Is it okay to use a lozenge with a Nasogastric Tube (NGT)?

Lozenges Can Be Used with Nasogastric Tubes in Specific Circumstances

Lozenges can be used with nasogastric tubes (NGTs) when the benefits outweigh the risks, but should be avoided in patients at high risk of aspiration or with impaired swallowing function.

Assessment of Appropriateness

When considering whether to use a lozenge in a patient with an NGT, follow this algorithm:

1. Assess aspiration risk:

   • Evaluate swallowing function
   • Check for history of aspiration
   • Determine level of consciousness
   • Assess cough reflex strength

2. Consider NGT purpose and placement:

   • Is the NGT for gastric decompression or feeding?
   • Is the patient fully dependent on NGT for nutrition?
   • Is the NGT placement temporary or long-term?

3. Evaluate lozenge necessity:

   • Is the lozenge therapeutic (e.g., for oral pain/discomfort)?
   • Are there alternative delivery methods available?

Clinical Recommendations

When Lozenges Are Appropriate:

• In alert, oriented patients with intact swallowing function 1
• When the patient has sufficient cough function and no aspiration during videofluoroscopic swallowing studies 2
• As part of oral diet training for patients transitioning from NGT feeding to oral intake 2
• For symptomatic relief when no alternative formulations exist

When Lozenges Should Be Avoided:

• In patients undergoing rapid sequence intubation (RSI) who are at high risk of aspiration 1
• In patients with impaired consciousness
• When there is significant risk of the lozenge causing regurgitation of gastric contents 1
• In patients with severe dysphagia without proper swallowing evaluation 2

Special Considerations

Medication Administration

If the lozenge contains medication, consider:

• Bioavailability may differ between oral and nasogastric administration routes 3
• Some medications should not be crushed or altered for NGT administration 3
• Alternative formulations (liquid, dissolvable) may be preferable

Risk Mitigation

• Ensure proper NGT placement before allowing oral intake 4
• Monitor for signs of aspiration during and after lozenge use
• Position patient upright (30-45 degrees) during and after lozenge use
• Consider using a low-adherent film contact layer to secure NGT properly 1

Potential Complications

• Aspiration of the lozenge or secretions
• Gagging or vomiting that could displace the NGT 1
• Increased risk of Clostridioides difficile infection with unnecessary NGT use 1

Conclusion

While lozenges can be used with NGTs in select patients, careful assessment of aspiration risk is essential. For patients transitioning from NGT feeding to oral intake, supervised oral diet training that includes lozenges may be appropriate 2. However, in patients at high risk for aspiration or those with impaired swallowing, lozenges should be avoided to prevent potentially serious complications.