Nasogastric (NG) Tubes For Neonates

Nasogastric (NG) Tubes For Neonates

Aim of the leaflet
This leaflet has been developed to inform and support parents whose baby requires
a nasogastric (NG) tube for short term feeding, or for the administration of
medicines.

If you have any concerns or queries regarding anything in this leaflet, please speak to your

baby’s doctor or nurse.

What is nasogastric (NG) feeding?
An NG tube is a thin, soft plastic tube that is inserted through your baby’s nose, down
the back of their throat, down the oesophagus and into the stomach. It allows a baby
to be fed directly into their stomach. Having feeds this way is known as ‘enteral
feeding’.

Some babies are still developing and so are unable to sufficiently feed through their
mouths and therefore do not receive enough nutrition for them to grow adequately.
The reasons preventing your baby from taking sufficient feeds may be a short or long
term issue: most babies only need an NG tube for a few days or weeks whilst in
hospital but some may need to be discharged home with an NG tube whilst they
continue to establish full sucking feeds. If this is the case, then the Outreach Team
will liaise with you.

Some examples of why a baby may need this feeding help are:

• They have been born prematurely and are still developing their suck, swallow and breathing coordination.
• They may require breathing support which can make it difficult to feed by mouth.
• They may tire easily and so are unable to take the volumes required by mouth.
• They may be unwell.

Some babies can feed by mouth as well as having NG feeds as a normal part of their
oral feeding development.

What are the advantages and disadvantages of an NG tube?

Advantages:

• Provides a safe method of feeding
• Adequate nutrition to supports growth & development
• Can be safely inserted without the use of an anaesthetic
• Can be removed easily when no longer required

Disadvantages:

• Is visible on your baby’s face
• Insertion can sometimes cause distress and be uncomfortable
• Can be dangerous if tube is inserted into the lungs (airway) instead of the stomach
• Can increase nostril secretions when first passed or if the baby has a cold
• Can sometimes lead to redness or a pressure area where tube lies on the face

Inserting the NG tube
The NG tube will be inserted by a competent nurse. The length and size of the tube
needed depends on your baby’s size and this will be measured by the nurse before
insertion. Your baby may be wrapped securely in a blanket to provide comfort and to
stop them pulling at the tube as it is passed.

The nurse will insert one end of the tube into your baby’s nostril. If your baby has previously had an
NG tube in situ, the other nostril will be used in order to alleviate and prevent pressure areas.

As the tube is passed down the back of your baby’s throat they will be encouraged to swallow. This
could mean letting them suck on a dummy or a gloved finger dipped in milk.

Once the tube has been passed to the correct length as measured, it will be secured to your
baby’s cheek with some adhesive dressing. Some soft dressing may have been placed on your
baby’s cheek prior to the tube insertion in order to protect the skin on their cheek from the tube.

Your baby will be awake during the insertion of the tube. It is not a painful procedure
but can sometimes be uncomfortable and distressing.
You are encouraged to stay with your baby during the insertion of the tube to comfort
them, but if you do not feel able to another nurse can stay with them. The procedure
is quick and babies recover very well shortly afterwards. It may make your baby
sneeze, cough or retch as it tickles their throat. This will soon pass.

The NG tubes that are used on the ward can remain in place for up to 90 days, but
may be replaced sooner if becomes blocked or is pulled out by your baby.

Checking the tube
When putting the tube down there is a risk of it passing into the lungs instead of the
stomach. The tube can also move if it is accidentally pulled or if your baby is vomiting,
retching or excessively coughing. If this happens and the tube is used, milk can
accidentally go into your baby’s lungs where it will cause breathing difficulties and
could lead to a life threatening incident or infection.
For this reason, the tube position must be checked to be in the stomach after it is
passed and before the tube is used to give any feed or medicines. It is also important
to check the position of the tube after periods of coughing, vomiting or retching.

The tube position is checked by measuring the acidity of the stomach contents. If the
tube is in the correct position in the stomach, the fluid drawn back through the tube
should have a pH (acid level) of 5 or below (which indicates acidity). Some medicines
can alter the pH of the stomach, such as anti-reflux medicines, but you will be informed
if this is the case with your baby.

The NG tube should not be used if the pH reading is above 5 unless guided by
a nurse or doctor.

Process of checking the tube
This process will be completed by your nurse before the tube is used. You can be
taught this process and assessed to be competent.

1. Before starting, gather all the equipment you will need:

• pH testing strips
• Correct size syringe (5ml & 20ml)
• Milk feed or medicine

2. Wash your hands before and after checking the tube.
3. Check that the tube has not appeared to have moved. You can do this by checking
   the number visible at the nostril – it should be the same as when the tube was first
   passed. Check that the tape is not loose.

4. Attach 5ml syringe to the tube and gently draw back the syringe plunger to collect
   fluid, approx. 1-2ml is needed. This process is called aspirating the tube.
5. Place a few drops onto the coloured end of the pH strip.
6. Match the colour change on the pH strip to the colour chart on the bottle and identify
   the pH.
7. A pH of 5 or below identifies that there is acid present and the tube is in the correct
   position in the stomach. The tube is safe to use.
8. Replace any remaining aspirate back down the tube.

Do not put anything down the tube if you are unsure of the tube position and
correct placement cannot be confirmed.
If you are unable to correctly aspirate the tube, do not proceed to put anything down
the tube. Follow the steps below or ask your nurse to assist or if at home contact the
Outreach Team.

