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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Pediatrics, Parenting

Nasogastric Tube Feedings at Home (7223)

Nasogastric Tube Feedings at Home (7223) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Pediatrics, Parenting

7223


Nasogastric Tube Feedings at Home

What is a nasogastric (feeding) tube?
A nasogastric tube is a thin, flexible, soft tube
that is passed through your child’s nose
(nostril), down the back of the throat, through
the swallowing tube (esophagus), and into the
stomach. It is taped under the nose to stay in
place. A nasogastric tube is sometimes called
an NG or feeding tube.


Why does my child need a NG
(feeding) tube?
A nasogastric feeding tube is used to give
fluids, food, and medicine when a child
cannot take them by mouth. Reasons a child
may need an NG include:
 Problems with sucking, chewing, or
swallowing.
 Unable to get enough nutrition with a
normal diet.
 Unable to swallow needed medicines.
 To remove fluids and gas from the
stomach.
 To prevent nausea and vomiting.
 To prevent pressure on stitches after
surgery.
How is the NG used?
If the tube is needed for giving medicine, this
is done using a syringe. For scheduled
feedings, a syringe or pump may be used. For
continuous feeding, formula is given using a
pump. The pump controls the rate of fluid
flow.

What is the feeding schedule?

Feeding method:
_____________________________________
_____________________________________

Formula name:
_____________________________________
_____________________________________

Total amount of formula per day:
________________________________

Total amount of water per day:
__________________________________

Amount of each feeding:
_____________________________________

Feeding Schedule:
_____________________________________
_____________________________________

Flush the tube with _____ mL of water before
and after each feeding
Other Instructions:
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________


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Do not make changes in the type or amount of
formula without talking to your child’s
provider first. Provider to call:
Provider:
_______________________________
_______________________________

Phone:
_______________________________
_______________________________

After Hours Instructions:
_______________________________
_______________________________

How do I give formula with a feeding
bag?
1. Wash your hands with soap and
water for 30 seconds.
2. Position your child sitting up if
possible, or on the right side with the
head of bed raised 30-45 degrees.
3. Be sure the NG tube is in the
stomach by looking at the placement
of the tape, and measuring the
distance from the nose to the tip of
the tube. The tape should be in the
same place as the last feeding. The
measurement should be the same as
the last feeding.
4. Clamp the feeding bag tubing.
5. Fill the feeding bag with formula.
6. Close the cover tightly. Hang the
bag at least 2 feet above your child’s
head.
7. Open the clamp. Let the tubing fill
until you see no air. Air in the
tubing will not hurt your child, but
will make your child’s stomach feel
full.
8. Clamp the tubing.
9. Connect the bag to the feeding tube.
10. Open the clamp.
11. Watch your child for any signs of
nausea, vomiting, diarrhea, stomach
swelling, or increased fussiness.
Any one of these signs may mean
that your child is not able to digest
the formula at the rate it is running.
If these symptoms occur, stop the
feeding and contact your provider
for instructions.
12. When the feeding is done, fill the
bag with the prescribed amount of
water. If it isn’t time to take extra
water, be sure to flush the tube after
each feeding with at least 10 mL of
tap water so that it doesn’t clog.
13. Clamp or cap the tube. Disconnect
the tube from your child.
14. Clean the supplies by rinsing the bag
and tubing with cold water. Then,
swish them in warm water and a
drop of liquid dishwashing soap.
Rinse thoroughly so that all of the
soap is removed. Hang to dry.

How do I give formula with a
syringe?
1. Wash your hands with soap and
water for 30 seconds.
2. Position your child in a sitting
position, or on the right side with the
head raised 30 θ - 45 θ.
3. Check placement of the NG tube
using the method described in step 3
above.
4. Remove the plunger from a 60 mL
syringe. Connect the syringe to the
feeding tube.
5. Hold the syringe upright and pour
the formula into it.
6. Hold the syringe 10-12 inches above
your child’s head. Allow formula to
be delivered by gravity over 20-30
minutes.
7. Keep filling the syringe as it empties
until the entire amount of formula is
given.
8. If the feeding should stop, you may
use the plunger of the syringe to
give a gentle push to get the feeding
going again.
9. Give the prescribed amount of water
to flush the tube.
10. Clean supplies as above (#14).


