention and comfort, even if you're not eating orally. Consult your doctor about cleaning your teeth and tongue with a sponge brush while the tube is in place.
Ensure secure placement of the tube to minimize nasal discomfort. Prevent skin and nasal irritation by securely pinning the tube in place. Check clips and tape regularly to maintain stability.
- In a hospital setting, inform your healthcare provider if the tube shifts or if clips and tape loosen for readjustment.
Discuss with your doctor the frequency of tube relocation. Prolonged use of a nasal tube can lead to skin irritation. Collaborate with your medical team to determine the appropriate schedule for repositioning or replacing the tube.
- Consider repositioning the tube slightly every 24 hours or switching nostrils every few days, as advised by your healthcare provider.
- Report any increased soreness or discomfort to your care team.
Prior to applying new tape, cleanse your skin with soap and water. Ensure thorough cleaning and drying of the skin with mild soap and warm water before tape replacement. This promotes better tape adhesion and prevents trapping of oils, dirt, and bacteria.
- Consider using a thin dressing like DuoDERM beneath the tube to minimize friction and discomfort.
- If tape removal causes irritation, consult your doctor for a recommended adhesive remover suitable for your skin.
Helpful Advice
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Your doctor will verify tube placement with a chest or lower abdominal X-ray, as the tube may shift post-insertion, requiring periodic re-evaluation.
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If you're responsible for caring for a loved one with an NG tube at home, seek comprehensive instructions from a medical professional regarding tube insertion, placement confirmation, and post-placement care.
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You may have the opportunity to practice tube insertion on a mannequin before attempting it yourself. Reach out to the doctor if you have concerns.
Important Warnings
- Immediately contact your doctor if you encounter issues such as difficulty administering fluids or medications through the tube, sudden changes in fluid output, redness, swelling, or bleeding around the tube, or abdominal pain or discomfort.
- Inform your medical team promptly if you experience symptoms like coughing, shortness of breath, or fever. These may indicate accidental placement of the tube in the airways instead of the esophagus, which poses a risk of pneumonia. Prompt evaluation of tube placement is crucial in such cases.