What to do if you cannot aspirate the tube:

• Turn your baby onto their left side and try aspirating the tube again.
• Try sitting or holding your baby upright and try aspirating the tube again.
• If your baby is safe and able to take feeds orally, try offering them a small amount of milk from a breast or bottle feed and try aspirating the tube again.

What to do if the pH reading is 5.5 or above:
This may mean that the tube is no longer in the stomach. Do not put anything down
the tube. Ask your nurse to assist or if at home contact the Outreach Team.

How to use the NG tube to administer feeds or
medicines
Small amounts of medicines can be slowly pushed into the NG tube using a syringe. You will be shown how to do this by your nurse.

The milk feeds are given by gravity (lets the milk slowly drip into the stomach)

Giving a gravity feed

• Wash your hands. Gather all your equipment you may need including feed.
• Where possible, your baby should be placed in a semi-upright position so that their head is above their stomach.
• Always check the tube is in the correct position before proceeding to put anything down it.
• Remove the plunger from a 20 ml syringe and attach the syringe chamber to the tube.
• Pour required amount of feed into the syringe chamber topping up until total volume to be given is achieved.
• If it appears the feed is running too quickly, lower the height of the syringe slightly.
• If it appears the feed is running too slow, raise the height of the syringe.
• The feed should take approx. 15-20 minutes (depending on how much milk your baby is receiving). If the feed is given too quickly if may cause your baby discomfort and increase the risk of vomiting.
• If they are awake offer a dummy or clean finger dipped in milk for your baby to suck on during the feed, this will encourage their sucking development.

The amount of milk required will be established by the nurses, doctors or if at home
by Outreach.

During a feed

• Watch your baby during the feed in case they attempt to pull on the tube.
• If the NG tube moves out of place or is pulled by your baby during a feed it is important to stop the flow of milk and re-check the position of the tube.

Stop feeding if you also observe:

• Vomiting
• Coughing
• Choking
• Changes in colour – any paleness or blueness

To stop the feed kink the tube and empty the milk back into a bottle, then your hands
are free to attend to your baby.

Medicines
If your baby is receiving medications through the NG tube it is important that the
medicines are suitable and safe to go down the tube. Most medicines are available in
a liquid suspension that can be easily pushed down the tube. If a liquid suspension is
unavailable, some tablets can be crushed and dissolved in water to then be passed
down the tube. It is important that you check with the doctor who is prescribing the
medicine and the pharmacist dispensing it that the tablets are safe to be crushed and
that they can be given enterally.

Never mix medicines together before administration as there may be adverse
interactions.

Flush the NG tube after administering medication with either the milky aspirate drawn
out to check tube placement or a few mls of fresh milk.

Going home with an NGT

The nurses would have gone through a list of competencies with you in the early part
of your hospital stay. This will have covered some teaching and demonstration of how
to use the tube, how to resolve issues regarding the tube, and when to seek medical
advice.

The nurse would have then supervised and supported you to use the tube and signed
you off as competent when you are confident and able to use the tube safely.
The competencies will need to be completed prior to discharge if they have not
already been done.

A referral will have been made to the Outreach nursing team, who will support you
when you are at home.

You will be given a supply of syringes and other equipment you will need to use the
NG tubes at home on discharge and Outreach will provide more if required.

If your baby needs a new NG tube during the daytime, Outreach can visit you at home
to place a new tube. If it is out of hours or if Outreach are unable to attend, you may
need to bring your baby to the Neonatal Unit where one of the nurses can insert a
new tube.

How to care for your baby and their tube

Mouth care
You should continue to clean your baby’s mouth/lips regularly with breast milk or
sterile/cool boiled water and soft gauze. This is only required if they do not take an
oral feed for a few feeds in a row.

Skin care
A protective adhesive dressing underneath your baby’s tube protects the skin from
the adhesive tape used to secure the tube and to prevent a pressure area from the
tube.

It is advisable to replace tapes if they look dirty or are starting to come loose. You will
be shown how to do this by the nurses.

Bathing
Your baby will be able to bath safely as long as the cap on the end of the NG tube is
securely closed.

If your baby has a cold
You may need to pay particular attention to keeping your baby’s nose clear of
secretions. This is important because the presence of the tube means that one of their
nostrils is smaller than the other as the tube takes up space within the nostril. This
may mean that they work harder to breathe. If you are concerned, please speak with
your allocated nurse or a doctor.

Contact numbers:
Neonatal Unit- 01905 760661
Outreach– 01905 760661

If your symptoms or condition worsens, or if you are concerned about anything,
please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you
and your loved ones. If you have any questions or concerns, please do speak with a
member of staff on the ward or in the relevant department who will do their best to
answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well
and where improvements can be made. There are lots of ways you can share your
experience with us including completing our Friends and Family Test – cards are
available and can be posted on all wards, departments and clinics at our hospitals. We
value your comments and feedback and thank you for taking the time to share this with
us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the
nurse in charge or the department manager in the first instance as they are best placed
to answer any questions or resolve concerns quickly. If the relevant member of staff is
unable to help resolve your concern, you can contact the PALS Team. We offer informal
help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf,
if you feel unable to do so, to resolve your problems and where appropriate refer to
outside help.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please
be aware that you may need to leave a voicemail message, but we aim to return your
call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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