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Can I give medicines through the NG
tube?
 Medicine can be given with a syringe
through the feeding tube.
 It is best to use medicine in a liquid
form. If you must give pills, be sure
to thoroughly crush and dissolve pills
in warm water so they do not clog the
tube.
 Give each medicine separately. Do
not mix medicines together or mix
with formula.
 Never crush enteric-coated or time-
release capsules. If you have
questions about which medicines can
be crushed, please talk to your
pharmacist or health care provider.
 Flush the feeding tube with 5 mL of
water after each medicine is given,
and 10-20 mL of water after all
medicines are given to be sure they get
into the stomach.
 Do not add any medicines to formula
in the feeding container.

How do I check the placement of the
feeding tube?
The most important part of caring for an NG
at home is checking that it is in the correct
position (i.e. sitting in the stomach) before
you put anything down it. The feeding tube
should be marked where it exits the nose after
the first placement. This mark should not
change over time. Use a tape measure to
measure the distance from where your child’s
tube exits the nostril to the end cap of the
tube. Record this measurement every time
you use the tube, or every 4-6 hours during a
continuous feeding. If the mark moves, and
the tube has slipped, call your provider before
using the tube. Another way to tell if the NG
tube is in the stomach is to attach a syringe to
the end of the feeding tube and gently pull
back. There may be fluid in the syringe
and/or tubing that looks like formula, or clear
green to yellow fluid. Return this fluid to the
stomach. If you do not obtain fluid, it may be
a sign that the tube is not in the stomach.
Contact your provider before using the tube.

The securing tape should be changed every
other day, or when it is loose, so that the NG
tube stays secure.

Babies and children who need the tube for a
long time at home will need to have the tube
replaced at times. This normally means your
child will need to return to a provider to have
the tube replaced. Do not try to reinsert an
NG tube if you have not been trained to do
so. If you are going home with an NG tube,
you need to have a clear plan in place before
leaving the hospital. This plan should include
who to contact and what to do if the tube
moves or comes out. Any adult caring for
your child will need education on how to care
for the tube and how to feed your child.
Please ask your nurse for more information.

If your child’s nose is sore, move the tape to a
different place on the nose. The tape may
also need to be changed if it is coming loose.
This is a good time to clean the skin under the
tape. Be careful not to let the tube slip out.
1. Wrap or swaddle your child in a
blanket, or have another person hold
your child’s arms so the tube cannot
be pulled while you are caring for the
site.
2. Wash your hands with soap and water.
Dry well.
3. Prepare your supplies – tape, cotton-
tipped swabs, water, soap, and lotion.
4. While carefully holding the tube,
remove the old tape.
5. Use a cotton-tipped swab moistened
with water and soap to clean the edges
of both nostrils. Rinse thoroughly.
Pat dry.
6. Look inside the nostril where the tube
is to check for any redness, pain, or
sores. You may put a small amount of
lotion or Vaseline® in the nostril to
prevent irritation.

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7. Secure the tube to the nose by
wrapping a narrow piece of tape
around the tube in each direction.
Secure the other end of the tube to the
cheek on the same side of the face
where the tube exits.
8. If you feel your child is having pain,
you note a sore area, or the tube has
come out, tape the tube down. Do not
use the tube. Contact the provider
who is ordering the feedings to get
further instruction.

What is a residual, and how do I
check for it
The “residual” is the amount of contents
remaining in your child’s stomach from the
previous feeding. The residual is checked
before a feeding to make sure your child is
not too full before another feeding is given.
To check for a residual:
1. Place an empty syringe on the end of
the feeding tube.
2. Pull the plunger back to withdraw
stomach contents.
3. Measure the amount of residual on the
syringe. Your provider will discuss
with you how much residual is
appropriate for your child.
4. Return the stomach contents to your
child.
5. Flush the tube with 5-10 mL of warm
water to prevent clogging.
6. If the residual is more than
recommended for your child, delay the
feeding for 30 minutes, and then check
the residual again.

What can I do while my child is
being fed?
Feeding time is a special time for babies.
Babies enjoy being held closely, cuddled,
rocked, or talked to during tube feedings just
as if they were being fed by mouth. Hold your
baby, and encourage the baby to use a pacifier
during feeding to practice sucking and
swallowing.
Toddlers will need to stay in one place, so
playing a game or doing a quiet activity may
be useful. Older children can sit at the table
with the family and receive a tube feeding
while the family eats a meal.

More information about feeding
tubes
1. What should I do if the tube is
blocked?
If the tube won’t flush, try using warm
water. Gently flush 10-15 mL of fluid
through the tube. Do not use
carbonated beverages, juice, or
vigorous pressure to unclog the tube.
If the tube still will not flush, call your
nurse or doctor. Flushing the tube
before and after giving medicines,
after intermittent feedings, and every
4-6 hours during continuous feedings
will prevent this problem.

