Nasogastric (NG) Tubes in Pediatric Medicine
Nasogastric (NG) Tubes in Pediatric Medicine
A nasogastric tube is a flexible tube that is passed through the nose, down the throat and esophagus, into the stomach. In pediatrics, NG tubes are crucial medical devices used for both diagnostic and therapeutic purposes.
Key Points:
- Material: Usually made of polyurethane or silicone
- Duration: Can be short-term or long-term based on indication
- Types: Feeding tubes and decompression tubes
- Safety: Requires proper placement verification
Types of NG Tubes
- Feeding Tubes
- Smaller diameter (5-8 Fr)
- Single lumen
- Used for enteral nutrition
- Decompression/Sump Tubes
- Larger diameter (8-16 Fr)
- Double lumen
- Used for gastric decompression
Size Selection Guide
- Premature infants: 5-6 Fr
- Term newborns: 6-8 Fr
- Infants to 2 years: 8-10 Fr
- Children 2-6 years: 10-12 Fr
- Children 6-12 years: 12-14 Fr
- Adolescents: 14-16 Fr
Common Indications
- Feeding
- Failure to thrive
- Neurological impairment affecting feeding
- Critical illness
- Post-operative nutrition
- Decompression
- Bowel obstruction
- Pre/post-operative management
- Gastric outlet obstruction
- Continuous gastric drainage
- Medication Administration
- Gastric Lavage
Contraindications
- Absolute
- Basilar skull fractures
- Severe facial trauma
- Known esophageal strictures
- Recent upper GI surgery
- Relative
- Severe coagulopathy
- Esophageal varices
- Caustic ingestion
Insertion Procedure
- Pre-Insertion Assessment
- Confirm indication
- Check contraindications
- Select appropriate tube size
- Gather necessary equipment
- Measuring Technique
- Measure NEX (Nose to Ear to Xiphoid)
- Add 1-2 cm for infants
- Mark measured length on tube
- Insertion Steps
- Position patient upright if possible
- Lubricate tip with water-soluble lubricant
- Insert through nare and advance gently
- Ask older children to sip water/advance during swallowing
- Never force tube against resistance
Position Verification Methods
- Primary Verification (Required)
- X-ray confirmation (gold standard)
- Must be performed before first use
- Secondary Methods
- Aspirate pH testing (< 5.5)
- Visual inspection of aspirate
- Auscultation (unreliable alone)
- Documentation Requirements
- Length at nares
- Verification method used
- X-ray confirmation
- Patient tolerance
Potential Complications
- Insertion-related
- Nasal trauma/bleeding
- Inadvertent bronchial placement
- Esophageal perforation
- Intracranial placement (rare)
- Usage-related
- Sinusitis
- Pharyngeal irritation
- Aspiration
- Tube blockage
- Pressure ulcers
- Long-term
- Gastroesophageal reflux
- Chronic sinusitis
- Vocal cord irritation
Daily Care & Maintenance
- Tube Care
- Check marking at nares daily
- Rotate tube position on nose
- Flush with warm water after feeds/medications
- Check tube patency every shift
- Nasal Care
- Clean nares daily
- Apply water-soluble lubricant
- Check for pressure areas
- Documentation
- Tube position verification
- Feeding volumes/residuals
- Complications/issues
- Patient tolerance
Troubleshooting
- Blocked Tube
- Flush with warm water
- Use pancreatic enzymes if needed
- Replace if unsuccessful
- Displaced Tube
- Stop feeds immediately
- Remove and replace if needed
- Verify position before resuming use
