NG tubes are commonly known as feeding tubes or enteral nutrition tubes and are inserted into the stomach through the nose, mouth, or rectum.
The purpose of these tubes is to provide nutrients to patients who cannot eat normally due to illness or injury.
Knowing how to fit and remove these tubes is an important part of medical training, and should always be done with the utmost care and respect for your patient, minimizing their discomfort as much as possible.
We took a closer look at all you need to know to remove an NG tube, including some of the most commonly made mistakes.
What Is An NG Tube?
An NG tube (also called a feeding tube) is a thin plastic tube that’s used to feed liquid food directly into the stomach.
It can also be used to administer medications and fluids intravenously, and may also be used for draining excess fluid where required.
These tubes are usually placed in the stomach by a doctor during surgery or after a serious accident. They may also be used when someone has difficulty swallowing because of a stroke, head injury, or other condition.
The NG tube is connected to a bag containing a special formula that provides nutrients to the body.
This formula is often stored in a refrigerator until it’s needed. Once the formula is ready, it’s fed through the tube into the stomach using a syringe.
NG tubes come in different sizes and have a small hole on one end so that liquids can flow out easily. The other end has a larger opening which allows air to enter the tube if necessary.
NG tubes are usually removed once the person recovers from the procedure (see also our article on intubation) . However, this isn’t always the case. In some cases, doctors will leave them in place permanently.
How Do I Fit An NG Tube?
When inserting an NG tube, there are several things you must do correctly:
1. Check The Length
Make sure the tube is long enough to reach the stomach. You can find the right-sized NG tube by measuring from the bridge of the nose to the earlobe, and then to 5 cm below the xiphoid process.
This will give you the correct length of the tube.
2. Lubricate The Top of The Tube
Before placing the tube down the throat, lubricate the top of the tube. This helps prevent irritation and soreness and makes the insertion process smoother and easier for your patient.
3. Place The Tube In The Nasal Cavity
Place the tip of the tube just inside the nostril, and push it gently towards the back of the nasal cavity, moving back and downwards – you should expect to feel some mild resistance.
4. Ask The Patient To Swallow
Give the patient some water, and ask them to swallow, advancing the tube with each swallow – this will help the patient to swallow the tube, allowing passage through the esophagus.
5. Check The Placement
Once the tube is in place, check the placement is correct by asking the patient to speak. They should be able to speak comfortably and clearly, with no hoarseness or gagging.
These signs, along with any indications of respiratory distress, can indicate that the tube has entered the trachea, and the NG tube should be removed immediately.
In some cases, a chest x-ray may be required to confirm that the tube is in the right place.
6. Secure The Tube
Once you have confirmed the position of the tube, attach one end to the patient’s nose.
How Do I Remove An NG Tube?
To remove an NG tube safely, follow these steps:
1. Wash Your Hands
Wash your hands (see also ‘What Is The Correct Order Of Steps For Handwashing?‘) thoroughly before touching anything else.
2. Prepare A Sterile Field
Prepare a sterile field by cleaning the area around the tube with alcohol wipes.
3. Turn Off Suction
If the tube is attached to suction, you will need to turn off the suction.
4. Clean The Tube
Clean the outside of the tube with soap and warm water. Make sure to clean all areas of the tube, including the valve at the bottom.
5. Disinfect The Area
Clean the area around the tube again with alcohol wipes.
6. Remove The Tape
Remove the tape from the nose of the patient.
7. Pinch The Tube
Pinch the end of the tube with a clamp, or using your fingers.
8. Ask The Patient To Breathe
Ask the patient to take in a deep breath, and gently but quickly remove the tube in a smooth, consistent motion. Remove the tube into a towel, and dispose of it correctly.
9. Make The Patient Comfortable
Once the tube is removed, make sure that the patient is comfortable, that any adhesive is removed from the skin, and that they are responding normally.
Common Mistakes When Removing An NG Tube
Removing an NG tube incorrectly can cause serious complications, such as damage to the airway, which could lead to death. Here are some common mistakes when removing an NG tube:
- Not Turning Off Suction
When removing an NG tube, turning off the suction is very important. If suction is on, there is a risk of aspiration (inhaling) of gastric contents into the lungs.
- Not Pinching The Tube
When pinching the tube, do not pinch too tightly. Too tight a grip can cause the tube to break, leading to further complications.
- Leaving Adhesive On Skin
Adhesives used to secure tubes to the skin must be carefully removed. Failure to remove adhesives properly can result in infection.
- Pulling Too Hard
Pulling the tube out too hard can tear the tube, causing it to become stuck inside the body. This can also cause injury to internal organs.
- Using Inappropriate Tools
Using inappropriate tools for removal can damage the tube, making it difficult to insert another tube. Reusing the same tool for multiple procedures is also a serious error, and increases the chance of contamination.
- Failing To Check For Placement Before Removal
Before removing an NG tube, always check to see if the tube is still in the appropriate location.
Final Thoughts
NG tubes are an important part of patient care, and it is crucial that they are managed and removed properly.
Make sure that you are correctly trained in the techniques, and that you have the right equipment available to help you manage patients in a safe, dignified manner.