Nasogastric Tubes (Insertion and Feeding)

Nasogastric (NG) tubes are used to feed babies and children who cannot take in enough calories by mouth. The NG tube is placed in the nose or mouth and slid into the stomach. The formula is put into the tube and flows to the stomach. Some NG tubes have a guidewire for easier insertion. The guidewire is removed after the tube is placed in the stomach. 

You Will Need

Preparing to Place the Tube

1. Wash your hands.
2. Cut a piece of tape, DuoDERM, or Tegaderm that is long enough to secure the tube from your child’s nose. Put the tape on their cheek.
   This will help protect your child’s skin under the tube.
3. Refer to Picture 1 for the following instructions. Take the tube from the tip of the nose (A) to the earlobe (B), then to the middle of the belly (C), which is halfway between the bottom of the breastbone and the belly button. Mark the tube at point C with a marker or piece of tape. This will let you know how far to insert the tube to reach the stomach.
4. Children should be placed in a sitting position. Place babies on their backs. You may need to wrap your baby in a blanket so they don’t grab the tube.

Placing the Tube

• Put a small amount of water-soluble lubricant on the tip of the tube. Never use Vaseline^® or any other oil-based substance.
• Put the tube slowly into the nose while aiming toward the ear. Using gentle pressure, keep putting the tube in until the mark you made on the tube reaches the nose.
  • If the tube does not go in easily, remove it. Never force the tube. Change your child’s position, lubricate the tip of the tube, and try again.
  • Encourage your older child to swallow the tube. The tube may go into place easier for a baby if they suck on a pacifier.
• Put the tube on the tape, DuoDERM, or Tegaderm on your child’s cheek. Then, secure the tube with another piece of tape (Picture 2).
• The tube may be coiled up and taped to your child's back. You may also use tape to secure the tubing to their clothing.

Placement for NG Tube With a Guide Wire

• When using an NG tube with a guide wire, carefully remove the guide wire after the tube is in place. Use the free end of the tape on your child’s cheek to keep the tube in place.
• NEVER put the guide wire back into the NG tube after the tube is in your child.

How to Check the Placement of the Tube

Check to make sure the tube is in the stomach each time before a feeding. To check the placement of an NG tube:

• Look at your child after the tube has been placed and they have calmed down. If they are gagging, coughing, or turning blue, it may not be in the right spot. Remove it.
• If you’re still worried about placement, insert a syringe into the end of the tube and pull back gently. If you get stomach contents in the syringe, the tube is in the correct position.
• Make sure the mark on the tube is still at your child’s nose. If it’s not, the tube should be re-inserted to the correct position. Check again to make sure your child is not gagging or coughing after the tube is in place.

Feeding

You can feed your child after checking tube placement. The doctor or health care provider will tell you how much formula to use for each feeding and how often.

1. If the formula is in the refrigerator, take it out and let it sit at room temperature for 30 minutes before feeding. You may also warm the formula by putting the container or bottle in a bowl or cup of warm water.
   • Pour a drop of the formula on the inside of your wrist to test the temperature. Be sure it is warm, not hot.
   • NEVER WARM FORMULA IN THE MICROWAVE.
2. Hold your child while feeding. You may give your child a pacifier to suck on during feedings. This helps your baby learn feeding skills. They will start to connect sucking with the feeling of being full.
3. Remove the plunger from the syringe or open your feeding bag.
4. If your child is getting gravity feeds by syringe:
   • Put the tip of the syringe into the open end of the feeding tube. Hold the tip of the syringe no higher than 10 inches above the child’s head.
     • The height of the syringe affects how fast the formula goes in.
     • Holding it higher may feed your child too fast. Your child may throw up (vomit).
   • Pinch the tube while you pour the formula into the syringe.
   • Release the tube and let the formula enter the stomach slowly. Add more formula as the syringe empties (Picture 3). Feed your child slowly over 15 to 20 minutes. 
   • If the formula does not flow, change your child’s position. If it still does not flow, put the plunger into the syringe and gently push enough so the formula will flow again.
   • Remove the plunger.
   • If your child starts to vomit during a feeding, stop right away. Keep their head upright and their face turned to the right side. Wait for vomiting to stop before feeding again.
   • If they keep vomiting, take the NG tube out and call your child’s doctor or the nurse helpline at (614) 355-1100. 

If your child is getting feeds by pump, a person from the equipment supply company will teach you how to use it. The pump can help feeds go in slower than gravity feeds. 

After the Feeding

1. For syringe feeds, pour 5 to 10 mL of water into the syringe after the formula is gone. This clears the tube to prevent clogging. This helps prevent infection.
2. Remove the syringe and place the cap on the tube. Babies should be burped every 2 to 3 ounces and after feedings.
3. If you put your child to bed after the feeding, put them on their back without stuffed animals, toys, or a blanket (Picture 4). This is the safest position for your baby.
4. If your child begins to vomit, turn their head to the side and open the cap to the tube.

Cleaning the Equipment

1. Place a clean paper towel on an empty tray.
2. Rinse the syringe and measuring container with cold water.
3. Then, wash them in hot, soapy water.
4. Rinse and dry.
5. Place the clean items on the tray.
6. Cover with a paper towel and store out of the reach of children and pets.

Removing the Tube

1. Your child’s doctor may want you to remove the tube. If you need to remove it, loosen the tape. Pinch the tube to prevent breathing in (aspirating) stomach contents.
2. To remove the tube, loosen the tape on the face. Pinch the tube to prevent your child from breathing in stomach contents and gently remove the tube from the nostril.
3. If the NG tube needs to be replaced, a new NG tube should be inserted. If a new tube is not available, the tube can be washed and reused (see cleaning instructions). If the NG tube uses a guide wire, replace the guide wire in the NG tube before replacing. Remove the guidewire upon placement.
4. Change which nostril is used each time you replace the NG tube.
5. Change the tube once a month unless it becomes clogged, dirty, or damaged. 

Warning

• The feeding set tubing can get wrapped around a child’s neck. This can lead to choking (strangulation) or death. 
• DO NOT leave the feeding set tubing where infants or children can get tangled up in it.
• Talk to your child’s doctor or health care provider:
  • If your child has been tangled in their tubing before.
  • To learn steps you can take to help make sure the tubing does not get wrapped around your child’s neck, such as keeping the tubing away from the child as much as possible.
  • Any other concerns you may have about the risk of strangulation from feeding set tubing. 
• If your child is injured by feeding set tubing, please report the event to the FDA. Your report can provide information that helps improve patient safety. The website to make a report is: https://www.accessdata.fda.gov/scripts/medwatch/index.cfm?action=reporting.home

Other Tips and Advice

• If the doctor or health care provider has ordered liquid vitamins, put the correct dose into the formula.
• If feeding by mouth (oral) was suggested, feed your baby after placing an NG tube. Feeding before placing the tube may cause vomiting.
• Do not change your baby’s formula. Do not give them more than the doctor ordered.
• If your child seems hungry after feeding, ask the doctor about increasing feedings.
• You can use the same tube for up to 1 month unless it gets clogged, dirty, or damaged. Always have a spare tube with you for back-up.
• Ask if there are recommendations for your child’s specific condition. 

If you have questions, ask your child’s doctor or health care provider.

Nasogastric Tubes (Insertion and Feeding) (PDF)

HH-II-32 8/84, Revised 4/22 Copyright 1984, Nationwide Children's Hospital