2. What should I do if the tube is
leaking?
If the tube is cracked or leaking, the
tube will need to be replaced.

3. What should I do if my child is
vomiting?
 Call your doctor if vomiting
persists after 1 day. Vomiting
causes a loss of body fluids, salts
and nutrients.
 Do not give a feeding if your child
is vomiting.
 Check the residual. It the residual
is higher than recommended, delay
the feeding. Recheck the residual
every 30-60 minutes until the
residual is low enough to start the
feeding.
 Give feedings in an upright
position to decrease the chances of
vomiting.
 Try smaller, more frequent
feedings, being sure that the total
amount of feeding for the day is
the same as what is ordered.
 Try to slow the rate of the feeding.

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 Have your child rest after each
feeding. But, do not let him or her
lie down flat during the feeding
and for 1 hour after a feeding.
 If your child develops difficulty
breathing during or immediately
after a feeding, stop the feeding
and call your provider. It is
possible your child may have
inhaled formula or stomach
contents into the lungs.
 Infection may cause vomiting.
Clean and rinse equipment well
between feedings.
 Do not let formula in the feeding
bag hang longer than 8 hours.
 After the formula can is opened,
the can should be stored in the
refrigerator until used.
 If your child has nausea and
vomiting, your provider may
recommend changing the feedings
temporarily. Follow your
provider’s instructions about
feeding during illness.

4. What should I do if my child has
diarrhea?
Diarrhea is frequent loose, watery
stools. Diarrhea can be caused by
giving too much feeding at once,
running the feeding too quickly,
unable to tolerate the type of formula,
spoiled formula, or infection. Some
medicines can cause diarrhea. Some
children have loose stools with
changes in formula, medicines, or
feeding routines.
 Avoid hanging formula for longer
than 8 hours.
 Keep opened formula in the
refrigerator for no more than 24
hours.
 Slow the feeding rate or give
smaller amounts of formula more
often.
 Give more water after each
feeding to replace water lost in
diarrhea.
 Call your provider if the diarrhea
does not stop after 1 day.

5. What should I do if my child
becomes dehydrated?
Dehydration is a loss of water and
fluids from the body. Dehydration
may occur for a variety of reasons –
diarrhea, vomiting, fever, or sweating
for example.
 Signs of dehydration include
decreased or dark urine, crying
with no tears, dry skin, fatigue,
irritability, dizziness, dry mouth,
weight loss, and/or headache.
 Extra water may be given after
each feeding to replace water lost.
 Call your provider if you notice
signs of dehydration.

6. What should I do if my child
becomes constipated?
Constipation may be caused by certain
types of formula, changes in formula,
medicines, or feeding patterns, or not
enough water. Give more water
flushes throughout the day, especially
during hot weather. If constipation
becomes chronic, contact your
provider.

7. How do I bathe my child with a NG
in place?
Bathe your child as is normal for the
age and developmental level, as long
as the NG tube is not submerged under
water.

8. What should I do if my child has
gas, bloating or cramping?
Be sure there is no air in the tubing
before attaching the feeding tube.


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9. Why is oral care still important?
Good mouth care is essential for
overall health. Your child should have
their teeth, gums and mouth brushed at
least twice a day using a soft
toothbrush or sponge brush even if
he/she is not eating by mouth.

10. What to do if the tube is out of place
If the tube is longer in the stomach,
call your provider or Home Health
Nurse. Do not use the tube. You will
need to have a new tube placed. If the
tube is pulled out during a feeding,
stop the feeding right away, and
contact your Provider to have the tube
replaced.

11. When should I call my child’s
provider?
 Your child has trouble breathing.
 Your child turns blue.
 You see blood around the tube, in
your child’s stool, or in stomach
contents.
 Your child coughs, chokes, or
vomits while feeding (stop the
feeding if this occurs during
feeding).
 Your child has a bloated or rigid
belly (belly feels hard when it is
gently pressed).
 Your child has diarrhea or
constipation.
 Your child has a fever of 100.4 θ F
or higher.























The Spanish version of this Health Facts for You is # 7232

Your health care team may have given you this information as part of your care. If so, please use it and call if you have
any questions. If this information was not given to you as part of your care, please check with your doctor. This is not
medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health
needs are different, you should talk with your doctor or others on your health care team when using this information. If
you have an emergency, please call 911. Copyright © 11/2016. University of Wisconsin Hospitals and Clinics Authority.
All rights reserved. Produced by the Department of Nursing. HF#7223