Child health

Patient information for Translation

Paediatric Nasogastric Tube Feeding

Information for families of children who are going home with a Nasogastric Tube (NGT)

What is a Nasogastric Tube?

A Nasogastric Tube is a thin soft plastic tube that is passed through one of your child’s nostrils, down the back of the throat, through the oesophagus (food pipe) and into the stomach. The nasogastric tube is sometimes called a ‘NGT’. The NGT is held in place by being taped to the side of your child’s face near the nostril. The tube is used to give your child’s feeds and sometimes medication.

Why does my child need a NGT?

NGT feeding is a way to ensure that your child gets enough nutrition and fluid into their body. A child may have an NGT for a variety of different reasons, including: gastroesophageal reflux, swallowing problems, brain and spinal cord problems, or if they are unable to get enough nutrition in orally to help them develop and grow. Your child will receive food in a liquid form; NGT can be used alone or as a supplement to feeding by mouth, depending on your child’s changing nutritional and/or medical needs.

What are the advantages and disadvantages of a NGT?

Advantages

• Provides a safe method of feeding
• Can be removed easily when no longer required
• No anesthetic is needed for insertion
• Child may feel more comfortable because their stomach is full as this may not happen with oral feeding.

Disadvantages

• Can appear unsightly
• Insertion can sometimes cause distress although this soon resolves once the tube is in place
• Can be dangerous if inserted into the airway instead of the food pipe.

How much feed will my child need and how will it be given?

The Dietitian will advise you on your child’s individual nutritional needs, as every child is different. You’ll be prescribed an amount of a specific feed to give to your child, which will contain all the nutrients that he/she requires.

Important

• Don’t change the amount of feed you give your child without discussing it with the dietitian first
• Only give your child’s prescribed feeds, medication and water flushes down their NGT.

Your dietitian will discuss with you the most appropriate method to feed your child. This depends on your child’s medical condition and particular needs and family and home circumstances.

There are three different methods of feeding your child using the NGT:

• Bolus (intermittent) – a specific amount of feed that is given in one go, usually will go over a period of time
• Continuous
• A combination of both.

How is a NGT inserted?

The nurse will pass your child’s first NGT. The length and size of the tube will depend on your child’s size. The nurse will first measure the correct length; they will then pass it down your child’s nostril. Once the tube has been passed to the measured length the NGT will then be secured to your child’s face with adhesive tape. Inserting the NGT doesn’t hurt but may feel uncomfortable for a short while. It may also make your child sneeze, cough or retch as it tickles their throat. This soon passes.

How to check the position of the NGT?

It is important to check that the NGT is in the correct place (the stomach). The food pipe and the airway separate from each other below the voice box and there is a small risk that the NGT could end up in the airway instead of the stomach. If your nurse is at all concerned that the tube is not in the correct place the tube will be removed immediately and replaced. Checking the position of the tube should occur on insertion as well as every time it is used. It is also important to check the tube position after periods of vomiting or a coughing episode as the NGT can change its position.

The contents of your child’s stomach are normally acidic. The most reliable way of checking that the tube is in the stomach is by checking the acid level of some of the fluid drawn back from the tube. If the tube is in the stomach, the fluid will normally have a pH (acid level) of 5.0 or below. Occasionally your child may have been prescribed medication that may alter the pH of the stomach, such as an anti-reflux medication. If this is the case it is always better to check the pH of the stomach before any medication is given. The nasogastric tube should not be used if the pH reading is 5.5 and above.

How to check the position of the tube

This process will be taught to you by your nurse before discharge and you will continue you to do this at home. This process must be completed before putting any feed or medication down the tube:

1. Collect all the equipment you need

• pH strips
• 20ml syringe
• Colour chart (outside of PH strips box)

1. Wash your hands before and after checking the tube
2. Check that the tube position has not obviously changed. Look for the following:

• The amount of visible tube is the same length as before
• Any loose tape

1. Remove the plug from the top of the NGT and attach the 20ml syringe
2. Draw back 2-3mls of the syringe plunger to get some stomach fluid (this is called aspirating)
3. Place a few drops along the pH strip
4. Match the colour change on the strip to the colour chart and identify the pH
5. A pH of 5.0 and below indicates that the NGT is correctly positioned in the stomach and so the feeds and/or medication can be given.

Do not give any feeds or medicine if you are unsure of NGT position

What to do if you can’t obtain any fluid?

1. Turn the baby onto their left side and try aspirating again
2. If you still can’t get any fluid, inject 1-2ml of air into the tube using a syringe, as the tube may be sitting against the wall of the stomach or is blocked at the tip, then try aspirating again

If you still can’t get any fluid then please contact your community nurse.

What to do if the pH reading is 5.5 or above

Firstly check position of tube, has it moved? Secondly have you given an anti-reflux medication like Omeprazole, Lansoprazole or Ranitidine if so this could alter child’s pH please give medication time to absorb and then re-check aspirate. Lastly it could mean that the tube has moved out of the stomach. If pH is above 5.5 please do not feed. Contact community nurse or local children’s ward for advice.

