Care of the Nasogastric (NG) Feeding Tube for the Oncology Patient

These instructions are for Children's Hospital of Philadelphia (CHOP) oncology patients who need an NG (nasogastric) tube at home for nutrition or medicine.

Supplies for NG tube care:

• 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 strips

• Scissors

• Waterproof permanent marker or pen

Instructions for taping the NG tube:

• It is important to secure the tube with tape to prevent it from falling out or moving out of place.

• There are numbers along the tube. Your provider will tell you what number should be showing at the edge of your child's nose.

• Mark the tube at this number with a permanent marker or a piece of tape. Use this mark to know if the tube has moved.

• If the tape that holds the tube becomes loose, you must secure the tape to prevent the tube from falling out or moving. Follow the steps below:

  1. Measure and cut Duoderm.

  2. Measure and cut the Tegaderm to the correct size.

  3. If using a skin barrier, apply it to the skin where you will be putting the Duoderm.

  4. Peel backing off of Duoderm to uncover adhesive.

  5. Place Duoderm on your child's cheek.

  6. Place the NG tube on top of the Duoderm.

  7. Peel the backing off of the Tegaderm to uncover adhesive.

  8. Place the Tegaderm over the tube onto the Duoderm.

  9. When re-taping the tube, hold the tube firmly in place to prevent movement. After re-taping, check the mark you have made on the tube to determine if the tube has moved.

Instructions for checking NG tube placement:

1. Attach an oral syringe with 5ml of air to the side port. Flush the tube with air to clear the tube of any fluid.

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.

   • If you are not sure the tube is in the stomach, call your healthcare team.

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 and your child is not having any trouble breathing or changes in behavior, wait 15-30 minutes and recheck the pH.

   • After rechecking, if the pH is still greater than 5, call your healthcare team.

4. Once you have confirmed that the tube is in the stomach, flush the tube with the amount of water or air as you have been taught.

Instructions to prevent the NG tube from clogging:

• Always flush the tube before and after each medicine and feeding with the amount of air or water as you have been taught.

• For continuous feeds, flush every 12 hours.

• If your tube does become clogged, attach a 5ml oral syringe with warm water to the end of your feeding tube. Try to flush the tube. If you are unable to flush, pull back on the plunger of the syringe. Repeat this push and pull action up to 5 times. If you still cannot flush the tube, try warm water in a 3ml or 1ml oral syringe and repeat the above steps.

Instructions for care of NG tube:

• Check the pH before giving anything through your child's feeding tube, such as medicines or formula.

• Always check that the mark on your child's feeding tube has not changed. If the mark has moved, reposition the tube and check your child's pH.

• Always check the pH of your child's feeding tube if they do not seem the same and you think something is wrong.

• Remove the tube and call your healthcare team if:

  • The tube comes out or is clogged.

  • Your child starts choking.

  • Your child has trouble breathing or their face turns bluish-gray in color.

Reviewed on October 17, 2022, by Patty Burns-Lynch, MSN, RN