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Nasogastric (NG) Feeding Tube Insertion

Important information about nasogastric (NG) feeding tubes:

NG tube inserted through nose, ending in stomach
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  • An NG tube is a soft, thin, flexible tube used to deliver liquids to the stomach. It can be used for nutrition or medicine.

  • A caregiver inserts the tube through the mouth, down the throat, through the esophagus (food pipe), and into the stomach.

  • The NG tube can be used for a short time or longer, depending on your child’s needs.

Preparing for NG tube placement

  1. Wash hands with soap and water or clean with hand sanitizer for 15 seconds and allow to dry.

  2. Gather supplies:

    • Feeding tube without stylet or feeding tube with stylet

    • Oral syringe

    • Water

    • Tegaderm™

    • Duoderm™ (optional)

    • Cavilon™ No Sting Barrier Film - optional for use over 1 month of age

    • Water-soluble lubricant (such as K-Y jelly®)

    • pH strip

    • Scissors

    • Waterproof permanent marker or pen

      Feeding tube without stylet

      Feeding tube with stylet

  3. Remove feeding tube from package.

  4. Choose a nostril. Choose a different nostril each time you insert the tube.

  5. Measure distance to insert feeding tube. Start with the feeding hole at the end of the tube. Measure from the tip of the nose to the bottom of the earlobe, and then to the stomach (halfway between the bottom of the breastbone and the belly button). Mark this point on the tube with a waterproof permanent marker.

    How to measure distance to insert the NG tube.

  6. Prepare supplies that will be used to secure the tube:

    • Measure and cut Duoderm (to protect skin).

    • If using Cavilon No Sting Barrier Film, apply it to the skin where you will place the Duoderm. Let the skin barrier dry.

    • Peel backing off the Duoderm to uncover the adhesive. Place Duoderm on the cheek where you will tape the tube.

    • Prepare Tegaderm to keep tube in place. Measure and cut the Tegaderm to size needed.

Instructions for inserting NG tube:

  1. Explain to your child what you are going to do. If your child is young, it may be helpful to have someone help you hold them.

  2. Place your child in an upright position. This may be sitting or with head elevated 30-45 degrees. They should not lean forward or tilt their head or neck back.

  3. Lubricate the end of the tube by dipping it in water or water-soluble lubricant (such as K-Y jelly).

  4. Insert end of the tube into the nostril towards the back of the throat and downward.

  5. Thread the tube downward to the marked point on the tube. Encourage your child to swallow.

    • Infants: your baby may suck on a pacifier as you insert the tube.

    • Older children: your child may drink water through a straw as you insert the tube.

  6. It is normal for your child to gag when you are placing the tube. Remove the tube if:

    • You meet resistance.

    • Your child starts choking.

    • Your child has trouble breathing.

    • Your child turns bluish gray in color.

    • Your child keeps gagging, coughing, or throwing up after the tube is placed.

    • Your child remains very restless and irritable after placing the tube.

    • Your child's behavior is not normal.

      Tegaderm on skin

      Tegaderm on top of Duoderm

  1. Once the tube is in place, secure it with the Tegaderm. Place the Tegaderm as close to the nose as possible.

    • If using Duoderm, place tube across the Duoderm. Then place Tegaderm over the tube, adhering the Tegaderm to the Duoderm.

Instructions for confirming NG tube placement:

Once the tube is secured, check for proper tube placement.

 

  1. Attach an oral syringe to the medicine port.

    • If the feeding tube does not have a stylet, make sure the feeding port is closed.

    • If the feeding tube has a stylet, make sure it is firmly in the main feeding port.

  2. Slowly pull back on the plunger of the syringe to get stomach contents. Completely cover the test area on the pH strip with the fluid.

    • If you are unable to pull back any fluid, push 3-5 ml of air into the tube and try again to pull back fluid. You may repeat this 2-3 times.

    • If you are still unable to pull back any fluid, lay your child down on their left side. Wait a few minutes and try again to pull back fluid.

    • After rechecking, if you are still unable to pull back fluid, remove the tube and reinsert it. After reinserting, if you are still unable to pull back any fluid, please call your healthcare provider.

  3. Check the pH by comparing the pH strip with the color scale. Gastric (stomach) pH should be 1-5. If the pH is greater than 5, follow these steps:

    • Wait 15-30 minutes and recheck the pH.

    • After rechecking, if the pH is still greater than 5, remove the tube and reinsert it. After reinserting the tube, if the pH is still greater than 5, call your healthcare provider.

  4. Once you have confirmed that the tube is in the stomach with a pH of 1–5, make sure the feeding port is closed or the stylet is firmly in the feeding port. Then attach an oral syringe with 5 mL of water to the medicine port and push the water through the tube. This clears stomach fluid from the tube and activates a lubricant inside, making it easier to remove the stylet (if one is present).

  5. If the feeding tube has a stylet, remove the stylet and close the feeding port. Save the stylet. If the tube comes out, you will need the stylet to reinsert the tube. Do not reinsert the stylet while the feeding tube is in your child. Do not use the stylet if it is bent.

  6. Write down the number marking where the tube is secured.

  7. Change the tube to a new one if there is a leak in the tube or you can no longer read the markings on the tube.

  8. If you need to reinsert the tube and are reusing a tube:

    • Clean the tube by rinsing the tube with warm water only. Air dry on a paper towel.

    • Remeasure the tube.

    • Clear the tube by flushing with 3-5ml of air.

    • If the feeding tube has a stylet, coat the stylet with water-soluble lubricant before placing it in the tube.

    • Discard the tube if you are unable to get the tube clean, it has an odor, or the stylet no longer reinserts properly (if present).

  9. Call your healthcare provider if your child’s mouth, lips, or face become irritated.

Instructions for NG tube care:

  • Before giving medicine or formula through your child’s feeding tube, always check the pH.

  • Make sure the mark on the feeding tube hasn’t moved. If it has, reposition the tube and check the pH again.

  • Check the tube placement (pH) if your child is not tolerating feeds or medicine, or if you think something is wrong.

  • Keep a backup OG tube at home. Contact your home care provider when your supplies are running low or when you insert your last OG tube.

 

Reviewed on April 2025 by Carly Ehritz, MSN, RN

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