How do I prevent the NGT is blocked?

Once NGT has been confirmed as having a pH of 5.0 or less, it is important to:

• Always flush the NGT with water before and after every feed. This keeps the NGT clean and stops feed from building up inside the tube and blocking it. For infants aged less than one year, use sterile water.
• Always flush the tube between and after medications
• If medication needs to be crushed make its all dissolved before giving it through NGT

What should I do if NGT is blocked?

You’ll know the NGT is blocked because it will be hard to flush it. This may be due to inadequate flushing or very thick feed or medicines. If this occurs:

• Check the NGT is not kinked
• Gently massage the tube with your fingers, from the insertion side out.
• Firstly try flushing the NG Tube with water. If this doesn’t work then get a capsule of Creon, dissolve with Sodium Bicarbonate.
• If this doesn’t work repass the NGT.

What should I do if NGT falls out?

• Don’t panic! If you have been taught to reinsert the NGT then do so.
• If not been taught to repass NGT then in Community Children’s Nursing Team working hours contact them to reinsert
• If not in Community Children’s Nursing Team working hours and your child needs a feed or medication before the next morning then attend local A&E department

How to administer a short intermittent (bolus) feed

• Wash your hands
• Test the position of the tube (as explained in ‘how to check the position of the tube’)
• Once pH is shown as 5 and below, connect a 50ml syringe (without its plunger) to the NGT
• Pour the required amount of feed into the syringe
• Hold the syringe into the air and gravity will cause the feed to flow down the NGT into your child’s stomach
• Raising and lowering the height of the syringe will alter the rate at which the feed flow. Feeding too quickly may cause your child to vomit
• Once feed has been given. Disconnect the syringe and flush the NGT with water

How to administer medication

• Wash your hands
• Test the position of the tube (as explained in ‘how to check the position of the tube’)
• Once pH is shown as 5 and below, connect the syringe containing the medication to the NGT and slowly push in the medication.
• If several medicines are being given at one time. Flush the tube with 3-5ml of water between each medication.
• Flush with 10mls of water after all medicines have been given

How to get supplies: Feeds/Delivery sets, syringes, feeding pump and other equipment

• Before your child leaves hospital you will be taught how to use a feeding pump by a representative of the company that provides the feeding pump. Your child will not be discharged until this is completed
• When your child is set for discharge the ward and nurses will provide you with 2 weeks’ worth of equipment, feed and a spare tube. The community nurse will then explain how to get equipment regularly in the community after that. This is usually by a home delivery company
• The GP should send the prescription for the special milk to the home delivery company so that the feed can be delivered each month
• If your child is on bolus feeds discuss with your child’s community nursing team how this this equipment will be ordered for your child.

Waste disposal at home

Each community borough has different ways of disposing equipment, so ask your child’s community children’s nurse how you get rid of used equipment and any feed that is left.

Large print and other languages

This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. For more information, speak to your clinical team.
এই তথ্যগুলো সহজে পড়া যায় অথবা বৃহৎ প্রিন্টের মত বিকল্প ফরম্যাটে পাওয়া যাবে, এবং অনুরোধে অন্য ভাষায়ও পাওয়া যেতে পারে। আরো তথ্যের জন্য আপনার ক্লিনিক্যাল টিমের সাথে কথা বলুন।

Na żądanie te informacje mogą zostać udostępnione w innych formatach, takich jak zapis większą czcionką lub łatwą do czytania, a także w innych językach. Aby uzyskać więcej informacji, porozmawiaj ze swoim zespołem specjalistów.

Macluumaadkaan waxaa loo heli karaa qaab kale, sida ugu akhrinta ugu fudud, ama far waa weyn, waxana laga yabaa in lagu heli luuqaado Kale, haddii la codsado. Wixii macluumaad dheeraad ah, kala hadal kooxda xarunta caafimaadka.

Bu bilgi, kolay okunurluk veya büyük baskılar gibi alternatif biçimlerde sunulabilir, ve talep üzerine Alternatif Dillerde sunulabilir. Daha fazla bilgi için klinik ekibinizle irtibata geçin.

یہ معلومات متبادل فارمیٹس میں دستیاب کی جا سکتی ہیں، جیسا کہ پڑھنے میں آسان یا بڑا پرنٹ  اور درخواست پر متبادل زبانوں میں بھی دستیاب ہو سکتی ہیں۔ مزید معلومات کے لیے، اپنی کلینکل ٹیم سے بات کریں'۔

Patient Advice and Liaison Service (PALS)

Please contact us if you need general information or advice about Trust services: www.bartshealth.nhs.uk/pals

Tell us what you think

Tweet us @NHSBartsHealth
Talk to us via facebook.com/bartshealth
Leave feedback on NHS Choices www.nhs.uk

Reference: BH/PIN/964

Publication date: Feb 2020

All our patient information leaflets are reviewed every three years.

©Barts Health NHS Trust

Switchboard: 020 7377 7000

www.bartshealth.nhs.uk