What are the guidelines for managing a Nasogastric Tube (NGT)?

From the Guidelines

Nasogastric tube (NGT) management should prioritize placement verification, maintenance, and complication prevention to minimize morbidity, mortality, and improve quality of life. The most recent and highest quality study 1 recommends considering NGT use on an individual basis, taking into account the risk of gastric stasis and aspiration related to gut dysfunction, and daily revaluation of the need for NGT, removing it as early as possible.

Key Considerations for NGT Management

• Verify correct placement before initial use by checking pH of aspirate (should be ≤5.5) and documenting insertion depth 1
• Secure the tube to the patient's nose with hypoallergenic tape, changing the tape daily and rotating nostril position if long-term use is needed 1
• Flush the tube with 30ml of water before and after medication administration or feeding, and every 4-6 hours during continuous use to prevent clogging 1
• Monitor for complications including nasal erosion, sinusitis, aspiration pneumonia, and tube displacement 1
• Perform daily oral care and nasal inspection 1
• When administering medications, use liquid formulations when possible or properly crushed tablets suspended in water, administering each medication separately with water flushes between 1
• For feeding, elevate the head of bed 30-45 degrees during and for 30-60 minutes after feeding 1
• Document all assessments, interventions, and patient responses 1

Additional Recommendations

• Consider early removal of NGT to minimize postoperative ileus 1
• Use a multifaceted approach to minimizing postoperative ileus, including minimally invasive surgery, optimized fluid management, opioid-sparing analgesia, early mobilization, early postoperative food intake, laxative administration, and omission/early removal of nasogastric intubation 1
• Assist patients to mobilize as soon as possible after surgery 1

From the Research

NGT Management Guidelines

The management of a Nasogastric Tube (NGT) involves several key steps to ensure correct placement and minimize the risk of complications.

• Verification of NGT Placement: The gold standard for verifying NGT placement is radiography 2, 3, 4. However, other methods such as measuring the acidity or pH of the gastric aspirate can also be used 2, 4.
• Ongoing Verification: Ongoing verification of NGT placement is crucial to prevent displacement and ensure patient safety. This can be done by checking the tube location at regular intervals (e.g. 4-hour intervals) and verifying placement/patency in patients who complain of pain, vomiting, or coughing 3.
• Marking the Tube: The tube should be marked with inedible ink or adhesive tape where it exits the nares to facilitate ongoing verification 3.
• Patient Comfort: Measures can be taken to alleviate pain, discomfort, and nausea associated with NGT insertion, such as the use of metoclopramide infusion 5.
• Early NGT Removal: Early removal of the NGT can help reduce pulmonary complications and promote return of bowel function, especially when combined with metoclopramide 6.

Best Practices for NGT Management

Best practices for NGT management include:

• Standardizing care for initial and ongoing NGT location verification 4
• Using evidence-based methods for verifying NGT placement 2, 3, 4
• Implementing a multidisciplinary team approach to ensure good coordination and patient safety 2
• Monitoring practice changes to determine whether a best practice is sustained 3